Psychedelic Science in post-COVID-19 Psychiatry
Abstract: 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.
_____
Crises induce a wide range of psychological reactions, with varying degrees of adaptability. The combination of uncertainty and social distancing induced by the COVID-19 pandemic can lead to excessive fear/anxiety, loneliness and depressive thoughts (Holmes et al. Reference Holmes, O’Connor, Perry, Tracey, Wessely, Arseneault, Ballard, Christensen, Cohen Silver, Everall, Ford, John, Kabir, King, Madan, Michie, Przybylski, Shafran, Sweeney, Worthman, Yardley, Cowan, Cope, Hotopf and Bullmore2020, Luykx et al. Reference Luykx, Vinkers and Tijdink2020, Vindegaard & Benros, Reference Vindegaard and Benros2020). While the medium- to long-term mental health consequences are not yet known, an increase in psychological and psychiatric problems are predicted (Horesh & Brown, Reference Horesh and Brown2020, O’Connor et al. Reference O’Connor, Wrigley, Jennings, Hill and Niazi2020, Türközer & Öngür, Reference Türközer and Öngür2020), with an excess burden on vulnerable groups (Kelly, Reference Kelly2020). The implementation of a range of multidisciplinary strategies across socio-economic and psychological levels may be needed to mitigate the mental health burden of COVID-19.
Accumulating clinical data shows that psilocybin therapy may be an effective therapeutic strategy across a range of disorders, including depression (Carhart-Harris et al. Reference Carhart-Harris, Bolstridge, Rucker, Day, Erritzoe, Kaelen, Bloomfield, Rickard, Forbes, Feilding, Taylor, Pilling, Curran and Nutt2016, Davis et al. Reference Davis, May, Cosimano, Johnson, Barrett and Griffiths2019), obsessive compulsive disorder (Moreno et al. Reference Moreno, Wiegand, Taitano and Delgado2006) and addiction disorders (Garcia-Romeu et al. Reference Garcia-Romeu, Davis, Erowid, Erowid, Griffiths and Johnson2019, Johnson et al. Reference Johnson, Garcia-Romeu and Griffiths2017). In addition, clinical trials are underway to investigate psilocybin therapy in anorexia nervosa (NCT04052568) and there may be a role for psilocybin therapy in the treatment of anxiety disorders (Weston et al. Reference Weston, Gibbs, Bird, Daniel, Jelen, Knight, Goldsmith, Young and Rucker2020).
Recent advances in psychedelic science are gradually unravelling the multimodal mechanisms underlying the therapeutic effect of psilocybin therapy (for example Carhart-Harris & Friston, Reference Carhart-Harris and Friston2019, Lord et al. Reference Lord, Expert, Atasoy, Roseman, Rapuano, Lambiotte, Nutt, Deco, Carhart-Harris, Kringelbach and Cabral2019, Preller et al. Reference Preller, Duerler, Burt, Ji, Adkinson, Stämpfli, Seifritz, Repovš, Krystal, Murray, Anticevic and Vollenweider2020, Varley et al. Reference Varley, Carhart-Harris, Roseman, Menon and Stamatakis2020). Psilocybin reliably alters an individual’s state of consciousness, probably through agonist mechanisms at the 5-HT2A receptor, especially in the deep pyramidal cells in the cortex (Nutt et al. Reference Nutt, Erritzoe and Carhart-Harris2020). The transient, dose-dependent alteration of the complex interconnected neural networks of the brain (Lord et al. Reference Lord, Expert, Atasoy, Roseman, Rapuano, Lambiotte, Nutt, Deco, Carhart-Harris, Kringelbach and Cabral2019, Varley et al. Reference Varley, Carhart-Harris, Roseman, Menon and Stamatakis2020) encompassing the self-reflecting ‘ego’, induced by psilocybin, can lead to profound experiences of connectivity to others and the environment (Erritzoe et al. Reference Erritzoe, Roseman, Nour, MacLean, Kaelen, Nutt and Carhart-Harris2018, Griffiths et al. 2006, Reference Griffiths, Johnson, Carducci, Umbricht, Richards, Richards, Cosimano and Klinedinst2016, Grob et al. Reference Grob, Danforth, Chopra, Hagerty, McKay, Halberstadt and Greer2011, Kettner et al. Reference Kettner, Gandy, Haijen and Carhart-Harris2019, Smigielski et al. Reference Smigielski, Scheidegger, Kometer and Vollenweider2019) and can be harnessed by psilocybin therapy to re-conceptualise restricted and maladaptive habitual patterns of cognition and behaviour....[FullArticle]