Psilocybin Shows Promise as a Comparable Alternative to Traditional Antidepressants

Depression is a widespread mental illness, impacting about 280 million people worldwide. Researchers are interested in expanding treatment options and finding the most effective medications. A review and meta-analysis published in the BMJ compared the effectiveness of psychedelics to escitalopram. 

The results suggest that psilocybin may be comparable to current antidepressant treatment. Psychedelics are psychoactive substances that have the potential to treat several mental illnesses like depression and post-traumatic stress disorder (PTSD). Thus, there can be differing placebo effects and possible bias. The researchers of the current review wanted to compare monotherapy use of psychedelics with escitalopram, a common medication used to treat depression. To help get over some of the problems with the reduced placebo effects of psychedelics trials, the review authors made sure to distinguish between the placebo response in psychedelic studies and the placebo response in antidepressant studies. 

This review and Bayesian network meta-analysis included randomized controlled trials with adult participants who had clinically diagnosed depression. 

For all the data, they focused on changes in depressive symptoms as the primary outcome. Altogether, they were able to include data from 19 trials: 811 participants in psychedelic trials and 1968 participants in escitalopram trials.Based on their synthesis of the data, researchers did find that the placebo effect in psychedelic trials was lower than the placebo effect in escitalopram trials.This study used meta-analysis techniques to compare the effectiveness of psychedelics and escitalopram (Lexapro) for depressive symptoms. It’s notable that only high dose psilocybin showed greater effectiveness than escitalopram. 

This is in comparison to antidepressants, which take weeks, if not months, to kick in and only continue to work with continued use. Though not addressed in this study, the clinical consensus is that benefits of high dose psilocybin can last for months and potentially years after the acute episode of treatments. At times even only one treatment session is needed for otherwise chronic intractable depression. This is part of why psychedelic-assisted psychotherapy under safe, controlled professional settings is gathering such momentum and enthusiasm in the field of psychology and psychiatry.