If, like me, you've had your eyes on the media and various other publications, the subsequent development in mental health seems to be the emergence of psychedelic treatments for mental health.
Over the last two years, the media have reported on psilocybin being a wonder drug that can help treat Treatment Resistance Depression. You may have read an article and thought this must be better than the cycle of anti-depressant medication prescribed to me; this one has to work; nothing else has helped me.
Let's start with the facts.
What is Psilocybin?
You may know Psilocybin by its street name, "Magic Mushrooms". Psilocybin is a naturally occurring psychedelic compound produced by more than two hundred species of fungi.
In the UK, we have our very own Liberty Caps. Liberty caps are pretty common in the UK (if you know where to look). It's an autumnal mushroom that best grows in grass or parks that have not had any spraying of artificial fertiliser. They will usually sprout in September, and the onset of frost will kill them off, giving a minimal time window to collect.
Up until 2005, it was legal to possess fresh liberty caps, but the Misuse of Drugs Act changed this. Fresh and "prepared" (dried, cooked or made into a tea) psilocybin mushrooms became illegal in the United Kingdom.
Fresh mushrooms had previously been widely available, even in shops, but section 21 of the Drugs Act 2005 made fresh psychedelic mushrooms ("fungi containing psilocybin") a Class A drug. Possession and use of psilocybin and psilocin is prohibited since the 2005 Act, but mushroom spores, which do not contain psilocybin, are not regulated.
Psilocybin as an Anti-Depressant
Various trials have shown that psilocybin can reduce depression and anxiety more quickly than traditionally prescribed anti-depressants.
One of the largest ever studies of psilocybin was conducted by Compass at the end of 2021.
In short, they found that the psychedelic compound was "highly efficacious as a therapy for treatment-resistant therapy". The phase 2 b study was the largest randomised, controlled and double-blind trial of psilocybin. It was conducted with 233 patients who took part in conjunction with psychological support from trained therapists. All patients stopped taking their anti-depressant medication prescribed to them at the start. A single dose of psilocybin was given, either 25mg, 10mg or 1mg.
The results showed that the patients administered 25mg of psilocybin had a significant decrease in depressive symptoms compared to those given 1mg. The study found that such a low dose only functioned as a placebo.
The trial also revealed that those who received the higher dose of 25mg were still in remission three months later.
Let's be honest about this. Taking any substance, any prescribed medication is not without its risks. Adverse events recorded as mild or moderate in severity were shown in 179 patients. These events ranged from headaches, nausea, fatigue and insomnia.
Out of the 233 patients, twelve reported severe adverse events, including suicidal behaviour, intentional self-injury, and suicidal ideation.
As the study highlighted, there are risks from taking psilocybin for depression. It can make it worse.
But what's more interesting is the use of a low dose functioned as a placebo. More research needs to be done on dosing regulations. Is it better to take one dose or microdose, as many websites and media outlets are reporting?
Psilocybin Micro Dosing
A micro-dosing regime means taking only about 5-10% of a dose that would typically send you on a trip. The dosing regime seems to be two days on, one day off.
But do you do this week in week out? Do you take a break for a month or two? The truth is, we don't know. Most reports on micro-dosing come from the users themselves. This also presents another issue: how do you know how much you are dosing on? There are no standardisations for the mushrooms you pick or grow. There is no actual research for micro-dosing, although there are websites that may help you keep safe and offer you some good information.
LSD (lysergic acid diethylamide ) Micro dosing
Addiction Biology recently released data from a trial conducted using repeated low doses of LSD. This was a placebo-controlled, dose-response study.
User reports have claimed that taking a low dose of LSD at intervals can improve mood and cognitive functioning. The trial was conducted with fifty-six people, and the amount administered ranged from 13mg – 26mg over five sessions with 3-4 days between administration.
To put this in context, a standard dose of LSD that you would take to have a trip is between 100 – 200mg. Brain tests and emotional tasks were completed to assess the functioning and mood. This was done during dosing sessions and also on "drug-free" days.
"The results were a little bit disappointing in that we didn't see any dramatic improvements in mood or cognition or really any lasting changes on any of the measures that we looked at," said lead researcher Harriet de Wit, a professor of psychiatry and behavioural neuroscience at the University of Chicago."
The research contradicts many user reports who self-medicate and have said that it does improve their mood and emotions. So which is true? Are users who self-medicate just feeling a placebo effect?
It's worth noting the study clearly states micro-dosing LSD is safe, with no adverse effects on heart rate, blood pressure or other vital signs.
The data says micro-dosing both LSD and psilocybin is safe. And is an alternative form of consuming psychedelics compared to taking a single dose.
It is also clear that more research needs to be done. Considering LSD was first synthesised in the 1930's it's time to really look at how this Class A drug can support mental health and mental wellbeing.
As LSD works on the same serotonin neurotransmitters as prescribed anti-depressants, there has to be some validity in using psychedelics as a treatment option for treatment-resistant depression. We await more results.