Psilocybin to Treat Anxiety and Depression in Cancer Patients

Psychedelic Science Review Editor Barb Bauer conducts a review of some landmark studies.

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Stories about the therapeutic benefits of psychedelic drugs are becoming more frequent in the news. The magic mushroom compound psilocybin, for example, is showing promise for treating treatment-resistant depression. Leveraging what is known in this area of psychedelic science to the end-of-life challenges facing terminal cancer patients represents another opportunity to relieve suffering and improve the quality of life.

This article highlights four studies examining the effects of psilocybin (the pure compound, not the mushrooms) on depression and anxiety in cancer patients. Together they give an overview of the progress that has been made over the last decade.

Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. 1

A research team lead by Dr. Charles Grob conducted a pilot study in 2011 to test the feasibility of using psilocybin for treating the reactive anxiety experienced by patients with advanced-stage cancer. The paper was published in the Archives of General Psychiatry. This study brought the idea of treating cancer patients with hallucinogens back into the research light after some 35 years of desolation.

Twelve patients participated in this double-blind study and served as their own controls by receiving a niacin placebo in one session and 0.2 mg/kg of psilocybin in another. After each 6-hour session, the participants discussed several aspects of their experience with filled out several rating questionnaires. They also completed a series of questionnaires and self-report inventories two weeks before the first session and at other intervals up to 6 months after the second session.

After the data were analyzed, the authors observed, “Safe physiological and psychological responses were documented during treatment sessions. There were no clinically significant adverse events with psilocybin. This study established the feasibility and safety of administering moderate doses of psilocybin to patients with advanced-stage cancer and anxiety.”

The study participants experienced a significant reduction in their anxiety at 1 and 3 months, and improvements in their mood became significant at 6 months. In contrast to previous studies using higher doses of psilocybin, the participants did not experience a reduction in pain. The authors called the 0.2 mg/kg dose of psilocybin used in their study “modest,” yet sufficient to provide some psychological relief.

Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. 2

This 2016 study by Ross et al. published in the Journal of Psychopharmacology was a double-blind and placebo-controlled crossover (at seven weeks) trial using 29 patients. All the participants suffered from cancer-related anxiety and depression. Each received one 0.3 mg/kg dose of psilocybin or placebo (niacin) in conjunction with psychotherapy.

The authors summarized the results as follows, “…psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life.”

Further, at the 6.5-month follow-up, psilocybin had caused “enduring anxiolytic and antidepressant effects” in 60-80% of the participants. They also experienced improvements in existential distress, quality of life, and their attitudes toward death. A key finding of the study was that “The psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression.”

Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. 3

In 2016, a research team including Roland Griffiths and Matthew Johnson of the Johns Hopkins University School of Medicine conducted a double-blind and placebo-controlled crossover study of 51 patients with a life-threatening cancer diagnosis and suffering from depression and anxiety. Their paper was published in the Journal of Psychopharmacology. The study used a very low placebo-like dose of 1 or 3 mg/70 kg of psilocybin versus a high dose of 22 or 30 mg/70 kg. The psilocybin doses were administered “in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up.” The moods, attitudes, and behaviors of the participants were rated throughout the study by the participants, staff, and community observers.

The data showed that the high doses of psilocybin “produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety.”

Six months later, about 80% of the participants were still showing significant decreases in anxiety and depressed mood. The patients concluded that the high doses of psilocybin were responsible for these sustained improvements, as well as their improved attitude toward their life, themselves, their relationships, and their spirituality. Also, as the Ross et al. study observed, the psilocybin mystical experience was important to the positive therapeutic outcomes.

The authors of the study concluded, “The present study demonstrated the efficacy of a high dose of psilocybin administered under supportive conditions to decrease symptoms of depressed mood and anxiety, and to increase quality of life in patients with a life-threatening cancer diagnosis.”

Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer.4

This 2020 paper by Agin-Liebes et al. in the Journal of Psychopharmacology presents an analysis of the long-term follow-up data for 15 of the 16 surviving patients from the 2016 Ross et al. study described above. On average, the data were gathered from the patients at 3.2 and 4.5 years after psilocybin administration.

Analysis of the data showed that 4.5 years after psilocybin, about 60-80% of the participants still had “clinically significant antidepressant or anxiolytic responses.” An overwhelming 71-100% said the positive changes in their lives were due to the psilocybin-assisted therapy experience. They rated it as one of “the most personally meaningful and spiritually significant experiences of their lives.”

The authors summarized, “…[the] results suggest that the treatment continues to be associated with reductions in anxiety, depression, hopelessness, demoralization, and death anxiety up to an average of 4.5 years following single psilocybin session in conjunction with psychotherapy.”

Summary

Healthcare professionals make every effort to relieve the mental and physical suffering of their patients. Using psilocybin to treat anxiety and depression in terminally ill cancer patients is showing promise as a safe and effective addition to traditional palliative care. Further research is needed to learn more about the psilocybin drugs to use and optimizing dosages to provide the best patient outcomes.

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shaggy
2 months ago

Any way to make someone’s short life more meaningful and less painful should be legal. Start with smallest dose possible and micro increase if the patients’ mood does not increase in a week or so.

    References
  1. Grob CS, Danforth AL, Chopra GS, et al. Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Archives of General Psychiatry. 2011;68(1):71-78. doi:10.1001/archgenpsychiatry.2010.116
  2. Ross S, Bossis A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165-1180. doi:10.1177/0269881116675512
  3. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513
  4. Agin-Liebes GI, Malone T, Yalch MM, et al. Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer. J Psychopharmacol. 2020;34(2):155-166. doi:10.1177/0269881119897615