Trial PaperAnxiety DisordersDepressive DisordersPalliative & End-of-Life DistressPsilocybin

Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer

In a randomized, double‑blind, crossover trial of 51 patients with life‑threatening cancer, a single high dose of psilocybin produced large, rapid and sustained reductions in clinician- and self-rated depression and anxiety and increased quality of life, meaning and optimism, with about 80% of participants showing clinically significant improvement at six months. The therapeutic effects were mediated by the intensity of mystical‑type experiences during the session and were corroborated by community observer ratings.

Authors

  • Roland Griffiths
  • Matthew Johnson

Published

Journal of Psychopharmacology
individual Study

Abstract

Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety. This randomized, double-blind, cross-over trial investigated the effects of a very low (placebo-like) dose (1 or 3 mg/70 kg) vs. a high dose (22 or 30 mg/70 kg) of psilocybin administered in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up. Instructions to participants and staff minimized expectancy effects. Participants, staff, and community observers rated participant moods, attitudes, and behaviors throughout the study. High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety. Participants attributed improvements in attitudes about life/self, mood, relationships, and spirituality to the high-dose experience, with >80% endorsing moderately or greater increased well-being/life satisfaction. Community observer ratings showed corresponding changes. Mystical-type psilocybin experience on session day mediated the effect of psilocybin dose on therapeutic outcomes.

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Research Summary of 'Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer'

Introduction

Cancer patients commonly develop chronic psychosocial distress characterised by depressed mood, anxiety, and reduced quality of life, with up to 40% meeting criteria for a mood disorder. Existing pharmacological treatments (antidepressants, benzodiazepines) have limited and mixed evidence in this population, and psychological interventions have produced small-to-moderate effects. Earlier uncontrolled and small controlled studies from the 1960s–70s, and more recent pilot work, have suggested that classic hallucinogens such as psilocybin may reduce psychological distress in patients with life‑threatening illness, but rigorous modern trials comparing active versus inactive conditions have been limited. Griffiths and colleagues designed a randomised, double‑blind, counterbalanced cross‑over trial to provide a more rigorous test of psilocybin's effects on depression, anxiety, and related measures in psychologically distressed cancer patients. The study compared a very low (1 or 3 mg/70 kg) versus a high (22 or 30 mg/70 kg) oral dose of psilocybin in 51 participants, with sessions separated by about 5 weeks and a 6‑month follow‑up. Procedures sought to minimise expectancy effects and to assess both clinician‑rated and self‑reported outcomes, observer ratings, and putative mediators such as mystical‑type experience.

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References (15)

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People of color in North America report improvements in racial trauma and mental health symptoms following psychedelic experiences

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Effect of lysergic acid diethylamide (LSD) on reinforcement learning in humans

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Mystical Experiences in Retrospective Reports of First Times Using a Psychedelic in Finland

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Long-term effects of psychedelic drugs: A systematic review

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Natural Psychoplastogens As Antidepressant Agents

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Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

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Rostral Anterior Cingulate Thickness Predicts the Emotional Psilocybin Experience

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The experimental effects of psilocybin on symptoms of anxiety and depression: A meta-analysis

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Modulation of Social Cognition via Hallucinogens and “Entactogens”.

Preller, K. H., Vollenweider, F. X. · Frontiers in Psychiatry (2019)

The Impact of Ayahuasca on Suicidality: Results From a Randomized Controlled Trial.

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Characterization and prediction of acute and sustained response to psychedelic psilocybin in a mindfulness group retreat

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Self-Rated Effectiveness of Microdosing With Psychedelics for Mental and Physical Health Problems Among Microdosers

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Modulation of Serum Brain-Derived Neurotrophic Factor by a Single Dose of Ayahuasca: Observation From a Randomized Controlled Trial

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Effects of acute and repeated treatment with serotonin 5-HT2A receptor agonist hallucinogens on intracranial self-stimulation in rats

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41 cited
Psychedelic drugs-a new era in psychiatry?

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States and traits related to the quality and consequences of psychedelic experiences

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Sub-Acute Effects of Psilocybin on Empathy, Creative Thinking, and Subjective Well-Being

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136 cited
Trait Openness and serotonin 2A receptors in healthy volunteers: A positron emission tomography study

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Microdosing psychedelics: personality, mental health, and creativity differences in microdosers

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142 cited
Intensity of Mystical Experiences Occasioned by 5-MeO-DMT and Comparison With a Prior Psilocybin Study

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Psychiatry might need some psychedelic therapy

Johnson, M. W. · International Review of Psychiatry (2018)

Predicting responses to psychedelics: a prospective study

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339 cited
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DMT models the near-death experience

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Psychedelics as anti-inflammatory agents

Flanagan, T. W., Nichols, C. D. · International Review of Psychiatry (2018)

Integrating Psychedelic Medicines and Psychiatry: Theory and Methods of a Model Clinic

Sloshower, J. A. · Plant Medicines Healing and Psychedelic Science (2018)

The Use of Salvia divinorum from a Mazatec Perspective

Maqueda, A. E. · Plant Medicines Healing and Psychedelic Science (2018)

Individual Experiences in Four Cancer Patients Following Psilocybin-Assisted Psychotherapy

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Unifying theories of psychedelic drug effects

Swanson, L. R. · Frontiers in Pharmacology (2018)

Neuroendocrine Associations Underlying the Persistent Therapeutic Effects of Classic Serotonergic Psychedelics

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Clinical interpretations of patient experience in a trial of psilocybin-assisted psychotherapy for alcohol use disorder

Bogenschutz, M. P., Podrebarac, S. K., Duane, J. H. et al. · Frontiers in Pharmacology (2018)

Powerful substances in tiny amounts An interview study of psychedelic microdosing

Johnstad, P. G. · Nordic Studies on Alcohol and Drugs (2018)

121 cited
The hidden therapist: evidence for a central role of music in psychedelic therapy

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213 cited
Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression

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Psychiatry & the psychedelic drugs. Past, present & future

Rucker, J., Iliff, J., Nutt, D. J. · Neuropharmacology (2017)

Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms

Carhart-Harris, R. L., Roseman, L., Bolstridge, M. et al. · Scientific Reports (2017)

68 cited
Patients’ accounts of increased “Connectedness” and “Acceptance” after psilocybin for treatment-resistant depression

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Psilocybin-Assisted Therapy: A Review of a Novel Treatment for Psychiatric Disorders

Thomas, K., Malcolm, B., Lastra, D. · Journal of Psychoactive Drugs (2017)

Psychedelics, personality and political perspectives

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164 cited

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