Psilocybin, from magic mushrooms, eases anxiety and depression in cancer patients

Posted by Big Rat on Campus on Dec 15, 2016 in Rat News | Subscribe

In 2010, doctors diagnosed Dinah Bazer with ovarian cancer. After treatment and chemotherapy, it went into remission, but as the months wore on, she became increasingly terrified that the disease might return. Two years after diagnosis, she felt worse than ever. “The fear was eating me alive,” she says. “It was destroying my life.”

She heard about a study at New York University, where physicians were using psilocybin—the active ingredient in psychoactive mushrooms of the genus Psilocybe, referred to by some as magic mushrooms—to treat cancer patients struggling with extreme anxiety and depression. After being carefully screened, Bazer entered the study and got to know the psychologists running it during several therapy sessions. Then, one day, she was given a moderately high dose of psilocybin.

After feeling the drug kick in, she felt like she was lost at sea, afraid. One of her therapists held her hand, and this gave her mooring. She had a vision of her fear as a dark mass under her ribcage. It was consuming her. She became angry, furious. “Get the fuck out!” she screamed.

A moment later, the fear was gone. “It completely evaporated,” she says.

Next, she felt transported to a place where she felt nothing but love. “I’m an atheist, but the best way to describe it—I felt bathed in God’s love… probably the most powerful emotion I’ve ever felt.”

Four years later, the anxiety hasn’t come back. She feels happy to be alive and does things she couldn’t do before, like making new friends, meditating, and simply slowing down. “It really changed everything for me,” she says. “I’m so much more active, so much more able to reach out. I feel like I belong in the world.”

When Dr. Stephen Ross, study leader and director of addiction psychiatry at NYU Langone Medical Center, first heard anecdotes like this from study participants, he was skeptical. “But after seeing this 20 to 30 times, I thought: This is amazing,” he says. “It’s a real effect.”

Two long-awaited studies published on 1 December in the Journal of Psychopharmacology attest to this. One conducted at NYU involved 29 patients; another, done at Johns Hopkins University, had 51. Both studies followed similar protocols, and both found that after being given psilocybin, 80 percent of patients experienced a drop in anxiety and depression that lasted for six months or more. In some cases, as in Bazer’s, it appears to be permanent. Both the patients and their psychiatric evaluators concurred that these people were more optimistic, felt their lives were more meaningful and had a better quality of life.

In cases where the cancer was terminal, the treatment allowed people to accept their impending deaths and suffer less than they might have without the psilocybin, says Roland Griffiths, who led the Johns Hopkins study. “There’s something about these experiences that allows people to see their disease process in a much larger scope,” he says. “They might say – ‘I’m very sad, I’m dying. But in a larger sense it’s OK, and it’ll be alright.’ They’re certainly not welcoming their death, but they’re no longer deeply fearful of it.”

Charles Grob, a researcher and psychiatrist at UCLA, says there is no other drug that can be taken once and have such long-lasting effects. He’s not surprised, though, because he conducted a 2011 study on psilocybin which found similar improvements in 12 cancer patients.

The results have been hailed by leading psychologists as a potentially paradigm-changing way to treat anxiety and depression in patients with cancer or other terminal illnesses. Griffiths says it also raises hopes that the drug could one day be used to do the same for healthy people.

Nineteen scientists and doctors, including two former heads of the American Psychiatric Association, wrote 10 commentaries in the journal about the importance of the work. “To many people brought up on the Reagan drug-war era with the ‘drugs fry your brain’ message, psilocybin may seem a strange and possibly even a dangerous drug treatment of serious mental illness,” writes David Nutt, a neuropsychopharmacologist at Imperial College London, in an editorial. But the high quality of the research and the strong support shown for it – the “list of the commentators reads like a Who’s Who of American and European psychiatry” – should “reassure any waverers that this use of psilocybin is well within the accepted scope of modern psychiatry,” Nutt adds.


Tripping in the Lab

In both studies, participants got to know the participating psychologists over the course of more than a dozen hours to establish rapport and a sense of trust and comfort before the psilocybin experience. After taking the psilocybin or a placebo dispensed in a single white capsule, patients laid down in a comfortable room they were familiar with. They were invited to wear eyeshades and listen to calming music.

The NYU researchers split their group in two, with half getting psilocybin the first time, and half getting an “active placebo” of niacin, which can induce a rush of blood to the skin that mimics the beginning of a psychedelic experience. Then they had a second session where the groups switched, half getting the placebo and the rest getting the real thing. In both cases, niacin had little effect.

The Hopkins protocol was slightly different. Patients had two sessions, one with a high dose of psilocybin and one with a very low dose. The researchers found that the small dose had negligible effects compared to the large one.

This is not to say that popping psilocybin mushrooms is a good home remedy to treat depression or anxiety. For one thing, psilocybin is listed as a Schedule I substance in the United States, a category reserved for chemicals that the Drug Enforcement Administration (DEA) considers to have no medical value and a high potential for addiction. Possession is illegal.

In these studies, patients ingested psilocybin under carefully-controlled settings, and participants were screened for a history of mental illness or schizophrenia. When used carelessly, or in people with an underlying vulnerability toward psychosis, psilocybin can cause problems, Ross says. He has treated people in his private practice who’ve had delusional episodes after taking it, he says. And psilocybin may also lead to anxiety that can spiral out of control in an unsupported environment.

No long-term negative effects have been observed in any patients studied so far, the researchers say. A small percentage of participants encountered short-lived nausea and headaches, while one-fifth to one-quarter of participants experienced residual anxiety.

Griffiths adds that before psilocybin could be legally used in healthy people, or in people with anxiety or depression without serious illness, it would need to go through the kind of rigorous testing now being performed on cancer patients. These two papers set the stage for a phase 3 clinical trial to be evaluated by the Food and Drug Administration. That could lead to reclassification of the drug by the DEA, he adds.

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Researchers are testing the drug in cancer patients because there are few good treatments for this group. Up to 40 percent of these people have symptoms of a mood disorder. Besides making life miserable, severe anxiety and depression also make cancer itself more difficult to treat, leading to decreased adherence to medication, longer hospital stays and increasing risk of suicide. Antidepressants and anti-anxiety drugs don’t work as well in these patients as they do in the general population, Ross says. This is due in part to the complexity and difficulty of dealing with imminent death, which our whole society doesn’t handle particularly well, he adds. Doctors label these fear and concerns “existential distress.”

Exactly how psilocybin causes long-lasting changes isn’t clear, but scientists have some clues. Psilocybin is known to bind to a receptor normally used by serotonin, one of the brain’s most important neurotransmitters, which is involved in everything from mood to perception to sleep. MRI studies done at Imperial College London show that this activity changes the activity of neurons throughout the brain, allowing different regions to communicate that aren’t usually connected. This is thought to help facilitate breakthroughs that people report while under its spell, Griffiths says.


Under the Hood

But both studies also found that the degree to which anxiety and depression improved was linked to the intensity of the patients’ “mystical experience.” It may sound a little far out for psychiatry, but most of the participants taking the drug reported such experiences. Psychologists describe mystical experience as moments during which people report a sense of unity with other humans and the universe. They can have profound insights, feel they are transcending space and time, and also have trouble putting it all into words, Ross says.

There’s something about these moments that allows people to reframe how they think about their disease, and to escape “their story” about being a victim, Griffiths says.

Ross argues that psilocybin should not be a Schedule I drug. These two studies, as well as previous research, suggest that it does have medicinal value. And there’s no evidence whatsoever that it’s addictive, Ross says. In fact, psilocybin and similar psychedelics show some promise for treating addiction.

One small 2014 study found, for example, that psilocybin may help people give up another addiction—cigarettes. In the paper done at Hopkins, 12 of 15 participants quit lighting up after taking the drug, and were abstinent six months later, a success rate much higher than seen with other similar initiatives. A larger study is now underway at the university.

Psilocybin (and another hallucinogen, LSD) may also help treat alcoholism. One proof-of-concept trial done at the University of New Mexico in 2015 found that 10 alcoholics who took psilocybin in a controlled environment drank significantly less than before, and this was maintained for a period of nine months. Bill Wilson, the founder of Alcoholics Anonymous, wrote that he believed LSD could help “cynical alcoholics” embrace a higher power, though the organization was scandalized by the suggestion and rejected it. Wilson himself finally got sober after a mystical experience brought on by ingesting the so-called belladonna cure in a New York City hospital in 1934. This concoction contains hallucinogenic alkaloids found in the nightshade plant that are chemically similar to psilocybin.

Mystical experiences have been written about and witnessed since prehistoric times, and are very similar to what people report feeling during religious conversions (although they need not involved a recognizable divine power, as Bazer’s case illustrates). These experiences can occur spontaneously, brought on by fasting, breath work, religious ceremonies and the like, Griffith adds. “It appears to be biologically normal that we have these experiences—these are part of [being] human.” However, these activities often take a long time, and are harder to study. Psychedelics can more reliably elicit them in a majority of people, Griffiths says.

In the 1940s, Swiss chemist Albert Hofmann discovered the psychoactive effects LSD, after which it was used by researchers in Europe and the United States. Investment banker Gordon Wasson also became one of the first Westerners to take psilocybin mushrooms, in Mexico, and introduced them to a wide audience in a 1957 article about his trip published in Life magazine. These mushrooms, as well as synthetic psilocybin (first isolated and produced by Hofmann) led to an explosion of psychedelic research in the 1950s and 1960s; there were more than 1,000 studies published on LSD, for example. These compounds showed promise for treating addiction, anxiety and depression. However, the drugs “escaped the lab” and their nonmedical use among members of the counterculture gave them a bad name, Ross says. All research ground to a halt shortly after LSD was outlawed by the U.S. federal government in 1968.

Grob’s 2011 paper was one of the first to look again at hallucinogenic drugs in cancer patients. It followed a 2006 study at the University of Arizona that found that psilocybin helped temporarily reduce symptoms of obsessive-compulsive disorder in nine subjects. Griffiths has also tested psilocybin in more than 50 healthy subjects. Most of these people reported improved quality of life afterward and said the experience was one of the most profound of their lives.

The 19 scientists and doctors who wrote commentaries on the research all said basically the same thing—that research on psychedelics should be more widely explored. “It’s time to take psychedelic treatments in psychiatry and oncology seriously, as we did in the 1950 and 1960s, which means we need to go back to the future,” Nutt says.

Griffiths says he hopes further work reveals more about “what’s going on under the hood” during these spiritual experiences. But he says it’s important to have the “humility to know that some of these questions may be unanswerable.… I’m open to having great wonder about this.”

© Washington Post

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