Psilocybin-assisted Therapy in Serious Illness and End of Life

There has been a resurgence of interest in the use of psilocybin, the active psychedelic compound found in several species of “magic mushrooms”, due to accumulating data supporting its use in many conditions including depression, anxiety, substance use disorders, and PTSD.  It has particularly robust data for use in people with advanced and terminal illness.

What is psilocybin?

Psilocybin is the active ingredient in several species of “magic mushrooms” including Psilocybe cubensis (the only legal species in Colorado where is it is grown by licensed cultivators and tested for dose strength). It is a prodrug that is converted to the active compound, psilocin, in the gut and liver.

How does psilocybin work?

Psilocybin is a 5HT-2A receptor agonist, active in many parts of the brain, increasing connectivity between many brain regions. 

This activity is thought to increase neuroplasticity for a few weeks after administration, decreasing the activity of our “default mode network” (the typical cognitive, emotional and behavioral responses we have developed over the years) allowing people to truly “change their minds” and create new patterns of thought, emotions, and physical responses.  

During psilocybin journeys, people experience a wide range of effects including hallucinations, loss of sense to time, space, and even self.  Some of the effects can be disturbing or distressing, others can be expansive and joyful.  People frequently report mystical experiences including increased sense of connection to others, to nature, to the universe and/or to a higher power.  

In people facing the end of their lives, this often presents as losing the fear of dying along with an increased sense of acceptance and peace.

In order to be most effective, psilocybin should be given within a framework of safety which includes adequate screening and preparation for dosing and, most importantly, with facilitated integration to help “cement” new changes in place over time.

What is the evidence of benefit?

Psilocybin has been shown to be particularly helpful in reducing depression and anxiety in those with advanced or terminal illness.  Studies in advanced cancer have shown that >80% of participants show a significant reduction in depression and anxiety after a single high-dose psilocybin session (up to 50% have complete resolution with another 20-30% showing a 50% reduction in these symptoms which is remarkable when compared to other anti-depressant medications and treatments).  Other beneficial effects include decreased sense of demoralization and spiritual distress as well as an increased sense of connection to others.  Effects of this treatment persist for at least 6 months after a single high dose in most people.   

While the largest studies have been done in people living with cancer, psilocybin is being studied in other life-limiting conditions and preliminary and anecdotal data report decreased nociceptive and neuropathic pain as well as physical improvement in people with neurodegenerative diseases such as Parkinson disease or history of stroke.

Caveats include that these studies were conducted in mostly highly-educated white people, many of whom had previous experience with psychedelics at some point in their past.

Is psilocybin safe?

Overall, the current evidence that we have shows that psilocybin is safe for many people and the risk of adverse events when administered in a safe setting by a trained professional.

Psilocybin is not right for everyone.  It is not appropriate for people with conditions such as schizophrenia or bipolar disease, uncontrolled high blood pressure, or severe heart disease.  Certain medications are not safe with psilocybin, especially lithium and MAOI’s.  SSRI’s can blunt the effects (which can be overcome with higher dose) and anti-dopaminergic agents can blunt or block the effects in some (so must be tapered or held).

There are some risks.  The most common side effects are headache, nausea and transient increases in blood pressure.  Anxiety is common as well during treatment, though for many this is an important part of the healing that occurs with psilocybin. 

How can someone get psilocybin treatment?

The state of Colorado has a regulatory framework to ensure that the medication is safe and can be dosed correctly, that people are screened for safety and contraindications and that facilitators have completed the right training to hold a safe space (often called “set and setting”) for someone using psilocybin.

More questions?

You can reach me at 720-323-4572 or arobinson@goldenhourhealingpllc.com.