Magic Mushrooms May Treat Depression. But Hurdles to Psilocybin Access Abound
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Diamond was tripping on an August morning in Baltimore.
The mom and entrepreneur sat cozily under a weighted blanket at Sheppard Pratt Hospital. Little mushroom people jumped across imaginary flower petals behind her eye mask. A therapist monitored Diamond from close by, ready to serve her food and measure her depression symptoms.
In the weeks leading up to today, clinicians had asked Diamond, "Can you remember a time when you were happy for more than a month?" No, she thought.
Diamond told them she’d been having what psychologists call "passive" suicidal thoughts, like, "If this car ran into me and I died, things would be OK."
Such thoughts weren't new for Diamond; growing up, she had been hospitalized for wanting to kill herself. Over the years, she tried many medications for her depression, including Seroquel, Prozac, Trazodone and Risperidone.
"A lot of ‘dones,’ a lot of ‘ols,’" she said. Some of them helped her sleep, but left her feeling numb. She recalled thinking, "I still feel sad, so what are we doing here, antidepressants?"
Diamond was curious whether a clinically guided mushroom trip would help, and she enrolled in this clinical trial testing the safety and efficacy of psilocybin, the psychoactive ingredient in "magic mushrooms," for her type of bipolar depression. KQED is only using Diamond's first name because she uses psilocybin, which is illegal federally.
Diamond met with a therapist before and after a daylong psilocybin session, as part of the months-long trial. On her "dosing day" she grounded herself with an intention she set with her therapist earlier: self-grace.
While she was hallucinating, Diamond remembers feeling like someone buried her. She felt like she was losing air, light, everything.
"I was panicking," Diamond said. "I was fearful."
But then she remembered that "they tell you to, if anything comes up, just go with it. I settled in and I was like, OK, so this is death."
The "go-with-the-flow" mantra Diamond adopted during the trial has stuck with her to this day.
Like Diamond, about 280 million people worldwide have depression. For some, traditional medications don't work. Researchers are studying whether psilocybin could help, and many of the dozens of trials have had promising results.
Neuroscientist Dennis Parker Kelley helps run psilocybin trials at UCSF, and thinks the drug has incredible potential.
"More potential than we have really seen with any other pharmacological treatments in the past several decades," Kelley said.
It's so promising that psilocybin treatment could get Food and Drug Administration approval for stubborn forms of depression within the year. Meanwhile, San Francisco state Sen. Scott Wiener's bill decriminalizing drugs like these is pressing ahead in the state Legislature.
But it could be tricky for clinicians to move psilocybin into mainstream treatment.
First, psychedelic-assisted therapy can be prohibitively expensive.
"People who don't have health insurance, this could prevent them from being able to meaningfully experience these therapies" Kelley said.
Psilocybin sessions typically last six to eight hours and are accompanied by a handful of therapy meetings before and after. Many people might not have time for these treatments. Plus, most studies require participants to wean off their current antidepressants before trying the treatment. This might not be necessary for all medications, and researchers like Kelley are trying to understand whether some drugs may be safe to mix with psilocybin.
All told, "I don't think people will be able to go home with psilocybin from their doctor anytime soon," Kelley said.
Indigenous groups in Mexico were using psilocybin long before these trials, and advocates have raised concerns about appropriation with the mushrooms. Critics have also raised concerns about power dynamics in the treatment room with psychedelics like psilocybin, and point to a documented history of sexual violation within psychedelic therapy.
Clinicians discourage people from taking psilocybin without a therapist or trained guide. Diamond heard author Michael Pollan, who has written extensively about psychedelic research, talk about the treatments. She went looking for a trial after learning there was a lack of Black guides and clinical trial participants in psilocybin research.
"We don't see a lot of people who look like us talking about what [psilocybin has] done for us," said Diamond, who is Black.
Before the trial, she tried to control her life by planning every minute of her day. She felt weak if she couldn't accomplish everything.
Now, she gives herself grace if she doesn't complete her to-do lists. Diamond wants to be an advocate for psilocybin, especially for Black people, through her consulting and wellness business.
Research psychologist Philip Corlett of Yale University says psychiatrists are desperate for new treatments, but the psilocybin data isn't as miraculous as it sounds. After all, the trials have been small, and participants could be feeling a placebo effect.
"I think these are extremely promising new treatments. But I think with great hype needs to come great responsibility," Corlett said.
Psilocybin may not help everyone whom antidepressants have failed. Trials generally don't include patients who are actively suicidal or experiencing psychosis, for fear of making it worse. In a large, phase 2 clinical trial for treatment-resistant depression conducted by the company Compass Pathways and published in The New England Journal of Medicine, some participants had worsening suicidal states — marked by suicidal ideation and self-injury — after taking psilocybin.
The American Psychiatric Association states that there is not enough evidence to support the use of psychedelics outside of clinical trials.
Clinical psychologist Rosalind Watts was a lead for such trials at Imperial College London. After guiding patients through psilocybin treatment for years, she thinks of the drug as a catalyst for healing. But, she said, the treatment needs a "therapeutic container," such as integration therapy or an Indigenous ceremony, to be effective.
"If it was just the drug, every time somebody went to Burning Man, they’d have their depression fixed. And that doesn't happen," Watts said.
People need community care to move through sometimes harrowing drug experiences, she said.
"My real feeling is that psilocybin is calling us to change our models of care," Watts said. "Because if we fit it into the existing profit-making, private health care models of clinics, it's going to be really, really ineffective."
For Diamond, psilocybin was effective. After the trial, she woke up one morning, energized. She knocked out her to-do list, worked out and left early to pick up her daughter from school. Music drifted through her car speakers as she sat in the sunny school parking lot, waiting for the "school's out" announcement.
"I thought to myself for the first time in forever that it would really suck to die today," Diamond recalled, tearing up. "And that was so profound because I had never felt that way in my whole entire life."