Dried Psilocybe mushrooms. Photo / Erik Fenderson, Wikipedia
As the world unlocks and we celebrate our freedom, the cost of Covid on our mental health is clear.
By the middle of 2020, one in five people in the UK was suffering from depression, twice the number in 2019, says the Office for National Statistics. As a result, there has been a spike in demand for antidepressants – prescriptions for which had already doubled in the past decade.
Even before the pandemic, criticism of antidepressants – the mainstay treatment for emotional distress for some 30 years – was growing.
For a considerable number of people, they do not work, or stop working over time, and they carry significant side-effects such as emotional blunting, and sexual dysfunction, and withdrawal symptoms.
It is high time for a new approach. So are magic mushrooms the alternative we've been waiting for?
Results this week from a small clinical trial, published in the New England Journal of Medicine, show that two doses of psilocybin – the main ingredient in magic mushrooms – are as effective as the antidepressant escitalopram when treating moderate to severe major disorders, when combined with talking therapy.
It adds to a growing body of research demonstrating the potential of psilocybin, and other psychedelic drugs, in treating mental health problems.
"For the past 10 years, it's become clear that psilocybin might have antidepressant properties," says Dr Robin Carhart-Harris, head of the centre for psychedelic research at Imperial College, London, and first author of the study. "This is a logical evolution."
His dream is to roll out psychedelic treatment, though he cautions against taking mushrooms, a class A drug in the UK, outside a clinical setting, as the therapy component of the treatment is so important.
In his trial, a group of 59 people were given either two 25mg doses of psilocybin three weeks apart and a daily placebo capsule, or two very low doses of the compound and the antidepressant escitalopram, over six weeks.
During the psilocybin sessions, patients lay on a bed and, under the supervision of a therapist, went "off on a journey", with guided imagery and music. All had sessions with a therapist throughout the trial. "Many of these patients largely had positive, spiritual experiences, without the fog that can be caused by antidepressants," says Carhart-Harris.
One patient had described sexual abuse at the hands of his father. "Under the influence of psilocybin, he saw his abuser manifested as a monster with a gun," says Carhart-Harris.
"With the support of his therapist, he was encouraged to look the demon in the eye. The figure shifted from a tormentor, to something sad and ridiculous. When he woke up, he was tearful, but felt a sense of release."
Powerful stuff. But are psychedelic drugs really safe for someone feeling vulnerable, and what if a treatment that seems revelatory to one patient is experienced as disturbing, or even dangerous to another?
Says Carhart-Harris: "There is no case to my knowledge of a psychotic break [episode] triggered by psilocybin. People think of Syd Barrett [the Pink Floyd musician who suffered severe mental health problems after taking psychedelics in the 60s] but he was on LSD, which is a different drug."
Others in the mental health field are less convinced. James Davies is a former NHS psychotherapist and co-founder of the Council for Evidence-Based Psychiatry, which aims to communicate the potentially harmful effects of psychiatric drugs.
"A patient does not have to suffer psychosis to suffer negative consequences from such treatments," he says. "Taking these drugs still could lead to distress. I'm a strong believer that part of a therapist's role is to bring calm and reassurance to their client, not disorientation or confusion."
He points out that the 59 people who took part in the Imperial trial were "mostly self-selecting"; that is, more adventurous types who were probably already favourably disposed to psychedelic drugs.
"The results show that – long term – psilocybin is unlikely to be effective," he says. "And what's out there is pretty ineffective anyway. For most people the differences between antidepressants and placebo are clinically meaningless. We are seeking a chemical solution to an emotional problem. Biological psychiatry has had its opportunity for decades, but it has not delivered."
An increasing number of professionals, including Davies, are advocates of drug-free talking therapies, such as the NHS Improving Access to Psychological Therapies programme, and "social prescribing", such as support groups and exercise.
Says Davies: "I am not opposed to research. But the psychedelics trial seems to me an expensive distraction. This is a mental health crisis. Funding is limited, and we need to spend our money wisely."
Anonymous
My late 30s were difficult – I went through multiple miscarriages, financial problems and divorce. I was having trouble sleeping, worried about everything and spent a lot of time cooped up in my flat, crying. Therapy didn't help much.
The doctor wanted to prescribe antidepressants but I'd taken them for several years in my 20s and had disliked the flattened emotional state they put me in.
I read about the early research into psilocybin for depression and was intrigued. I'd taken mushrooms once in my youth and giggled non-stop in a field. But now I considered using them in a very different way – in a calm, quiet setting, with a "sitter" on hand to support me, and with the intention to find a different way to think about my life.
So one Saturday afternoon, I ended up sitting in a darkened living room, taking 5g of dried mushrooms steeped in a cup of tea. I knew mushrooms were safe from a physical perspective. I was, however, terrified about what would come up. What if my constant anxiety flared into a scary trip?
After about 20 minutes, I started yawning a lot – a common effect. Then the ceiling seemed to turn to liquid and a pot plant on a shelf looked as though it was dancing. I felt apprehensive but my friend reassured me and I put on an eye mask and lay back, trying to focus within.
I could feel my brain trying to click into anxiety, but it was as though something inside it wouldn't allow it to go there. I saw myself in a meadow, with a giant, motherly woman stroking my hair, telling me everything would be okay. I grew as tall as this mother figure and went striding across fields and forests, even travelling up to the stars at one point. Afterwards, my friend said I was laughing and crying at the same time.
The peak intensity wore off after around two hours. We went for a walk in the garden where everything looked luminous and alive. I felt a strong connection with nature, and, in fact, with the whole world. When the effects wore off completely, I felt clear-headed and optimistic. The sense of connection was a big part of the healing for me. It showed me how isolated I'd been feeling and I resolved to change that.
Over the next few weeks, I found I had a new drive to look after myself, going back to yoga and overhauling my diet as well as starting to volunteer in my community. I think the experience gave me a new perspective. As the months went by, the initial "sheen" did fade but I felt a lot more capable of dealing with my problems.
While I used the mushrooms carefully, I didn't take them in a clinical setting, with the hours of therapy given to people involved in the research. Psychedelics aren't for everyone – the research is still at an early stage – and obviously I had to break the law to use them. But the experience I had proved to me how much psilocybin can shift you.
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