Evidence still ‘mixed’ for drug’s use for mental illness
Years after Australia approved the use of psychedelics including psilocybin, and decades after a British aristocrat urged scientific analysis, Europe is close to opening the way for treatments.
Before her death this year, a British aristocrat once known unkindly as the “crackpot countess” suggested science was about to answer a question she had spent her career asking: can psychedelic drugs, and magic mushrooms in particular, prove an effective treatment for long-term depression?
The only way to win credibility for the benefits of psilocybin, the hallucinogenic compound found in magic mushrooms, was to use “science as a tool to prove what one was saying was true, not part of a kind of druggie fantasy”, said Amanda Feilding, who died in May, aged 88. Today, it seems as though science is finally about to come good.
A growing number of countries are approving its medicinal use, including New Zealand, which on Wednesday allowed a single expert to begin to prescribe the drug. David Seymour, the deputy prime minister, said: “Psilocybin remains an unapproved medicine, but a highly experienced psychiatrist has been granted authority to prescribe it to patients with treatment-resistant depression.”
“This is huge for people with depression who’ve tried everything else and are still suffering,” he added. “If a doctor believes psilocybin can help, they should have the tools to try.”
While New Zealand has only just caught up with Australia, which legalised the treatment two years ago, the evidence of its effectiveness is mixed. Clinicians in Australia have suggested that some patients improve, some do not and up to one-in-five experience a “bad trip”.
Europe, meanwhile, has been lagging. For two decades Jana Bednarova tried the “talking cure” and antidepressants, but remained lost in depression and anxiety. Then, four years ago, she was in Amsterdam contemplating ending her life when she decided to try magic mushrooms.
“It gave me a few hours of calm and clarity,” the 49-year-old said, smiling broadly at a lakeside cafe in the Czech capital, Prague. “It gave me hope. Maybe I didn’t have to die.”
For people like Bednarova, the Czechs could be on the brink of a breakthrough. Twelve years after the country legalised cannabis for medical purposes, it is on the verge of becoming the first in Europe to do the same for psilocybin, after the lower house of its parliament approved a proposed bill to allow the drug’s use in clinical settings.
Legal problems relating to its recreational use have slowed research across the globe, in particular in Europe. But with increasing numbers of patients and shortages of antidepressant drugs, the Czechs are pushing ahead.
Advocates say that in the long term psilocybin would reduce the burden on health services and lower the cost of treating depression during what has been described as Britain’s “mental health epidemic”.
A study published in The Lancet Psychiatry journal in 2016 found that 67 per cent of participants with clinical depression were in remission within a week of taking psilocybin and 42 per cent were still free of depression three months later.
Imperial College London researchers have found it is as effective as the conventional antidepressants that cost the NHS pounds 55 million a year, while also boosting participants’ wellbeing and sex drive.
This evidence prompted David Nutt, a former UK government “drugs tsar” and neuropsychopharmacologist at Imperial, to say in 2022 that psilocybin could be a “real alternative” in the treatment of depression.
A new treatment option is urgently needed. One in six people in England take antidepressants and the number of adults seeking treatment for depression has been rising steadily over the past decade.
National Health Service data showed 8.7 million people were on antidepressants last year, up from 6.8 million in 2016. About one in three people diagnosed with depression experience “treatment-resistant depression”, which does not respond to drugs or therapy. It is this cohort of patients – about three million people – who experts believe could benefit most from psilocybin.
The Czech Republic’s legislation will regulate the drug in a similar way to medicinal cannabis, with a limited number of doctors able to prescribe it. During trials patients will be housed in specialised environments and receive extensive psychotherapy. Doctors admit this makes the treatment program expensive, but many insist the results are worth it.
Jana Pazderova, who recently began psilocybin therapy, said its effect had been transformative. “It transported me somewhere outside, to a mountain viewpoint,” she said. “I started crying because I realised how beautiful the world is.”
The therapy has also been tested on people with the neurodegenerative disorder Parkinson’s disease. Trials in the United States have reported that psilocybin in a controlled setting improved a patient’s mood, cognition and motor function for months. No serious side-effects were recorded and a larger trial, involving 100 more patients, has been given approval.
In his introduction to the Czech bill, Marek Benda, an MP from the ruling centre-right Civic Democratic Party (ODS) who proposed the legislation, noted that drugs such as cocaine and opium were already routinely used by doctors. Adding psilocybin to the list appears to carry little political risk, it seems.
A recent survey suggested 68 per cent of Czechs would support its use in medical treatment. The bill is now due to head to the Senate, the upper house, which is expected to give it the nod. A signature from President Pavel would be the final step.
Dr Pavel Mohr, a professor at the Czech National Institute of Mental Health, agreed that psilocybin had promise but said it needed to be combined with psychotherapy and significant work by the patient.
A lot of regulation was also required for the drug to be managed safely, he added. “We must clarify who can prescribe this treatment, under what conditions, and for whom,” Mohr said. “You can’t just start giving psychedelic drugs to anyone.”
Professor James Rucker, who leads the psychoactive trials group at King’s College London, also cautioned against seeing psychedelic treatments, which have “potentially powerful side-effects” as a panacea.
“What New Zealand have done is loosened the leash very slightly, and that is probably quite a sensible move,” he said. “There are lots of reasons to believe psilocybin may have a powerful antidepressant effect, but it is not so easy to demonstrate this in controlled clinical trials because participants know whether they get the drug because of the effects.”
Evidence collected “in different ways, in different places, over an extended period of time” was the only way to appropriately test the drug, Rucker said.
But for the millions across Europe resistant to conventional treatment, the Czech legislation “represents hope”, according to Bednarova. “Depression is a dark cloud, a heavy weight on your chest. But now I have peace inside for the first time in so long.”
The Times
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