Recently, an article was published in the NEJM comparing psilocybin (the key ingredient in "magic mushrooms") to escitalopram. Current literature comparing psilocybin to established, first-line treatment has been lacking, so this was a much anticipated study. The small study was comprised of two groups – one received two separate doses of 25 mg of psilocybin three weeks apart, plus six weeks of daily placebo pills; the other received two separate doses of 1 mg of psilocybin three weeks apart, plus six weeks of daily oral escitalopram, an SSRI. The SSRI group’s low psilocybin dose was considered so low that they were unlikely to have an effect, in other words a placebo dose.
The study was small (30 in the psilocybin group and 29 in the SSRI group) but still provided key findings that require context when evaluating. Both groups showed a reduction in Quick Inventory of Depressive Symptomatology scores (QIDS-SR-16), which is a self-reported survey that is used to rate depressive symptom severity. Reduction in depression scores of at least 50%, was seen in 70% of people in the psilocybin group, compared with 48% in the SSRI group. These results are great in that psilocybin group had more symptom reduction but unfortunately the statistics proved that the difference was insignificant.
But that’s okay…
Even if the effect proves to be the same after larger trials have completed, we must look at the bigger picture. The patients who had psilocybin therapy only had two sessions, while the SSRI group took a medication every single day. In other studies, psilocybin has been shown to have lasting effects that do not require frequent psychedelic therapy. We have to consider that when people start on SSRIs they are often are committed to them for life. A therapy provided intermittently versus a daily medication is not an insignificant difference. Another important distinction is that SSRIs have adverse effects too. In fact, the SSRI group in this study reported more adverse effects, including anxiety and decreased libido. Psilocybin’s main adverse effect was a headache the next day. Those are not minor differences.
The primary outcome of interest was a self-reported score, QIDS-SR-16. The statistically insignificant difference got a lot of the attention as a win for conventional treatment. However, secondary outcomes for psilocybin included enhanced feelings of connectedness with the self, others,and the world; enhanced ability to confront, process, and accept difficult emotions that had been suppressed; and catharsis and release of long-term grief and other avoided emotions.
This is why the Science can be deceiving. The primary outcome is not reflective of psychedelic therapy’s real potential. Curing depression is the wrong endpoint. Helping people connect with others again and grow from past trauma is the ultimate endpoint.
DISCLAIMER: IIT does not endorse recreational use of psilocybin.In this study, all participants received psychedelic-assisted psychotherapy under the supervision of a trained guide and oversight by a physician. IIT provides psychedelic therapy in Minnesota with the same protocols but with Ketamine only at this time.