Psilocybin for Depression?

Research is beginning to accumulate indicating that the psychedelic psilocybin (think "magic mushrooms) may be helpful for depression.  Ketamine, another hallucinogen, is FDA approved to treat depression, although it is generally not paid for by insurance.  Studies have thus far been with small numbers of subjects.  It had been previously studied in individuals with life threatening cancer.  The most recent publication was in the prestigious Journal of the American Medical Association (Psychiatry).  Treatment effects were rapid; patients were given two separate treatment sessions, a very brief and relatively inexpensive treatment.  

One drawback was that there was only a four week follow up of results.  I have had patients who were referred by their psychiatrist for ketamine treatment.  (I am a psychologist, and I was not involved in the process.)  Most did not find it helpful.  The one who did started needing booster treatments after a few weeks.  Thus, I do not see hallucinogens as a magical answer.  

However, I believe that it is a shame of U.S. drug development policy that these substances have not been seriously investigated before now.  If a substance was labeled as being a street drug or as an abusable drug, it was hard for investigators to get approval to do serious research with it.  

We now need to move rapidly forward to know whether these substances have any legitimate medical value.  Here in Oklahoma, cannabis products are readily available.  Unfortunately, we now have a thriving street corner industry rather than a more traditional model of going to a pharmacy to get medication.  But at least there is a new openness to considering that psychoactive chemicals found in the natural world might, just might, be useful medications, even if they are sometimes abused and sold on the street.

After initial studies of the effects of an hallucinogen by itself are completed, a second wave of research will be needed.  At that point, we will need to look at combining psychotherapy with the experiences patients under its influence, experiences that may break through their normal psychological defenses and set them free from old, repetitive ways of thinking.  I believe that such combined treatment could produce synergistic effects that would be the real value of such drugs.