Do Hawthorn Berries Conflict With Mushrooms – Known for its hallucinogenic properties, the liberty cap mushroom (Psilocybe semilanceata) grows in a meadow in Shropshire, England. Photo: Kevin Wells/Getty Images/iStockphoto
New tests have shown the drug psilocybin to be so effective in treating depression that Oakland was the last US city to decriminalize it last week. Some researchers say that ignoring the evidence can be “indefensible,” but how does it work as a reliable treatment?
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Lying in bed at London’s Hammersmith Hospital, swallowing a capsule of psilocybin, the active ingredient in magic mushrooms, Michael had no idea what was coming next. The 56-year-old part-time web developer from County Durham in northern England has battled depression for 30 years and tried many forms of talk therapy and antidepressants. His mother’s death from cancer, followed by the suicide of a friend, left him at one of his lowest points. While searching online to see if the mushrooms growing in his yard were hallucinogenic, he stumbled upon the first medical trial at Imperial College London.
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In the decorated clinic room, listening to music and surrounded by candles and flowers, Michael waited impatiently for the medicine to be administered. After 50 minutes, he saw bright lights leading off into the distance and embarked on a five-hour journey into his mind. where he would relive his childhood memories and face his grief. Over the next three months, her depressive symptoms subsided. He felt good and accepted and enjoyed leisurely activities such as walks in the Yorkshire countryside and nature photography.
“I became a different person,” says Michael. “I couldn’t wait to get dressed, to go out into the outside world, to see people. I was very confident – just like I was when I was young before the depression started and it got really bad.”
The trial, completed in 2016, was the first modern study to target treatment-resistant depression with psilocybin, a psychedelic drug found naturally in nearly 200 species of mushroom. To varying degrees, Michael and all 18 other participants saw a reduction in their symptoms after two treatments, including the higher, 25 mg dose. After five weeks, nine of the 19 patients found that their depression was still significantly reduced (50% or more)—results that remained stable for three months. They had suffered from depression for an average of 18 years and had all tried other treatments. In January of this year, the trial began its second phase: an ambitious effort to test psilocybin in a larger group and with scientific rigor (including a control group that Michael’s study did not have), comparing the drug’s effectiveness to escitalopram, a common antidepressant. The team has now treated a third of the 60 patients and says early results for psilocybin are promising.
Emperor’s current work is one of the new studies that a group of professors, campaigners and investors hope will lead to medical approval of psilocybin as a transformative treatment. Others soon to begin include an 80-person study by the Usona Institute, a Wisconsin-based medical nonprofit, and a trial at King’s College London, as well as a 216-person trial already underway in the U.S. and Europe. Canada and Canada, operated by London-based life sciences company Compass Pathways. Robin Carhart-Harris, head of the Imperial Center for Psychical Research and scientific adviser to Compass, believes psilocybin could be a licensed drug within five years or sooner. “At this point,” he says, “the weight of the evidence is like a force that cannot be ignored and cannot be defended against.”
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Psilocybin mushrooms have been part of religious rituals for thousands of years. The Aztecs in Mexico called it a mushroom
, or “God’s flesh,” a tribute to the sacred power he believed in. In 1957, Albert Hoffman, a Swiss chemist working for the Sandoz pharmaceutical company, isolated psilocybin from a mushroom. Fifteen years ago, he accidentally took LSD, felt dizzy from work, and felt its psychedelic effects when he came home. In the 1960s, Sandoz sold psilocybin and LSD for medical research, but the substances were soon outlawed after they became associated with the counterculture of the 60s.
Psilocybin today remains in the most restricted category under the UN Convention on Psychotropic Substances, the US Controlled Substances Act of 1970 and the UK Misuse of Drugs Act of 1971. David Nutt, professor of neuropsychopharmacology at Imperial, who is overseeing the current trials, disputes this evidence, saying that heavy restrictions on the drug (and other psychedelics) have hindered research and “falsified” its risks and medical potential. For him, this decision is “one of the worst examples of censorship of science and medicine in the history of the world.”
If successful, a new wave of research could reverse psilocybin’s reputation after decades of taboo. Carhart-Harris believes the drug offers a better and more comprehensive treatment than current antidepressants, and it could be a powerful new therapy for many other mental illnesses, including anxiety and eating disorders. A 2016 Johns Hopkins University study of 51 life-threatening cancer patients found that high doses of psilocybin significantly reduced end-of-life depression and anxiety in 80% of cases over six months and helped patients accept death; In the same year, a New York University study showed similar results. Ongoing trials are looking further into psilocybin’s ability to reduce smoking and alcohol dependence after initial pilots showed strong results. (Johns Hopkins researchers showed in a small study, for example, that 80% of heavy smokers had not smoked for at least a week six months after treatment with psilocybin.)
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Carhart-Harris believes that the reason this drug is effective in treating depression is because it helps people see their lives more clearly. When he sees patients stumble, he often feels like he’s seeing a truer version of reality than the serious therapists who guide them: “It’s like being around someone who’s exceptionally wise about what’s coming out of their mouths.” It is unclear how much of the relief from depression comes from psychiatric support relative to treatment. However, since the first trial, several patients have taken supplements on their own because their depression has returned.
Much is unknown about the neuroscience of psychedelics, but after taking psilocybin, fMRI brain scans of patients showed reduced blood flow and resting activity in the amygdala, which is often overactive during depression and anxiety. They also show loose connections between brain networks that then reconnect in what the Imperial team suggests is the part of the brain that psilocybin “repairs.” This may explain why the drug prompts some patients to reexamine long-held beliefs and break compulsive thought patterns and behaviors. Imperial researchers believe that psilocybin works differently than most current treatments. While conventional antidepressants dampen emotions to help people cope, psilocybin works on the serotonin system to increase emotional responses and encourage people to actively fight depression, which can cause lasting changes in the mind.
For 48-year-old university design technician Kirk Rutter, psilocybin seems to work and why he hopes it will become medically available. He sees medicine not as a silver bullet, but as a medicine that reveals deep truths to patients and demands the application of such teachings. Some other treatments, such as cognitive behavioral therapy, are often combined with antidepressants to try to restructure thinking patterns, but many current options don’t work. More than 300 million people worldwide suffer from depression, according to the World Health Organization, but researchers say many of the most severe cases do not respond to antidepressants.
Rutter was in that group, having tried counseling and two prescription drugs for five years before the imperial court because his depression worsened after his mother’s death. After taking psilocybin, she began to break her catastrophic thought cycles and was confident enough to make major life changes, such as selling her house and moving away from abusive neighbors, rebuilding her finances, and traveling for pleasure after years away from the country. He says of psilocybin, “It removes any inhibitions and allows you to process what you need in a seductive way. You are drawn to it involuntarily and involuntarily.” After a week of treatment, she noticed a sense of optimism returning to her life. Hell, he thought, I haven’t had that in a long time.
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Even the staunchest proponents of psilocybin agree that it needs more evidence of its effectiveness in large groups in controlled environments and studies of potential adverse effects before releasing it as a drug. Current trials exclude people with a family history of psychosis for fear that the drug could cause latent schizophrenia. There are questions about the effects of psilocybin. Some patients report barely experiencing any psychedelic effects, while others, like Michael, have experienced severe effects at low doses but less so at high doses. James Rucker, who worked on the first imperial study and now led the psilocybin trials at King’s College London, remains agnostic.
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