Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression
File(s)
Published version
Author(s)
Roseman, L
Nutt, DJ
Carhart-Harris, RL
Type
Journal Article
Abstract
Introduction: It is a basic principle of the ‘psychedelic’ treatment model that the quality of the acute experience mediates
long-term improvements in mental health. In the present paper we sought to test this using data from a clinical trial assessing
psilocybin for treatment-resistant depression (TRD). In line with previous reports, we hypothesized that the occurrence and
magnitude of Oceanic Boundlessness (OBN) (sharing features with mystical-type experience) and Dread of Ego Dissolution (DED)
(similar to anxiety) would predict long-term positive outcomes, whereas sensory perceptual effects would not.
Material and Methods: Twenty patients with treatment resistant depression underwent treatment with psilocybin (two separate
sessions: 10mg and 25mg psilocybin). The Altered States of Consciousness (ASC) questionnaire was used to assess the quality of
experiences in the 25mg psilocybin session. From the ASC, the dimensions OBN and DED were used to measure the mystical-type
and challenging experiences, respectively. The Self-Reported Quick Inventory of Depressive Symptoms (QIDS-SR) at 5 weeks served
as the endpoint clinical outcome measure, as in later time points some of the subjects had gone on to receive new treatments,
thus confounding inferences. In a repeated measure ANOVA, Time was the within-subject factor (independent variable), with
QIDS-SR as the within-subject dependent variable in baseline, 1-day, 1-week, 5-weeks. OBN and DED were independent variables.
OBN-by-time and DED-by-time interactions were the primary outcomes of interest.
Results: For the interaction of OBN and DED with Time (QIDS-SR as dependent variable), the main effect and the effects at each time
point compared to baseline were all significant (p = 0.002 and p = 0.003, respectively, for main effects), confirming our main
hypothesis. Furthermore, Pearson’s correlation of OBN with QIDS-SR (5 weeks) was specific compared to perceptual dimensions of
the ASC (p < 0.05).
Discussion: This report further bolsters the view that the quality of the acute psychedelic experience is a key mediator of
long-term changes in mental health. More specifically, future therapeutic work with psychedelics may consider investigating ways
which enhance mystical-type experience and reduce anxiety, given the growing evidence that this serves the efficacy of the
treatment model.
long-term improvements in mental health. In the present paper we sought to test this using data from a clinical trial assessing
psilocybin for treatment-resistant depression (TRD). In line with previous reports, we hypothesized that the occurrence and
magnitude of Oceanic Boundlessness (OBN) (sharing features with mystical-type experience) and Dread of Ego Dissolution (DED)
(similar to anxiety) would predict long-term positive outcomes, whereas sensory perceptual effects would not.
Material and Methods: Twenty patients with treatment resistant depression underwent treatment with psilocybin (two separate
sessions: 10mg and 25mg psilocybin). The Altered States of Consciousness (ASC) questionnaire was used to assess the quality of
experiences in the 25mg psilocybin session. From the ASC, the dimensions OBN and DED were used to measure the mystical-type
and challenging experiences, respectively. The Self-Reported Quick Inventory of Depressive Symptoms (QIDS-SR) at 5 weeks served
as the endpoint clinical outcome measure, as in later time points some of the subjects had gone on to receive new treatments,
thus confounding inferences. In a repeated measure ANOVA, Time was the within-subject factor (independent variable), with
QIDS-SR as the within-subject dependent variable in baseline, 1-day, 1-week, 5-weeks. OBN and DED were independent variables.
OBN-by-time and DED-by-time interactions were the primary outcomes of interest.
Results: For the interaction of OBN and DED with Time (QIDS-SR as dependent variable), the main effect and the effects at each time
point compared to baseline were all significant (p = 0.002 and p = 0.003, respectively, for main effects), confirming our main
hypothesis. Furthermore, Pearson’s correlation of OBN with QIDS-SR (5 weeks) was specific compared to perceptual dimensions of
the ASC (p < 0.05).
Discussion: This report further bolsters the view that the quality of the acute psychedelic experience is a key mediator of
long-term changes in mental health. More specifically, future therapeutic work with psychedelics may consider investigating ways
which enhance mystical-type experience and reduce anxiety, given the growing evidence that this serves the efficacy of the
treatment model.
Date Issued
2018-01-17
Date Acceptance
2017-12-20
Citation
Frontiers in Pharmacology, 2018, 8
ISSN
1663-9812
Publisher
Frontiers Media
Journal / Book Title
Frontiers in Pharmacology
Volume
8
Copyright Statement
© 2018 Roseman, Nutt and Carhart-Harris. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
License URL
Subjects
1115 Pharmacology And Pharmaceutical Sciences
Publication Status
Published
Article Number
974