First Randomized Trial of Psilocybin Assisted Therapy for Depression!

In recent years, psychedelics have reemerged as a popular topic in cultural, political, and scientific discourse. From Michael Pollen’s best-selling book How To Change Your Mind to legalizing psilocybin-assisted therapy through Measure 109 in Oregon, people are curious about how and why these substances may be powerful tools in psychological healing. Additional data, especially on common problems like depression, is particularly important as psilocybin therapy starts to become more widely used.  Until now, psilocybin therapy for depression has never been studied in randomized clinical trials. But now, the first data have been published, with excellent results.

In this trial, Alan K. Davis and other investigators at the Center for Psychedelic and Consciousness Research at Johns Hopkins conducted the first randomized, clinical trial exploring psilocybin-assisted therapy for treating Major Depressive Disorder (MDD). Traditional treatment methods typically include psychotherapy or pharmacotherapy, or a combination of the two. Current pharmacotherapies, such as SSRI’s, often have limited efficacy and can result in negative side effects such as suicidal ideation, decrease in sexual drive, and weight gain. Additionally, people must be on antidepressants for several weeks before experiencing any benefit, with many only partially responding. Lastly, many people do not respond to treatment, whether that’s pharmacological or psychological. Clearly more treatments are needed.

The team at Johns Hopkins treated 24 people with depression with two administrations of psilocybin combined with therapeutic support. This intervention produced strong antidepressant effects that persisted for 12 months, with 71% of their participants showing a clinically significant response 4 weeks after treatment. Unlike traditional antidepressants, psilocybin was not associated with serious adverse effects and does not have to be taken daily. The only frequent nonserious adverse effects found by Davis et al. were mild-to-moderate headaches and challenging emotions during the session itself. In sum, while this study is small, it provides excellent data to support the idea that psilocybin-assisted therapy is effective for the treatment of depression, while we await results from larger studies that are ongoing.

Although we have come far in psychological healing, there is still more work to do in order to provide services that are effective and accessible to all who need it. Antidepressants do not work for everyone, making promising treatments like psilocybin-assisted therapy worthy of further exploration. If you would like to learn more about psilocybin-assisted therapy for depression, Portland Psychotherapy is hosting a seminar series, Therapy and Research in Psychedelic Science (TRIPS), that includes a presentation from Alan K. Davis, the lead investigator in this trial. He will be discussing what this therapy looks like from the point of view of the patient along with a description of the therapeutic process involved in preparing for and integrating psilocybin experiences as a part of therapy. Click here to register for this event and check out the other events in our seminar series!

TRIPS Seminar Series

By Sarah Smith

Ketamine May Alleviate Bipolar Depression, Too

Ketamine May Alleviate Bipolar Depression, Too

Some months back, I wrote a blog post about researchers using the ketamine as a fast acting treatment for depression. Recently I was alerted to another study by the same core researchers from the National Institute of Mental Health (NIMH) using ketamine to treatment depression in people with bipolar disorder (Zarate et al., 2012). The study was a replication of a similar study published a few years ago (Diazgranados  et al., 2010).

It’s still just ketamine for depression

In this study, ketamine wasn’t used to treat bipolar disorder as a whole. Rather, ketamine was used to treat depressive symptoms in people with bipolar disorder who were currently depressed. The people in the study were also maintained on mood stabilizers to help manage bipolar mania and hypomania.

Otherwise, the procedure and findings were similar to the other studies. People were randomly assigned to receive two infusions of either ketamine or a placebo (saline). The infusions took about 40 minutes, and the second infusion took place 2 weeks after the first.

Most people who received ketamine (79%) felt less depressed, but no one who received the placebo showed improvements. I should note, though, that it was probably pretty obvious to people who received the placebo that it was not ketamine, as ketamine is a powerful psychoactive with obvious psychological effects. In contrast, saline isn’t likely to cause a detectable physiological response.

The treatment is still very experimental

After my earlier post was published, I received calls from a few people looking for ketamine treatment in Oregon. I’m afraid ketamine is still very much an experimental treatment, and no one, to my knowledge, is using it outside of well-controlled research studies. The only studies I’ve come across were conducted by NIMH researchers in Bethesda, Maryland.

The caveats I discussed in my previous post about the feasibility of ketamine for treating depression remain the same. At this point, we’re still not sure what the long-term effects are of using ketamine for depression. Given that it’s so fast-acting and is already a club drug, there is some potential for abuse and addiction.

Ketamine might be a useful intervention for people who are acutely depressed and acutely suicidal. In this respect, I remain cautiously optimistic, as it could reduce costly inpatient stays.

I’m skeptical, though, that ketamine will prove to be a cure-all wonder drug. For example, a newer study found that people treated with ketamine relapse into depression in an average of 2 weeks (Ibrahim et al., 2012). Although ketamine is safely used as an anesthetic in surgical procedures, we don’t know the impact of frequent doses across an extended period of time.

The newer research I cite in this post doesn’t take any steps towards answering questions about ketamine’s effectiveness beyond a few weeks, but it does suggest that people with bipolar disorder who are in a state of deep depression might find quick, if not enduring, relief from depression.

UPCOMING TRAINING EVENTS

How to be Experiential in Acceptance and Commitment Therapy

Jason Luoma, Ph.D.
April 23, 2021 from 12-1pm

Acceptance and commitment therapy (ACT) is, at its core, an experiential treatment, but is frequently delivered in a non-experiential way. Experiential learning involves going beyond verbal discussion, insight, and explanations of experience. But how do we do this in ACT and how do we know when we are spending too much time engaged in non-experiential modes of learning? This workshop will outline a simple model you can use to identify when you are in less or more experiential modes during therapy and easy methods to switch to more experiential modes. You will then have a chance to practice it in breakout groups and get feedback. Read More.


Ethical & Legal Considerations in Psychedelic Integration Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 7, 2021 from 12-2pm

This workshop is based on extensive research and writing we have conducted into the legal and ethical issues of working with psychedelics in the current regulatory climate, as well as clinical practice doing harm reduction and integration therapy with psychedelics. It is informed by consultation with multiple experts on harm reduction, as well as attorneys knowledgeable about criminal and civil matters relating to drug use and professional practice. We will share with you all we know so that you can be more informed in the decisions you are making in your practice and be better able to decide whether to jump into this kind of work if you are considering it. Read More.


Case Conceptualization in Acceptance and Commitment Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 21, 2021 from 12-2pm

This workshop provides a chance to learn concrete methods for conceptualizing cases from the perspective of Acceptance and Commitment Therapy. Formulating a useful case conceptualization is a foundational clinical skill that is essential in delivering effective treatment, and one that can be often overlooked in the process of working with clients. Participants will learn several formats for doing formal case conceptualization outside of session as a means to further develop knowledge and skill with ACT theory, as well as to learn a means to enhance treatment planning. The importance of ongoing case conceptualization throughout a course of treatment will be emphasized, as well as common pitfalls in conceptualizing client problems. Participants will also have a chance to practice newly learned skills with a case in breakout groups. Read More.


ACT Precision Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Help You be Focused and Strategic in Your Interventions

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
June 18, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop focuses on helping you use ACT theory & in-session clinical markers to make more precise and strategic interventions. The main goal of this workshop is to help you become more adept at identifying in-session client behaviors that are indicators for particular ACT processes that are likely to be most relevant. The workshop uses a process we call ACT Circuit Training, which involves intensive analysis of a video of an ACT session and intentional practice in conceptualizing client behavior and generating possible ACT responses, followed by discussion and feedback. Read More.


ACT Agility Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Increase Flexible Responding

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
July 16, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop is intended to help therapists be more flexible and nimble in their use of ACT processes, strengthening their ability to fluidly shift as needed between processes within sessions. Therapist learning ACT often develop tunnel vision, focusing too much on particular processes or responding rigidly when more flexibility is needed. Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

April 9th, 2021 – Ketamine 101: An Introduction to Ketamine-Assisted Psychotherapy with Gregory Wells, Ph.D.
May 14th, 2021  Research on MDMA and Psychedelic-Assisted Therapy: An Overview of the Evidence for Clinicians with Jason Luoma, Ph.D.
June 11th, 2021 Becoming a Psychedelic-Informed Therapist: Toward Developing Your Own Practice with Nathan Gates, M.A., LCPC