🍄🚨🍄🚨 Another day, another cool preprint from our group:
An open-label, dose-escalation trial of psilocybin-assisted therapy for bipolar 2 depression
We enrolled individuals with
#bipolar 2 (BD-II) currently experiencing a major
#depressive episode. Participants must have had at least one unsuccessful medication trial of >6 weeks duration for BD-II over their lifetime. Four participants were on medications with potential
#psilocybin interactions, which were tapered under psychiatric supervision to ensure clearance (≥5 half lives) before each administration. Psychiatric exclusions included current hypomania, history of psychotic disorder, moderate substance use disorder in the past 12 months, psychedelic use in the past six months and imminent risk of suicide.
In this open-label, single-arm dose-escalation pilot trial, 14 participants received 10 mg of psilocybin, followed by 25 mg if depressive symptoms persisted. As usual participants underwent psychotherapy before, during, and after psilocybin administration sessions and were proactively monitored for adverse events. Depression and quality of life were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and Quality of Life in Bipolar Disorder Questionnaire (QoL-BD), along with exploratory measures.
Following the 10 mg session, MADRS scores significantly improved at all timepoints (A21: -12.7 [2.7], n=14, p<0.001) with 4 participants (28.5%) meeting remission criteria (MADRS ≤ 6) at 21 days after the 10mg dose. Non-remitting patients were given the 25 mg dose per protocol. After the 25 mg session, MADRS scores improved from baseline (B21: -18.6 [3.1], n=9, p<0.001). Sustained improvements in MADRS scores were observed at the 90-day assessment compared to baseline (AB90: -14.3 [2.8], n=12, p<0.001); Hedges’ g=1.9. QoL-BD scores improved 21 days following both the 10 and 25 mg administration sessions (A21: 35.5 [9.4], p<.001; B21: 55.9 [10.9], p<.001) and at the 90-day assessment (AB90: 31.2 [10.2], p=0.004); Hedges’ g=1.6.
As expected, common adverse events included mild-to-moderate anxiety, nausea, and headache on dosing day. There were three notable adverse events: active suicidal ideation 37 days after an administration session, passive suicidal ideation 11 days after an administration session, and a hypomanic episode two weeks after an administration session.
The small sample size and open-label design warrant cautious interpretation. The placebo response likely explains some of the observed benefits. However, in line with previous findings, baseline expectancy was not associated with clinical outcomes - to the best of my knowledge no psychedelic trial has provided empirical evidence for a positive expectancy bias at this point.
Our results offer initial evidence that psilocybin therapy may be clinically beneficial in BD-II when administered under controlled conditions with a safety profile similar to studies in other patient populations.
Full preprint:
tinyurl.com/52n6uv4t
🙏+♥️to all coauthors:
@drdowneydoes @thebandlab @ellenbradshaw and many others from the
@UCSFPsychiatry 's
@TrPR_Program!
#psychedelic #trial #MentalHealthMonday #medicalinnovation