Opinion: A hallucinogenic Class A drug could unlock the key to effective treatment for New Zealanders with severe depression, for whom conventional treatments do not work.
The latest NZ Health Survey identified that 17 percent – about 850,000 New Zealanders – were diagnosed with depression. About a third of those will be defined as ‘treatment-resistant’ (283,000 people) because their depression does not respond to antidepressants.
New approaches to the treatment of depression are needed given the reliance on antidepressants is not always effective.
Our team in the Department of Psychological Medicine at the University of Otago, Christchurch, is planning to launch Aotearoa New Zealand’s first trial of psilocybin to treat severe depression.
Psilocybin is the hallucinogenic compound found in magic mushrooms, an active ingredient which binds to the serotonin receptors in the brain to enhance mood. It has been reported that psilocybin can augment the effects of evidence-based psychotherapies to enable enduring improvements in symptoms of depression.
Psilocybin-assisted psychotherapies are a novel approach that need to be trialled here, and although there is no evidence available to suggest which psychotherapy would be best to combine with magic mushrooms, this is something we want to investigate.
By researching people’s experiences of magic mushrooms we have found the common elements of these experiences were intense emotional arousal, a sense of connectedness to oneself, others, and the world, and transformative insights into how to live one’s life.
It’s clear a sea change is needed in the worldwide treatment of depression – there’s been no significant innovation in mental health treatment in the past 40 years
There are two key elements in the safe and effective delivery of psilocybin-assisted psychotherapy. These are set (the psychological context) and the setting (environmental context), which both contribute to the safety and effects of magic mushrooms.
Psychotherapy provides the psychological context by preparing the person for the psilocybin experience, provides a framework for interpreting the experience, and helps the person integrate that into their lives to manage mood symptoms and to make meaningful changes. The environmental context provides safety and expertise to ensure the experience is therapeutic.
The psilocybin is given in capsule form and the person is monitored by two people throughout their experience. The psychological and environmental context lessen the possibility of a ‘bad trip’.
The optimal choice of psychotherapy for this intervention has not been established, but it needs to have an evidence base and be congruent with the psilocybin experience.
This means it needs to provide a framework for understanding the emotional arousal, promote connectedness and provide strategies for implementing insights from the psilocybin experience.
It must support the sense of losing oneself leading to greater self-acceptance and interconnectedness with others and the world.
The psychotherapy also needs to support and provide an interpretation of the psilocybin experience specific to the participant’s symptoms and goals, and provide a framework for ongoing mood improvement.
Our research team led by Associate Professor Cameron Lacey has regulatory approval to use magic mushrooms with psychotherapy. Once we have obtained funding to start the trial, we aim to recruit people who have tried two antidepressants for an adequate duration but have not had any improvement in mood.
The trial has ethics approval to recruit 20 patients, with a strict, vigorous criteria – all must be referred from their GP or specialist mental health service, and all must have depression that has not responded well to standard medication and talk therapy.
We will provide two doses of psilocybin in a controlled environment in the context of eight sessions of Interpersonal and Social Rhythm Therapy. The research team consists of a psychiatrist and experienced therapists who have many years of experience in providing therapy. We are all keen to find innovative approaches to the treatment of depression.
We have successfully used Interpersonal and Social Rhythm Therapy for over a decade to treat people with mood disorders. The key processes of this therapy are a) enhancing social support, (b) decreasing interpersonal stress, (c) facilitating emotional processing, (d) improving interpersonal skills, and (e) stabilising daily routines in a way that best suits the person’s lifestyle.
The therapy has a focus on circadian rhythm disruption (sleep/wake cycle) that accompanies depression. The sessions will focus on strategies for integrating the transformative insights from the magic mushroom (psilocybin) experience into daily life with particular emphasis on strategies for managing mood and social rhythms.
We have trained the therapists, established the right therapeutic environment, and imported the psilocybin capsules, so we are now seeking funding to start the psilocybin-assisted therapy. There may be organisations, companies, or individuals out there who have a philanthropic desire to help others struggling with depression.
It’s clear a sea change is needed in the worldwide treatment of depression – there’s been no significant innovation in mental health treatment in the past 40 years. Psilocybin may offer hope of a breakthrough – a new tool in the toolbox clinicians can consider when caring for people with treatment-resistant depression.
