Trial PaperDepressive DisordersNeuroimaging & Brain MeasuresMajor Depressive Disorder (MDD)Treatment-Resistant Depression (TRD)Safety & Risk ManagementEquity and EthicsPsilocybin

Psilocybin-assisted therapy for the treatment of resistant major depressive disorder (PsiDeR): protocol for a randomised, placebo-controlled feasibility trial

PsiDeR is a single-centre, randomised, placebo-controlled feasibility trial of psilocybin-assisted therapy in up to 60 people with treatment‑resistant major depressive disorder, testing a single 25 mg psilocybin dose plus psychological support with primary feasibility outcomes (recruitment, dropout and variance of the Montgomery–Åsberg Depression Rating Scale) at a 3‑week primary endpoint and 6‑week follow‑up. The protocol also collects optional neuroimaging and omics data for mechanism and biomarker analyses and offers an open‑label 25 mg psilocybin extension.

Authors

  • James Rucker
  • Allan Young
  • Nadav Liam Modlin

Published

BMJ Open
individual Study

Abstract

Introduction Psilocybin-assisted therapy may be a new treatment for major depressive disorder (MDD), with encouraging data from pilot trials. In this trial (short name: PsiDeR) we aimed to test the feasibility of a parallel-group, randomised, placebo-controlled design. The primary outcomes in this trial are measures of feasibility: recruitment rates, dropout rates and the variance of the primary outcome measure of depression. Methods and analysis We are recruiting up to 60 participants at a single centre in London, UK who are unresponsive to, or intolerant of, at least two evidence-based treatments for MDD. Participants are randomised to receive a single dosing session of 25 mg psilocybin or a placebo. All participants receive a package of psychological therapy. The primary outcome measure for depression is the Montgomery Asberg Depression Rating Scale collected by blinded, independent raters. The primary endpoint is at 3 weeks, and the total follow-up is 6 weeks. With further informed consent, this study collects neuroimaging and omics data for mechanism and biomarker analyses and offers participants an open label extension consisting of a further, open label dose of 25 mg of psilocybin. Ethics and dissemination All participants will be required to provide written informed consent. The trial has been authorised by the National Research Ethics Committee (20-LO/0206), Health Research Authority (252750) and Medicine’s and Healthcare Products Regulatory Agency (CTA 14523/0284/001-0001) in the UK. Dissemination of results will occur via a peer-reviewed publication and other relevant media. Trial registration numbers EUDRACT2018-003573-97; NCT04959253 .

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Research Summary of 'Psilocybin-assisted therapy for the treatment of resistant major depressive disorder (PsiDeR): protocol for a randomised, placebo-controlled feasibility trial'

Introduction

Major depressive disorder (MDD) is a common, disabling and costly condition, and approximately one third of patients meet standard definitions of treatment resistant depression (TRD), typically after failing at least two adequate antidepressant trials. Rucker and colleagues note that, apart from esketamine and transcranial magnetic stimulation, there have been few substantive pharmacological advances for MDD since the introduction of selective serotonin reuptake inhibitors. Classical psychedelics such as psilocybin were used clinically before broad prohibition in 1971; more recently, small phase I and II studies and open-label pilot work have reported marked symptomatic improvements and an acceptable safety profile in controlled settings, but earlier trials were often unblinded, uncontrolled or at risk of bias, limiting conclusions about efficacy and adverse-event differences compared with placebo. This protocol paper describes the PsiDeR trial, designed to evaluate the feasibility and safety of a randomised, placebo-controlled, double-blind design of psilocybin-assisted therapy in adults with TRD. The study aims to test whether such a trial is practicable—measuring recruitment and dropout rates—and to estimate the variance of the primary depression outcome (MADRS) to inform sample size calculations for a future efficacy trial. Secondary aims include preliminary comparisons of clinician- and participant-rated efficacy measures, and the collection of optional mechanistic data (neuroimaging and biological samples) and an open-label extension for participants who consent.

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Study Details

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