Just one dose of a hallucinogenic drug offers many cancer patients up to six months of relief from disease-related anxiety or depression.
Researchers report that a substantial majority of patients got a respite from cancer-related mood disorders after a single large dose of psilocybin, the active compound in perception-altering, vision-inducing “magic mushrooms.”
The researchers caution the drug was given in tightly controlled conditions in the presence of two clinically trained monitors. They don’t recommend use of the compound outside of a research or patient-care setting.
“The most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms,” says Roland Griffiths, professor of behavioral biology at the Johns Hopkins University School of Medicine. “This may represent a fascinating new model for treating some psychiatric conditions.”
Traditional psychotherapy for people with cancer, including behavioral therapy and antidepressants, can take weeks or even months, Griffiths says. It isn’t always effective, and some drugs, such as benzodiazepines, may have addictive and other troubling side effects.
The Johns Hopkins team released its results, involving 51 adult patients, at the same time as researchers from New York University’s Langone Medical Center announce results of a similar study with 29 participants. Both studies appear in the Journal of Psychopharmacology.
‘Deeply meaningful’ experiences
The Johns Hopkins group reports that psilocybin decreased depressed mood, anxiety, and death anxiety; it increased quality of life, life meaning, and optimism. Six months after the final session of treatment, about 80 percent of participants continued to show clinically significant decreases in depressed mood and anxiety, with about 60 percent showing symptom remission into the normal range.
Eighty-three percent reported increases in well-being or life satisfaction. Some 67 percent of participants reported the experience as one of the top five meaningful experiences in their lives, and about 70 percent reported the experience as one of the top five spiritually significant lifetime events.
“I could imagine that cancer patients would receive psilocybin, look into the existential void, and come out even more fearful.”
The new study grew out of a decade of research on the effects of psilocybin in carefully screened and prepared healthy volunteers, which found that psilocybin can consistently produce positive changes in mood, behavior, and spirituality. The current study aimed to see if the drug could also help psychologically distressed cancer patients. Up to 40 percent of people with cancer suffer from a mood disorder, the National Comprehensive Cancer Network says.
“A life-threatening cancer diagnosis can be psychologically challenging, with anxiety and depression as very common symptoms,” Griffiths says. “People with this kind of existential anxiety often feel hopeless and are worried about the meaning of life and what happens upon death.”
The 51 subjects had life-threatening cancers, such as breast, upper digestive, GI, genitourinary, or blood cancer. Each also had a formal psychiatric diagnosis, including an anxiety or depressive disorder.
Each had two treatment sessions five weeks apart, one with a very low psilocybin dose (1 or 3 milligrams per 70 kilograms) meant to act as a “control” placebo because the dose was too low to produce effects. In the other session, participants received a capsule with a moderate or high dose (22 or 30 milligrams per 70 kilograms).
Participants and staff members supervising the sessions were told that the participants would receive psilocybin both times, but did not know that there would be one higher and one lower dose. Blood pressure and mood were monitored throughout. Two monitors aided participants, encouraging them to lie down, wear an eye mask, listen to music through headphones, and direct their attention on their inner experience. If anxiety or confusion arose, the monitors provided reassurance.
In addition to changes in visual perception, emotions, and thinking, most participants reported psychological insight and often deeply meaningful experiences of the interconnectedness of all people.
“Before beginning the study, it wasn’t clear to me that this treatment would be helpful, since cancer patients may experience profound hopelessness in response to their diagnosis, which is often followed by multiple surgeries and prolonged chemotherapy,” Griffiths says.
“I could imagine that cancer patients would receive psilocybin, look into the existential void, and come out even more fearful. However, the positive changes in attitudes, moods, and behavior that we documented in healthy volunteers were replicated in cancer patients.”
The researchers assessed each participant’s mood, attitude about life, behaviors, and spirituality with questionnaires and structured interviews before the first session, seven hours after taking the psilocybin, five weeks after each session, and six months after the second session.
Fifteen percent of participants were nauseated or vomited, and one-third experienced some psychological discomfort, such as anxiety or paranoia, after taking the higher dose. One-third had transient blood pressure increases. A few reported headaches.
Psilocybin vs. niacin
Clinical trial results from NYU Langone Medical Center show that one-time treatment with psilocybin, combined with psychological counseling, quickly brought relief from distress that then lasted for more than 6 months in 80 percent of the 29 study subjects monitored, based on clinical evaluation scores for anxiety and depression.
“If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients,” says lead investigator Stephen Ross, director of substance abuse services in the psychiatry department at NYU Langone and an associate professor of psychiatry at NYU School of Medicine.
Although the neurological benefits of psilocybin are not completely understood, it has been proven to activate parts of the brain also impacted by the signaling chemical serotonin, which is known to control mood and anxiety. Serotonin imbalances have also been linked to depression.
For the study, half of the participants were randomly assigned to receive a 0.3 milligrams per kilogram dose of psilocybin while the rest received a vitamin placebo of 250 milligrams of niacin, known to produce a “rush” that mimics a hallucinogenic drug experience.
Approximately halfway through the study’s monitoring period (after seven weeks), all participants switched treatments. Those who initially received psilocybin took a single dose of placebo, and those who first took niacin, then received psilocybin. Neither patients nor researchers knew who had first received psilocybin or placebo. Guss says, “The randomization, placebo control, and double-blind procedures maximized the validity of the study results.”
One of the key findings was that improvements in clinical evaluation scores for anxiety and depression lasted for the remainder of the study’s extended monitoring period—specifically, eight months for those who took psilocybin first.
All patients in the study, mostly women age 22 to 75 who are or were patients at the Perlmutter Cancer Center at NYU Langone, had either advanced breast, gastrointestinal, or blood cancers and had been diagnosed as having serious psychological distress related to their disease. All patients, who volunteered to be part of the study, were provided with tailored counseling from a psychiatrist, psychologist, nurse, or social worker, and were monitored for side effects and improvements in their mental state.
Co-investigator Anthony Bossis, a clinical assistant professor of psychiatry at