Trial PaperDepressive DisordersMajor Depressive Disorder (MDD)Treatment-Resistant Depression (TRD)Obsessive-Compulsive Disorder (OCD)Substance Use Disorders (SUD)Palliative & End-of-Life DistressPersonality & Trait FactorsAnxiety DisordersPsilocybin

Effects of psilocybin therapy on personality structure

In 20 patients with treatment‑resistant depression, two psilocybin sessions with psychological support produced significant 3‑month decreases in Neuroticism and increases in Extraversion and Openness (Conscientiousness trended upward; Agreeableness was unchanged). The degree of insightfulness during the session predicted these changes, suggesting pronounced increases in Extraversion and Openness may be characteristic of psychedelic therapy and warrant confirmation in controlled studies.

Authors

  • Robin Carhart-Harris
  • David Nutt
  • Leor Roseman

Published

Acta Psychiatrica Scandinavica
individual Study

Abstract

Objective

To explore whether psilocybin with psychological support modulates personality parameters in patients suffering from treatment‐resistant depression (TRD).

Method

Twenty patients with moderate or severe, unipolar, TRD received oral psilocybin (10 and 25 mg, one week apart) in a supportive setting. Personality was assessed at baseline and at 3‐month follow‐up using the Revised NEO Personality Inventory (NEO‐PI‐R), the subjective psilocybin experience with Altered State of Consciousness (ASC) scale, and depressive symptoms with QIDS‐SR16.

Results

Neuroticism scores significantly decreased while Extraversion increased following psilocybin therapy. These changes were in the direction of the normative NEO‐PI‐R data and were both predicted, in an exploratory analysis, by the degree of insightfulness experienced during the psilocybin session. Openness scores also significantly increased following psilocybin, whereas Conscientiousness showed trend‐level increases, and Agreeableness did not change.

Conclusion

Our observation of changes in personality measures after psilocybin therapy was mostly consistent with reports of personality change in relation to conventional antidepressant treatment, although the pronounced increases in Extraversion and Openness might constitute an effect more specific to psychedelic therapy. This needs further exploration in future controlled studies, as do the brain mechanisms of postpsychedelic personality change.

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Research Summary of 'Effects of psilocybin therapy on personality structure'

Introduction

Major depressive disorder is common, causes substantial individual and societal burden, and a sizeable fraction of cases are treatment-resistant (treatment-resistant depression, TRD), defined here as poor response to two adequate trials of different antidepressant classes. Given TRD’s poor prognosis and high cost, alternative therapeutic strategies have been sought. Interest in classic serotonergic psychedelics such as psilocybin has re-emerged, and small pilot studies suggest psychedelic-assisted therapy can produce durable clinical benefits across conditions including addiction, obsessive–compulsive disorder, end-of-life distress, major depression, and TRD. One intriguing observation from prior work is that therapeutic effects often outlast the acute pharmacological presence of the compounds, and that psychedelic-occasioned ‘‘peak’’ or ‘‘mystical-type’’ experiences—characterised by ego-dissolution, unity, insight and connectedness—may be linked to longer-term change. Mm and colleagues set out to examine whether psilocybin with psychological support modulates personality structure in patients with TRD, whether any personality changes relate to the subjective quality of the psychedelic experience, and whether such changes might help explain the durability of psychedelic-assisted therapy. The study therefore investigated pre-to post-treatment change in the five NEO-PI-R personality domains and their facets, and explored associations between personality change, clinical response, and measures of the acute psilocybin experience.

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Study Details

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