Sorry to pull a fast one on you, but I did want to get your attention. Axis Integrated Mental Health will not be offering psilocybin treatment right now. Let me explain why.
With the recent passing of Prop 122, there has been a great deal of news about psilocybin or magic mushrooms as a treatment for depression and other mental health conditions.
This bill has decriminalized psilocybin in Colorado and enabled the licensing of psilocybin treatment centers. So what does this actually mean for patients?
In reading all the recent news articles, the actual effect that Prop 122 will have on mental health patients is confusing. The news stories recently make it sound like psilocybin treatment is now available to patients with a quick visit to an enlightened psychiatrist, psychiatric NP, PCP, psychologist, or therapist.
These same articles also lead the reader to believe that psilocybin is a safe, effective, treatment for depression, anxiety, PTSD, alcoholism and more. Neither of these are really true.
While the early research does show some promising results, it’s far too early to declare psilocybin an answer to all mental health problems. Below are four reasons why it’s far too early to consider offering psilocybin to our patients.
First of all, decriminalization does not equal legal. This is one of the major oversights that the media has conveniently overlooked. The slippery “decriminalized” distinction means that no medical prescriber can write you a prescription for psilocybin at this time.
Before obtaining FDA approval as a treatment for depression, anxiety, and PTSD more study on dosing needs to occur. A major challenge in studying psilocybin is the source of the key compound. Psilocybin comes from “magic mushrooms” which are a plant.
Like marijuana, this plant likely contains a slew of other compounds besides psilocybin. The natural production of psilocybin by growing these mushrooms is also hampered by, well nature.
As we’ve seen in marijuana production, the concentration of the active compounds is inconsistent. How will patients and providers know how much of the key drug psilocybin is in a certain amount of mushrooms? Will modifying these fungi to produce more psilocybin change the benefits observed in the limited studies?
This is exactly what happened in marijuana over the past 5+ years, as the focus on stronger THC content has actually caused increased anxiety, depression, and psychosis in heavy users.
Secondly, the data supporting the effectiveness of psilocybin is very limited. The key study showing the mental health benefits of mushrooms was tested in 51 cancer patients.
To date, there still has not been a large-scale, high quality study demonstrating the mental health benefits of mushrooms. The largest study so far was performed using a synthetic version of psilocybin (Comp360). Patients in this study did show improvements in mood after receiving this medication. However, the researchers did not share the amount of improvement seen in patients.
By comparison, ketamine and Spravato studies demonstrated an improvement in depression scores of greater than 50% improvement in depression.
Thirdly, the studies for psilocybin all include important conditions that may not be possible for all patients. The major studies for psilocybin have required that patients stop taking their current antidepressants in order to be included in the studies.
Common antidepressants actually prevent some of the effects felt when taking psilocybin, making their use at the same time limited. Of course, this also means that you’d have to wean off most medication to try psilocybin for your depression, anxiety, or PTSD.
If you then are one of the patients that don’t respond to psilocybin, you’ll have to restart on medication. This on/off transition could prove dangerous for many patients.
Finally, the psilocybin studies all include extensive psychotherapy in conjunction with the treatment. Most trials included 8 hours of psychotherapy at each dose.
This begs the question, would 8 hours of condensed therapy yield similar benefits? Although, you could argue that one would have to be on hallucinogens to sit through 8 straight hours of psychotherapy in one go.
The news stories have also ignored the cost of this level of condensed psychotherapy with two therapists. Since psilocybin is still in an investigational phase, insurance coverage is a long way off, and the price of a full day’s therapy will no doubt be high.
Overall, psilocybin has shown some initial promise as an additional tool in treating mental illness. However, it’s far too early to declare psilocybin the silver bullet of mental health treatment.
Let’s hope that in the meantime, people suffering from mental health issues don’t hear “psilocybin cures everything,” and causes them to begin an unsupervised, self-medication attempt at psilocybin treatment.
It’s also concerning that counselors and therapists could recommend psilocybin to clients without considering the effect of combining psilocybin with their current medications.
As a provider currently seeing the benefits of existing treatments such as TMS, Spravato, and ketamine in our clinic, I’ll be eagerly watching the ongoing research on psilocybin. And once psilocybins are shown to be effective, safe, and affordable for patients, they’ll be available at Axis Integrated Mental Health.
Until then, we’ll continue to offer TMS, Spravato, and ketamine treatments, which have decades of research to support their use.