“Psychedelic science in post-COVID-19 psychiatry”
Kelly, J., Crockett, M., Alexander, L., Haran, M., Baker, A., Burke, L., . . . O’Keane, V. (2021). Psychedelic science in post-COVID-19 psychiatry. Irish Journal of Psychological Medicine, 38(2), 93-98. doi:10.1017/ipm.2020.94
The medium- to long-term consequences of COVID-19 are not yet known, though an increase in mental health problems are predicted. Multidisciplinary strategies across socio-economic and psychological levels may be needed to mitigate the mental health burden of COVID-19. Preliminary evidence from the rapidly progressing field of psychedelic science shows that psilocybin therapy offers a promising transdiagnostic treatment strategy for a range of disorders with restricted and maladaptive habitual patterns of cognition and behaviour, notably depression, addiction and obsessive compulsive disorder. The COMPASS Pathways (COMPASS) phase 2b double-blind trial of psilocybin therapy in antidepressant-free, treatment-resistant depression (TRD) is underway to determine the safety, efficacy and optimal dose of psilocybin. Results from the Imperial College London Psilodep-RCT comparing the efficacy and mechanisms of action of psilocybin therapy to the selective serotonin reuptake inhibitor (SSRI) escitalopram will soon be published. However, the efficacy and safety of psilocybin therapy in conjunction with SSRIs in TRD is not yet known. An additional COMPASS study, with a centre in Dublin, will begin to address this question, with potential implications for the future delivery of psilocybin therapy. While at a relatively early stage of clinical development, and notwithstanding the immense challenges of COVID-19, psilocybin therapy has the potential to play an important therapeutic role for various psychiatric disorders in post-COVID-19 clinical psychiatry.
- Research has shown that a combination of various factors associated with the COVID-19 pandemic may bring about increased population incidence of fear/anxiety, loneliness and depressive thoughts.
- Long-term models of mental health associated with the pandemic cannot accurately predict the overall prevalence of these consequences, however it is thought that vulnerable groups will be disproportionately affected.
- Therefore, a multi-strategy approach spanning various socio-economic areas is required for best results.
- Recent advances in psychedelic science are highlighting the multi-modal mechanisms of psilocybin in a therapeutic setting.
- It is proposed that psilocybin therapy provides a translatable, transdiagnostic therapeutic avenue that can be personalised to the individual receiving treatment. This precision medicine aspect is important, as significant variations in drug response is a common occurrence.
- Preclinical studies show the potential for psilocybin therapy to induce hippocampal neurogenesis, promote dendritic spine growth and increase glutamate release in the prefrontal cortex.
- Recently, research conducted at Johns Hopkins University has highlighted the claustrum (located between the putamen and insular cortex) as a potential mediator in psilocybin therapy, due to the density of 5-HT2A
- A pilot study conducted in 2020* showed that psilocybin reduced both the negative affect and amygdala responses to emotional stimuli one week post-administration.
- Data collected and synthesized from Johns Hopkins University over a 16 year period (250 volunteers and 380 administration sessions) has revealed no significant psychological side-effects with only 0.9% experiencing minor issues. However more data is needed from a tolerability perspective to provide a definitive outlook.
Concluding remarks: This review piece has synthesized knowledge obtained from primary research studies regarding the therapeutic potential of psilocybin administration. The mental-health impact of COVID-19 is likely to be widespread, it is therefore vital that the mechanistic action of such disorders is greater understood – and that research into the efficacy and tolerability of compounds such as psilocybin is progressed in a safe yet accelerated manner. The aspect of personalization (dose/setting) is advantageous, as the realm of precision medicine continues to grow.