Psychedelic medicine, long taboo, is moving toward the mainstream: Two new studies show the hallucinogenic drug psilocybin might relieve anxiety and depression in cancer patients.
Dozens of distressed patients, treated under controlled conditions at two prestigious medical centers, saw spirit-lifting effects that lasted at least several weeks after taking the “magic mushroom” drug, according to results published Thursday in The Journal of Psychopharmacology.
In an unusual move, the journal also published 10 commentaries from experts in psychiatry, end-of-life care and drug policy. The experts said the studies were small and preliminary, but all supported continued research. They suggest psilocybin, while still illegal outside of studies, is "well within the accepted scope of modern psychiatry,” said an editorial by David Nutt, a professor of neuropsychopharmacology at Imperial College, London.
But the benefits remain unconfirmed and largely unexplained, commentators said. Just how a hallucinogenic experience might lift anxiety and depression over weeks or months is “the $64,000 question,” said Jeffrey Lieberman, a past president of the American Psychiatric Association and chair of psychiatry at Columbia University. He co-wrote one of the commentaries calling for more studies.
The studies were conducted with 29 patients at New York University Langone Medical Center and 51 patients at Johns Hopkins University. All had advanced cancers and were anxious or depressed.
The research teams set up cozy living-room style clinics, where the patients were treated twice — once with a synthetic psilocybin dose strong enough to produce an hours-long hallucinogenic trip, and once with either a very low dose of psilocybin (at Johns Hopkins) or niacin, a vitamin that can cause warm, tingling sensations (at NYU). Some got the real thing first; others got the substitute first.
The treatments were five to seven weeks apart, allowing the researchers time to compare the first patients to get the real treatment with those who waited. Then they gave the hallucinogenic dose to the rest, and followed everyone for another six months.
During their psilocybin experiences, the patients wore eye masks and headphones and were urged to lie back, listen to soothing music and “direct their attention inward,” said research leader Roland Griffiths, a professor of behavioral biology at Johns Hopkins. Therapists sat nearby, ready to comfort those who became briefly anxious or afraid, which happened in about one-third of cases, he said.
Patients reported the dream-like visions and heightened emotions typically produced by psilocybin. In the days and weeks afterward, therapists helped them sort through what many saw as “mystical experiences” of connection and love, Griffiths said.
The reported result: immediate sharp declines in anxiety and depression in patients treated first, when compared with initially untreated patients. Those who got delayed treatment also improved, and up to 80% were less distressed at the end of the studies than at the beginning. However, because all patients eventually got the drug, there were no comparison groups after the first few weeks — making it impossible to say whether the drug deserved credit for the prolonged improvements.
But, in results from the first weeks, “the overall effect sizes are really quite startling relative to what you would expect with other interventions,” such as antidepressants, Griffiths said.
“These are some very rich, powerful, experiences,” said Stephen Ross, an associate professor of psychiatry who led the NYU study.
New York participant Patrick Mettes gained “a tremendous insight into his own personal journey” and came away feeling that “love was the most important thing,” said his wife, Lisa Callaghan. Mettes died of his cancer in 2012. In a journal entry written shortly after his psilocybin dose, he said that at the peak of his experience, he became “one with everything in the universe. It was simply, perfection.”
Don't expect your average local hospital or hospice to be offering hallucinogenic trips any time soon. Any studies will require the permission of the Food and Drug Administration, the Drug Enforcement Administration and local review boards.
And you should not try this at home, researchers stressed — distancing themselves from a history in which psychedelic advocates such as Timothy Leary urged widespread use of LSD, psilocybin and other hallucinogens. Leary, a Harvard psychologist, started out using the drugs in legitimate studies but grew inpatient to spread them to the masses, urging young people to “turn on, tune in, drop out.” Widespread reports of dangerous reactions led to criminalization of the drugs and a decades-long pause in research.
“These are drugs that have real dark sides,” Ross said. Griffiths agreed. “These experiences can be dangerous for some vulnerable individuals,” including those with a history of psychosis, he said. Cases of “people jumping out of windows or running into traffic and getting run over,” do happen, he said.
But, he said, “we can administer these drugs safely to people who are carefully screened and supported before, during and after.”
Researchers have already started studies in other groups, including alcoholics and people trying to quit smoking.
The two new studies were funded by the non-profit Heffter Research Institute.