Will magic mushrooms help against treatment-resistant depression?

NEW YORK: Amid ongoing debate by countries to legalise psychedelic drugs, researchers in a new study discussed the therapeutic use of psychedelics -- focusing on the use of psilocybin for treatment of depression.

Psilocybin is a naturally occurring psychedelic substance found in so-called "magic mushrooms." Many recent clinical trials have reported positive effects of psilocybin in treating psychiatric disorders, including major depressive disorder (MDD) and treatment-resistant depression (TRD).

However, many challenges remain in defining their clinical benefits and overcoming the complex regulatory obstacles to their use.

“At a time of growing excitement regarding the potential use of psychedelic agents to improve outcomes of otherwise intractable disorders, psychiatrists and patients alike need perspective on the current state of the evidence and the prospects moving forward,” said lead author Amir Garakani, from the Department of Psychiatry at the Yale School of Medicine, in Connecticut, US.

Evidence suggests that therapeutic responses to psilocybin "stem from, or at least go hand-in-hand with, an intense emotional or mystical experience," Garakani said in the paper published in the September issue of Journal of Psychiatric Practice.

Studies suggest that psilocybin leads to increased "openness to experience" and psychological flexibility -- enabling patients to "reconsider stereotyped perspectives and move beyond accustomed patterns of thinking."

Research into psilocybin's biological effects suggest increased activity between brain networks, without corresponding increases within single networks. Greater changes in brain network flexibility have been linked to lasting reductions in depression symptoms six months later.

Clinical trial registries show a "multitude" of studies planned or in progress, targeting MDD, TRD, and other conditions such as cancer-related anxiety and post-traumatic stress disorder.

"The large number and wide-ranging scope of ongoing and future psilocybin trials not only show the interest in this drug in the scientific community but also the potential therapeutic role of psychedelics across diagnoses and clinical domains," the researchers said.

Overall, "psilocybin has demonstrated promise as a novel therapeutic and offers new perspectives on the function and dysfunction of the brain," to the researchers.

However, they added: "(I)t remains to be seen if the current clinical, legal, and research landscapes will allow delivery on that promise."

Earlier this year, Australia became the first country to announce approval for psychiatrists to prescribe psilocybin treatment for TRD. In the US, psilocybin has been designated as a "breakthrough therapy" for TRD and MDD. While two states have legalised or decriminalised psilocybin (Oregon and Colorado, respectively), it remains a Schedule 1 controlled substance under federal law.

An official American Psychiatric Association position states that there is "currently inadequate scientific evidence" to endorse the use of psychedelics for treatment of any psychiatric disorder, outside of approved research studies.

Nevertheless, "the research evidence presented here offers further support for the potential of psychedelics in mental health care," Dr Garakani said.