Most cancer patients and their families will tell you: Undergoing surgery, chemotherapy, radiation, pain management, and physical lifestyle adjustments constitute just half the battle when it comes to having cancer. Living with a life-threatening disease—and trying to make peace with the notion of possibly dying from it—can take a significant mental toll. Anxiety, depression, fear, and a sense that life is meaningless are far too prevalent among people with cancer to simply be dismissed as unavoidable side effects. And yet quality-of-life considerations for cancer patients have historically taken a backseat to medical investigations aiming to eradicate disease.
There's news out today that serves as an important step in the process of changing this reality. Two clinical trials exploring the therapeutic potential of psilocybin—synthetic equivalents of the active alkaloid in magic mushrooms—found that just one moderate-to-high dose of the storied psychedelic in a clinical setting, combined with psychotherapy, can diminish depression and anxiety for cancer patients in a profound, life-enhancing way. (A disclosure: The NYU trial is a Phase II study that replicates a Phase I study led by my dad, Charles Grob, published in 2011.) The studies, one of which was done at NYU and the other of which was at Johns Hopkins, were published in The Journal of Psychopharmacology.
"The finding that a single administration of a relatively short-acting drug has rapid, substantial, and enduring antidepressant and anti-anxiety effects is really unprecedented in psychiatry and psycho-oncology," says Roland Griffiths, the neuroscientist who led the 51-person Johns Hopkins trial. "It may represent a potential paradigm shift for treating patients suffering with cancer-related psychological distress."
To his point, an active session with psilocybin lasts just five hours. Psilocybin is not only a controlled substance and psychedelic with a complicated social history, but it's also a potential one-stop-shop—at least in terms of administered medication—for producing lasting change foreign to standard psychiatric and mental health treatment. (It's also shown early success in treating alcoholism.) Adds Griffiths, "I don't think we have any models in psychiatry that look like that. [Psilocybin's effect] looks more, actually, like a surgical intervention. You go in, something occurs, it's repaired and it's better going forward."
"Mystical experience" is a catchall phrase used to describe what many of the study subjects feel: interconnectedness, oneness, or, as NYU study participant and self-described atheist Dinah Bazer, who was diagnosed with ovarian cancer in 2010, puts it: "bathed in God's love."
What exactly occurs in the brain on psilocybin, though, still remains to be seen. "There's this correlation between decreased depression and anxiety," explains Griffiths. "So what does that mean? Of course we don't know. The mystical experience has to be a marker for something going on in the brain, and that's the excitement about the science that can unfold from this."
This is a patient population prime for a radical reimagining of mental health care. "There are about 1.6 million new [cancer] diagnoses per year," says psychiatrist Stephen Ross, who led the 29-subject study at NYU Langone Medical Center. "There are approximately 600,000 cancer-related deaths per year, there are about 11 million people in the US that have a current or past diagnosis of cancer, and approximately 40 percent [of the US population] will develop cancer in their lifetimes." He adds that around 40 to 50 percent of cancer patients suffer from diagnosable anxiety or depressive disorders; a third of cancer patients report symptoms of existential distress.
Plus, this is a patient population that doesn't statistically respond well to traditional antidepressant medications. Ross cites meta-analyses conducted with drugs like Prozac that show no better effect for cancer patients than placebo, with a slow response time to boot. By comparison, Ross adds, "We had an antidepressant response and remission rate immediately at 80 percent, which endured at 7 weeks and at 6.5 months. If you were to compare, if our treatment holds up, [that's] roughly twice as good as standard treatment, and works rapidly in a way that standard treatment does not."
Anxiety and depression can affect not just those diagnosed with metastatic or end-stage cancer, but those in remission, too. Considering that many people live with cancer or in the shadow of cancer for years on end, this could be the segment of the cancer patient population that might one day benefit from psilocybin-assisted therapy's effects over the most prolonged period of time.
"I described myself as doomed," says Johns Hopkins study participant Sherry Marcy, who underwent treatment for endometrial cancer in 2010, of her first meeting with the psilocybin cancer study team several years ago. But during her dosing session, "the cloud of doom seemed to lift. I reconnected with family and kids, and [with] my wonder at life. […] Before I was sitting alone at home, and I couldn't move. Psilocybin and this study made a huge difference, and it's persisted."