Psychedelic medicines have been implemented by numerous cultures for centuries. Only in recent years have psychedelic drugs paved their way into the western world as a therapeutic alternative to traditional pharmaceuticals. Major depressive disorder (MDD), is a common mood disorder, that can affect anyone regardless of gender, age, or race. Individuals diagnosed with MDD show feelings of hopelessness and despair, and lose interest in activities they once enjoyed (DSM-5, 2013). Although this condition is treatable, it does not come unhindered. Many first-lines of treatment prescribed for MDD are laden with undesirable side effects, such as decreased libido, and drowsiness (Hu et al., 2004). Depression is a multifaceted disorder; it is a combination of a variety of factors in one’s life, not a chemical imbalance alone–and thus must be treated intricately. The use of psilocybin to treat MDD has been shown to reduce depressive symptoms, and substantiate an overall shift in mood and emotional processing (Lyons and Carhart-Harris, 2018). When psilocybin is prescribed alongside psychotherapy, it has the potential to surpass the current first-line of treatment for MDD, by addressing the root cause of the depression.
The first-line of treatment for MDD primarily includes two types of serotonin reuptake inhibitors: SSRI’s and SNRI’s. Controversy exists as to whether these drugs exhibit significant efficacy when treating MDD. Anti-depressants are said to have a bandage effect: not only are they over-prescribed and easily attained, but they rarely treat the origin(s) of the issue(s). Depression is a highly recurrent disorder. At least 50% of those who recover from one episode of depression will relapse one or more times, and approximately 80% of those with a history of two episodes of depression, will also relapse (Burcusa and Iacono, 2007). A study examined the patient reports of side effects experienced whilst taking SSRI’s. Out of 401 patients who completed the interview, 86% reported at least 1 side effect, and 55% experienced 1 or more bothersome side effect(s) (Hu et al., 2004). At 17% each, the most common bothersome side effects found were sexual dysfunction and drowsiness. It was noted that most side effects occurred within the first 2 weeks of SSRI treatment, and continued to persist at the time of interview, the most notable side effects being blurred vision 85% and sexual dysfunction 83%. Overall, physicians (n=137) significantly underestimated the occurrence of the side effects reported, and they underrated how bothersome those side effects were to their patients (Hu et al., 2004). There are many other symptoms including insomnia, nausea, headaches and blurred vision that come with taking these medications, and it may take several weeks or longer for these medications to become effective (Mayo Clinic, 2018). During this time, the patient’s condition could worsen, or the side effects associated could potentially make them more depressed–thus, the individual must determine, is it worth it? Or is there an alternative?
In comparison to currently available anti-depressant medications, psilocybin has a novel pharmacology. Psilocybin is a prodrug of psilocin, a serotonin receptor agonist whose psychoactive effects are mediated by serotonin 2A (5-HT2A) receptor agonism, whereas selective serotonin-reuptake inhibitors are not direct 5-HT2A receptor agonists (Carhart-Harris et al., 2016, Halberstadt and Meyers, 2011). This novel feature of psilocin is significant because 5-HT2A receptor agonism has shown substantial improvements in well-being and optimism after psychedelic experiences in humans (Griffiths et al., 2008). A study analyzed 20 patients with treatment-resistant depression (TRD). The subjects were administered two doses of psilocybin (10 mg and 25 mg), with the second dose a week after the first. 19 individuals underwent initial fMRI brain imaging, and then underwent a second scan one day after the high dose treatment. Patients reported a decrease in depressive symptoms, such as improvements in mood and stress relief (Carhart-Harris et al., 2017). The fMRI imaging revealed reduced blood flow in the amygdala, known to be involved in processing emotional responses, stress and fear (Carhart-Harris et al., 2017). Another study analyzed the experiences of 110 healthy subjects who had received 1-4 oral doses of psilocybin (45–315 µg/kg body weight). Psilocybin dose-dependently induced profound changes in mood, perception, thought and self-experience and most subjects described the experience as “pleasurable, enriching and non-threatening” (Studerus et al., 2010). Furthermore, it when treating cancer-related psychological distress, it was found that in conjunction with psychotherapy, psilocybin produced rapid, and sustained anti-depressant effects (Ross et al., 2016). Even in those with TRD has psilocybin shown changes people perspective on their depression, and enable a more positive and accurate outlook on life and the future (Lyons and Carhart-Harris, 2018). The results from these studies suggest that psilocybin is a safe, and successful treatment for MDD, and has maximum efficacy when administered in the supervision of a physician or therapist in conjunction with psychotherapy.
The use of psychedelic drugs in the western world remains a divided topic. The surrounding stigma of psychedelic drugs being used as primarily “party” drugs can be obliterated through proper education from health professionals. It is not advised that psilocybin be used to self-medicate, but rather under the supervision of a licensed psychotherapist or physician, who can monitor progress/regression, and potential side effects. While ingesting too much psilocybin is not lethal–mixing drugs, ignorance about the purity, or the dosage, can all lead to potentially “bad trips” –a common adverse reaction related to the consumption of psychedelic drugs (Ona, 2018). Through effective harm-reduction strategies and interventions, any potential side effects of psilocybin can easily be avoided when following the correct dosage protocols. Research has shown that positive effects on attitudes, mood, and behavior are found within 20 and 30 mg/70 kg of psilocybin (Griffiths et al., 2011). Additionally, low socio-economic status has been found to be associated with a higher prevalence of depression (Freeman et al., 2016). When taking into consideration the distribution of psilocybin, it is important that it is available to those of varying socioeconomic classes, to ensure that everyone has the option to alternative treatment.
The bandage effect that anti-depressants exhibit often hinders the patient more than they, and their physician realize. Each case of MDD is distinct, and in order to reveal the true cause of the patient’s depression, the origin of their emotions cannot be bandaged by these harmful drugs. Doctors must change the way they presently view depression, and the first step in doing this is by actively looking for alternative solutions that is in the best interest of their patient’s physical and mental health.