Psilocybin Therapy and Patient Compliance

By Christopher Gunlock

Image released under Creative Commons CC0/Public Domain

               I’m training to be an integrative health coach and one of the biggest obstacles I’ve encountered is motivation. Making lifestyle changes to diet, exercise, environment or any habitual behavior can be extremely difficult, but it is vital to the healing process of chronic illness. However, based on recent research in psychedelic therapy, it may be possible to tap into a rate-limiting mechanism of these lifestyle changes needed to begin interventions.

               Treating chronic physical illness is about caring for the many layers of a person’s health. It spans both physical and mental illnesses like type-2 diabetes and depression [1]. The long list of comorbidities and complications with these epidemics begins to reveal many intermingled layers.

               Internal synergistic effects between the body and the mind can create a downward spiral when uncared for. For example, diabetes and heart disease sufferers are more likely to have depression, but depression contributes to a decline in executive functioning, which is needed to make responsible decisions. For an integrative practitioner or health coach, deciding not to change habits tends to be a significant barrier in improvement. Therefore, a diabetes or heart disease sufferer is not only more likely to get depressed, but also likely to get worse because of it [2], [3].

               Antidepressants are commonly prescribed for such issues, but come with many side effects such as sexual dysfunction, nausea/vomiting, weight changes, and sleep disruption. Antidepressants also present a delayed onset of effectiveness, which, when combined with these negative side-effects, often results in a loss of patient compliance, dose reduction and/or change of prescription. Selective serotonin reuptake-inhibitors remains the primary drug treatment for depression, potentially in the presence of other chronic physical illnesses [4, 5].

However, as one journalist Dr. Hickner suggests,

“…when it comes to patients with chronic diseases, such as diabetes and coronary artery disease, there is scant evidence to support the common belief that screening them for depression and treating them with SSRIs improves patient outcomes” [6].

The alternative he suggests is cognitive-behavioral therapy, which has only shown benefits on par with SSRIs, but I am going to propose a potentially more effective and less costly treatment, psilocybin.

Image released under Creative Commons CC0/Public Domain

               Psilocybin is a member of a group of compounds some refer to as serotonergic hallucinogens (SHs), which are defined as compounds that activate certain serotonin receptors. This effect causes it to act in a similar way to antidepressants, but without addictive qualities or long-term physical side-effects. There’s also the nature of its infrequent administration that differs dramatically from all other antidepressants [7]. Indigenous cultures have been known to regard psilocybin-containing mushrooms and other SHs as sacraments for centuries [8]. In the last decade, small clinical studies show majority groups benefiting from lasting psychological relief, which is impressive compared to conventional treatments and placebo [7, 9, 10, 11].

               The issue of their legality and lack of rigorous testing is a common argument against further research. However, it should be understood they were restricted from medical research because of political bias and unfounded safety concerns. This was due to the counterculture-related drug use in the 1960’s, of which the Nixon-era “War on Drugs” aggressively and hastily curtailed [7].

               Since then, psilocybin and all other SHs have been controlled at the highest level by the whole of the United Nations and abroad. Recently, however, some fortunate scientists have revisited psilocybin in the areas of neuroscience and psychopharmacology.

               Positive effects from early-phase and intermediate-phase clinical trials in the last decade have been shown across multiple research groups. Their focus has been on treatment-resistant anxiety/depression, end-of-life distress, alcohol addiction, tobacco addiction, obsessive compulsive disorder, functional brain-imaging, and hormonal modulation. These were mostly small sample populations and not always placebo-controlled, thus do not provide conclusive evidence for valid treatment on their own, but do demonstrate the ability to cause little to no harm and promote significant benefits in a controlled setting [7, 9, 10, 11].

               Going from here, researchers expect to see long-lasting positive effects with psilocybin sessions and follow-up psychotherapy from a few or even a single administration [11]. While this may be disheartening for those selling monthly prescriptions in the pharmaceutical industry, psilocybin is unprecedented from a medically philanthropic perspective.

References

[1] National Collaborating Centre for Mental Health (Great Britain), Depression in adults with a chronic physical health problem : treatment and management : National clinical practice guideline 91. British Psychological Society and the Royal College of Psychiatrists, 2010.

[2] S. Black, K. Kraemer, A. Shah, G. Simpson, F. Scogin, and A. Smith, “Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation,” Curr. Diab. Rep., vol. 18, no. 11, p. 118, Nov. 2018.

[3] N. Hamieh et al., “Depression, treatable cardiovascular risk factors and incident cardiac events in the Gazel cohort,” Int. J. Cardiol., Oct. 2018.

[4] D. J. David and D. Gourion, “Antidepressant and tolerance: Determinants and management of major side effects.” Encephale., vol. 42, no. 6, pp. 553–561, Dec. 2016.

[5] K. G. Kahl, M. Westhoff-Bleck, and T. H. C. Krüger, “Effects of psychopharmacological treatment with antidepressants on the vascular system,” Vascul. Pharmacol., vol. 96–98, pp. 11–18, Sep. 2017.

[6] J. Hickner, “Skip the antidepressant when the patient has chronic disease?,” J. Fam. Pract., vol. 66, no. 9, p. 538, Sep. 2017.

[7] S. Ross, “Serotonergic Hallucinogens and Emerging Targets for Addiction Pharmacotherapies,” Psychiatr. Clin. North Am., vol. 35, no. 2, pp. 357–374, Jun. 2012.

[8] Schultes RE, Hofmann A. Plants of the gods: their sacred, healing, and hallucinogenic powers.Rochester, VT: Healing Arts Press; 1992.

[9] M. W. Johnson and R. R. Griffiths, “Potential Therapeutic Effects of Psilocybin,” Neurotherapeutics, vol. 14, no. 3, pp. 734–740, Jul. 2017.

[10] R. R. Griffiths et al., “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial,” J. Psychopharmacol., vol. 30, no. 12, pp. 1181–1197, 2016.

[11] R. L. Carhart-Harris and G. M. Goodwin, “The Therapeutic Potential of Psychedelic Drugs: Past, Present, and Future,” Neuropsychopharmacology, vol. 42, no. 11, pp. 2105–2113, Oct. 2017.