MOST of us are well aware that depression is an all-too-common problem in our society.
While rates spiked during Covid lockdowns, the truth is that depression has been highly prevalent for a long time.
The Central Statistics Office (CSO), for example, reported that 14% of Irish people had depression when screened in 2019.
Fortunately, there are several therapies which are of proven value - psychotherapies such as cognitive behavioural therapy for example, and antidepressant medications such as escitalopram. These are extremely valuable weapons in combatting the awful burden of depression.
What is perhaps less well known is that a substantial proportion of people have the misfortune of not responding to these treatments. Rates of response to the most deployed treatments (the so-called frontline) are highest at 36.8%, following which the rate of response drops for the fall-back second, third and fourth lines.
If someone does not improve on receipt of two courses of treatment, they are considered to have treatment-resistant depression - and it is estimated that 100 million people globally belong to this group. This is not a small or rare problem.
Thus, recent news that there had been promising results in relation to a hallucinogenic substance called psilocybin - found in magic mushrooms - caused quite a stir (if not a stir fry).
But, as with all such research, the devil is in the detail and it’s important to know what the research actually says. It’s not at all as simple as “magic mushrooms cure depression”, and the paper by Professor Guy Goodwin and his colleagues provides great detail.
First the positives - and there are certainly positives. The research compared the impact of 25mg of a synthetic version of psilocybin to 10mg and 1mg doses.
Just a single dose was administered to everyone, all of whom had treatment-resistant major depression.
The results showed that the highest dose group did better than the lowest dose group at three weeks after administration.
Furthermore, the response rate for the 25mg group at three weeks, though not as high as for frontline drugs, seems higher than that reported from many second line drugs.
This is really promising, and important.
But there are also caveats, which are perhaps not so obvious from much of the coverage.
1. The effect had ceased to meaningfully exist at 12 weeks.
2. The drug administered was a synthetic version of psilocybin, tested for purity and stability - it was not magic mushrooms.
3. The participants had preparatory meetings with a psychotherapist prior to being given the drug, had a therapist at hand while undergoing the hallucinogenic experience, and had two further sessions with the psychotherapist in the days after the administration.
This was not an unsupported use of a hallucinogen - help and support was present all along.
4. The administration took place over 6 to 8 hours in hospital settings, with participants listening to calming music and wearing eye shades so as to direct their focus inwards.
This was not done at home or in another uncontrolled environment.
5. The majority of participants experienced headache, nausea, dizziness or fatigue on the day of administration.
Very importantly, a minority reported suicidal thoughts in the days and weeks after administration.
The paper’s authors caution that this must be a real concern.
So what’s the take-home from this study?
This medication has real potential to be an additional weapon in battling treatment-resistant depression.
There was a marked improvement in the 25mg group, and the theory is that the increased brain activity we see when people take psilocybin involves parts of the brain opening new lines of communication with one another - and so opening a window for people to develop new insights into and understandings of their lives and experience.
But this is not a proven medication, and more research is needed. It is not just taking magic mushrooms - it is a synthetic and pure version. Its therapeutic effect did not last beyond three weeks. It is administered under specific conditions, not at home - and with professional support, not alone or with friends. And it carries side effects which must be taken very seriously.
It makes sense to be cautiously optimistic, but it is vital to know what this sort of research does and does not say.
This research team may be on to something really beneficial to a lot of people; but we won’t know for some years, and we mustn’t allow the optimism to overwhelm the caution.