New research brings hope for healthcare clinicians facing post-pandemic mental health.
In an article published in December 2024, researchers treated thirty healthcare clinicians with a history of post-COVID pandemic depression, burnout, or post-traumatic stress disorder (PTSD), either with oral psilocybin or niacin used as a placebo. Psilocybin is a compound that comes from fungi like mushrooms and is converted in the body to psilocyn which is a hallucinogen similar to LSD. Psilocybin is a partial agonist of the 5-HT2A receptor, with the ability to induce neuroplasticity (the brain's ability to reorganize and rewire neural connections), which may be beneficial for depression.
Inclusion criteria included no previous mental health disorder prior to the pandemic, symptoms lasting at least six months, willingness to taper any antidepressant use if on one, and avoidance of pregnancy. Exclusion criteria included substance use disorder, use of psychedelics within the previous 12 months, unstable medical conditions or having a first-degree relative with a history of schizophrenia, bipolar disorder, or paranoid disorder.
The medications were given in a seven-hour session after preparatory sessions and there were three follow-up sessions with experienced clinicians. A clinician-administered Montgomery-Asberg Depression Rating Scale (MADRS) was used by blinded raters both before and at 28 days after the treatment, as well as tests for PTSD and burnout. At day 28 participants were told which drug they had received and the niacin group was given the chance to take the psilocybin, which 12 participants did.
It was reported that in the psilocybin group, participants had statistically significant and probably clinically significant larger decreases in depressive symptoms than the niacin group. The mean change in MADRS score (representing change in depressive symptoms) comparing the first preparation session to 28 days after therapy was −21.33 in the psilocybin group compared with −9.33 in the niacin group. The authors state that it is thought that a 6-to-9-point difference in MADRS scores are considered clinically significant. No significant change was found in burnout or PTSD symptoms between the groups.
There were a few minor side effects such as nausea or headache but no acute psychotic episodes.
Weaknesses of the trial include the small number of participants and the fact that by the end of the seven-hour treatment session all the participants correctly identified whether they had gotten psilocybin or niacin which could affect the blinding of the study. Also, while compared against a niacin placebo, this study did not compare psilocybin against standard therapy.
Comments:
This is one of a number of studies that have looked at the use of psychedelic drugs in the treatment of treatment resistant depressions and PTSD. Some of these studies have shown potentially positive effects, but patient selection and the presence and availability of therapists are felt to be important to prevent precipitation of a psychotic episode, and the therapy is still considered experimental.
Click here if you wish to read more about newer psychiatric treatments for depression that are being investigated.
References
Back AL, Freeman-Young TK, Morgan L, et al. Psilocybin Therapy for Clinicians With Symptoms of Depression From Frontline Care During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(12):e2449026. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827553
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