Psilocybin with psychological support improves emotional face recognition in treatment-resistant depression

Depressed patients show biases and deficits in emotional face processing, and conventional antidepressants can alter these biases before full symptom change. Stroud et al. tested whether psilocybin-assisted psychological support in treatment-resistant depression was associated with changes in dynamic emotional face recognition. The paper is a secondary analysis of the Imperial open-label psilocybin depression pilot, with an additional healthy control comparison group that did not receive psilocybin.

Seventeen patients with treatment-resistant depression from the psilocybin pilot completed the Dynamic Emotional Expression Recognition Task (DEER-T) at baseline and again 1 week after the 25 mg psilocybin session, approximately 1 month after baseline. Sixteen healthy controls completed the same emotional-recognition task over a similar interval without psilocybin. Patients also completed QIDS-16 and SHAPS at baseline and at the post-treatment assessment; controls completed QIDS-16 at both sessions. The primary DEER-T variable was reaction time on correct trials, analysed with mixed ANOVA models across time, emotion type, and group; accuracy, discrimination (Pr), and response bias (Br) were also analysed.

The primary emotional-processing result was a group-by-time interaction for reaction time (p = .035). At baseline, patients were slower than healthy controls at recognising emotional faces (p < .001), but this group difference was no longer significant after psilocybin (p = .208). In patients, mean reaction time across all emotions improved from 2192.58 ms to 2015.48 ms (p = .004, d = .876); controls did not show a significant pre-post change (p = .263, d = .302). QIDS-16 and SHAPS scores improved in patients over the same interval, and reaction-time improvement correlated with reduced anhedonia on SHAPS (r = .640, p = .010) but not with QIDS-16 change (r = -.073, p = .796). Accuracy, discrimination, and response-bias analyses mainly showed residual group differences for angry faces rather than a clear treatment-specific time-by-group effect.

The authors interpret the findings as preliminary evidence that psilocybin with psychological support may improve emotional face processing in treatment-resistant depression, potentially linked to reduced anhedonia and emotional reconnection. They caution that the study was open-label, non-randomized, small, and used healthy controls who were younger and did not receive placebo, psilocybin, or psychological support. Because no three-way interaction was observed across emotion, group, and time, emotion-specific interpretations are treated cautiously. The authors call for placebo-controlled studies and broader cognitive/perceptual testing to determine whether the observed reaction-time change reflects emotional-processing specificity or a more general cognitive or perceptual improvement.

In this secondary analysis, psilocybin with psychological support was associated with faster recognition of dynamic emotional faces in treatment-resistant depression, and the reaction-time improvement correlated with reduced anhedonia. The result is preliminary and requires randomized placebo-controlled confirmation.