Trial of Psilocybin Versus Escitalopram For Depression

Information

• Researcher Name: Robin Carhart-Harris Ph.D. et al.
• Publication Name: The New England Journal of Medicine
• Year: 2021
• Source: Trial of Psilocybin versus Escitalopram for Depression

Explanation of Terms and Acronyms

• Psilocybin: A psychedelic compound found in certain mushrooms.
• Escitalopram: A selective serotonin reuptake inhibitor (SSRI) commonly used as an antidepressant.
• Major Depressive Disorder (MDD): A mental disorder characterized by persistent feelings of sadness and loss of interest.
• QIDS-SR-16: A self-report scale for depression severity.
• Randomized Controlled Trial (RCT): A study design that randomly assigns participants to an experimental group or a control group.

Why Did They Do It?

Carhart-Harris and colleagues aimed to compare the antidepressant effects of psilocybin, a psychedelic compound, with escitalopram, a widely used SSRI. This research is significant given the growing interest in psychedelic therapy for mental health disorders and the need for effective depression treatments.

What Did They Do?

The study was a phase 2 double-blind RCT. Participants with moderate-to-severe MDD were randomly assigned to receive either psilocybin or escitalopram over six weeks. Both groups received psychological support, but the psilocybin group received two 25 mg doses of psilocybin, and the escitalopram group received two 1 mg doses (assumed to have negligible activity) along with daily oral escitalopram.

How Did They Do It?

The primary measure was the change from baseline in the QIDS-SR-16 score at week 6. Secondary outcomes included response and remission rates on the QIDS-SR-16 and other depression-related scales. The trial also monitored adverse events.

What Did They Find?

The study found no significant difference in the primary outcome between psilocybin and escitalopram groups. However, secondary outcomes generally favored psilocybin. Both treatments reduced depression scores, but the results must be interpreted cautiously due to the absence of a placebo control and the lack of correction for multiple comparisons in secondary outcomes. Adverse event rates were similar in both groups.

Impact on Their Field

This trial contributes to the understanding of psilocybin's potential as an antidepressant. While it did not show a significant difference from escitalopram in the primary outcome, several secondary outcomes favored psilocybin. These findings suggest that further research, particularly larger and longer trials, is necessary to fully assess psilocybin's efficacy compared to established antidepressants. The study also highlights the importance of psychological support in psychedelic-assisted therapy.