Psychedelic science in post-COVID-19 psychiatry
Alexander, L., Baker, A., Brennan, C., Burke, L., Crockett, M. T., Haran, M., Kelly, J. R., O’Keane, V.
This commentary (2020) examines how the COVID-19 pandemic has affected the trajectory of clinical trials investigating psilocybin-treatment for a wide range of conditions, some of which are likely to become even more prevalent in post-COVID-19 clinical psychiatry. Although many of these clinical trials have been temporarily stagnant due to safety measures, ongoing efforts from large scale clinical studies of psilocybin will provide valuable information on its safety, dose optimization, and its efficacy compared to a conventional selective serotonin reuptake inhibitor (SSRI) and additional studies will elucidate whether it is safe to combine them with psilocybin therapy.
Abstract
Introduction: 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.