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Psilocybin as an Effective Treatment for Patients with Life-Threatening Cancer and Psychological Distress: A Critically Appraised Topic

8 August 2020


Background: Patients with life-threatening cancer often suffer from depression and anxiety leading to decreased treatment adherence and quality of life. There are not evidenced based pharmacological or combined pharmacologicalpsychosocial interventions to address anxiety and depression in this population; standard antidepressants and anxiolytics studies show limited and conflicting efficacy. There is renewed interest in psilocybin research particularly in this population.

Methods: An exhaustive literature search using MEDLINE, CINAHL, and Google Scholar was conducted including a search of source bibliographies. Included studies were conducted on patients with life-threatening cancer with depression and/or anxiety, evaluating psilocybin in comparison to placebo or placebo-like dosing (including niacin and low-dose psilocybin) and measuring the reduction in cancer-related anxiety and/or depression. Inclusion criteria also was limited to randomized controlled trials.

Results: Two randomized controlled clinical trials showed significant within-group reductions in anxiety and depression immediately after receiving psilocybin as compared to baseline. Furthermore, both trials demonstrated longevity in the remission of anxiety and depression. One RCT compared niacin to psilocybin and measured primary outcomes with HADS, BDI, and STAI measures. For this study, the 6.5 month follow up revealed 60 to 80% antidepressant and anxiolytic response rates. Another RCT compared low dose psilocybin (1 or 3 mg/kg) to high dose psilocybin (22 mg or 30 mg/70 kg). Primary outcomes were measured with GRID-HAMD and HAM-A. Collapsing across the two groups, the overall rate of clinical response at 6 months was 78% and 83% for depression and anxiety with an overall rate of symptom remission at 65% and 57%, respectively.

Conclusion: Psilocybin appears to be effective at reducing depression and anxiety immediately after dosing as well as for several months after administration in patients with life-threatening cancer. Due to the lack of FDA approved treatments for depression and anxiety in this population, the reductions that were demonstrated provide grounds for further research to minimize negative health and wellbeing outcomes associated with anxiety and depression.

Keywords: Psilocybin, neoplasms, anxiety, and depression


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