Mind and Body

For cancer patients, one popular drug takes away the fear of death

For cancer patients who also have anxiety and depression, psilocybin could offer some solace.

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A cancer diagnosis can be a terrifying thing. Medical bills, loss of loved ones, and the fear of death can overwhelm people with cancer, and may even diminish their chances of survival. But a new therapy tested in people with life-threatening cancer offers potential relief for these crippling anxieties.

The therapy rests on psilocybin — a compound found in psychedelic or "magic" mushrooms — which is taken alongside a course of traditional psychotherapy. The study, which followed people diagnosed with cancer for four and half years, offers compelling evidence that a single dose of psilocybin improves anxiety, depression, and existential dread years after the drug leaves their systems.

“Three out of four of our participants said the therapy was the singular or in the top five most spiritually meaningful experiences of their lives and they continue to remember them,” Stephen Ross, researcher at NYU Langone and senior author on the study, said in a teleconference.

“These experiences rapidly changed their relationship to cancer, changes which this long-term follow-up study suggests endure for years.”

Ross and colleagues published their findings Tuesday in the journal Journal of Psychopharmacology.

"I have a greater appreciation and sense of gratitude for being alive.”

Current approaches to treating cancer-related psychological turmoil tend to fall short. Traditional drug treatments for depression and anxiety work for less than half of people being treated for cancer — in fact, people may as well take a placebo, research suggests. Psilocybin could offer a welcome — and even life-saving — alternative, the researchers say.

Untreated cancer-related anxiety, depression and existential distress are linked with higher suicide rates among people seeking treatment for cancer and decreased survival of cancer, probably related to impaired immune function, Ross explained.

“The implication here is that psilocybin profoundly altered the care of cancer patients, especially those confronting death,” Ross said.

Psychedelic boom

The study builds on research that dates back to the 1970s, when scientists tested the psychological effects of LSD in cancer patients. The results were promising, but research on psychedelics stalled for the next four decades. Now, clinical trials have picked up again.

The new results follow up a 2016 landmark study which illuminates psilocybin’s powerful psychological effects. In both studies, participants include a group of people diagnosed with life-threatening cancer.

In 2016, researchers divided 29 cancer patients into two groups: One group received a single dose of psilocybin (0.3 mg/kg) in a controlled setting and took part in nine psychotherapy sessions with trained clinicians. The control group received a placebo, Niacin (250 mg), which induces a similar flush to a psychedelic experience, along with the same amount of counseling sessions. After seven weeks, the researchers switched the groups’ drug treatments. The placebo group then received a single dose of psilocybin, while the psychedelic group received Niacin.

Psilocybin could offer a welcome alternative treatment to people with cancer who have anxiety over their diagnosis.Diana Sjölund / EyeEm/EyeEm/Getty Images

During the study, the participants filled out questionnaires designed to measure how depressed, anxious, hopeless, or demoralized they felt. They also self-reported their quality of life, spirituality, well-being, and whether they felt existential dread or had a mystical experience during treatment.

Psilocybin produced “immediate, substantial, and sustained improvements” in anxiety and depression in all the participants, the researchers reported.

“One day after getting psilocybin, 80 percent of the participants no longer met criteria for depression related to cancer,” Ross said. These effects were “immediate and clinically meaningful."

A single dose of psilocybin led to decreases in cancer-related demoralization and hopelessness, improved spiritual well-being, and increased quality of life. But this first study only tracked participants’ psyches for six and a half months, so whether psilocybin’s mood benefits persisted beyond the study period was not known. Until now.

The power of a single dose

To test the drug’s long term effects, the research team followed up with 16 of the 29 2016 study participants (nine patients had passed away). Of these, 15 people chose to be involved in the new analysis.

Researchers gave the participants the same mental-health questionnaires from the original study at two time points — 3.2 and 4.5 years after the initial psilocybin doses. The participants also filled out a questionnaire asking open-ended questions about positive changes that they attributed to the psilocybin-assisted therapy experience.

The majority of participants experienced reduced anxiety, depression, hopelessness, demoralization, and death anxiety. At both follow-up check-ins, 60 to 80 percent of participants showed hallmarks of having been successfully treated for depression and anxiety.

That means the original mood-boosting effects of the psilocybin dose appear to have endured nearly five years after the initial therapy. This is the longest study to date analyzing psilocybin’s effects on the mental health of cancer patients, the researchers say.

One participant responded in the questionnaire, “There’s a reckoning, which came with cancer, and this reckoning was enhanced by the psilocybin experience. I have a greater appreciation and sense of gratitude for being alive.”

Another wrote:

“[I] most certainly feel a stronger connection to a higher power due to the psilocybin experience, [as well as] greater openness towards others, more empathy, more interconnected with other people. I believe these changes are directly attributable to the psilocybin experience as well as the integration sessions afterwards.”

Mind shift

Participants overwhelmingly (71 to 100 percent) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives.

According to the study, not a single participant reported lasting negative or adverse effects from their therapy sessions.

The researchers caution that this isn’t evidence that cancer patients struggling with psychological conditions related to their diagnosis should run out and eat magic mushrooms. Psilocybin "should be taken in a controlled and psychologically safe setting, preferably in conjunction with counseling from trained mental health practitioners or facilitators,” Gabrielle Agin-Liebes, lead author of the study and researcher at Palo Alto University, said in a statement.

“The brain appears to be more interconnected when you use psilocybin.”

However the evidence does suggest that, under controlled settings, the therapy could make a profound difference to people's lives.

“My experience during the dosing was profound,” said one participant during a teleconference to discuss the research. “I experienced first grade anxiety and then that turned to great compassion for the suffering on Earth, in all different modalities. Then, that turned into a profound spiritual awareness of how connected we all are. That has lasted and opened me enormously.”

The participant “completely lost” the fear of her cancer returning, even though she had been diagnosed with a particularly rare and aggressive form of non Hodgkin's lymphoma.

The psychedelic therapy isn't necessarily "euphoric," Ross said. Instead, it enables patients to confront their fears, and "pass through them." Overcoming fear can be vital for a population like cancer patients who are grappling with their own mortality, he said.

How does psilocybin affect the brain?

Scientists aren’t sure how psilocybin affects the brain. But evidence suggests that the brain’s communication pathways seem to change when exposed to psychedelics like psilocybin and LSD.

“The brain appears to be more interconnected when you use psilocybin,” Ross said. “Parts of the brain that don't normally speak to each other communicate with each other.”

Some researchers hypothesize that the therapeutic effect might stem from an area of the brain called the “default mode network,” which helps to create a person’s sense of self. The network is typically active when people daydream. When someone has anxiety or depression, this network goes into overdrive, seemingly triggering them to ruminate and worry. Psilocybin may deactivate the network, enabling people to put their problems in perspective.

“The brain is very complex. We don't know how any psychiatric disorders work from a neurobiological perspective. We don't know any of our medications work, and psychedelics fit into that," Ross said.

We’re still years away from psilocybin becoming incorporated as standard treatment for people dealing with cancer-related psychological symptoms, and scientists can’t draw definitive conclusions yet. But if further research confirms the results, the discovery could positively shift the long-term outlooks of people with cancer who are dealing with deadly diagnoses.

The mental turmoil caused by cancer can be as devastating as the physical damage the disease causes. This study suggests psilocybin may be a potentially powerful tool for the almost 40 percent of the global population that will be diagnosed with cancer in their lifetime.

Abstract:
Background: A recently published randomized controlled trial compared single-dose psilocybin with single-dose niacin in conjunction with psycho- therapy in participants with cancer-related psychiatric distress. Results suggested that psilocybin-assisted psychotherapy facilitated improvements in psychiatric and existential distress, quality of life, and spiritual well-being up to seven weeks prior to the crossover. At the 6.5-month follow-up, after the crossover, 60–80% of participants continued to meet criteria for clinically significant antidepressant or anxiolytic responses.
Methods: The present study is a long-term within-subjects follow-up analysis of self-reported symptomatology involving a subset of participants that completed the parent trial. All 16 participants who were still alive were contacted, and 15 participants agreed to participate at an average of 3.2 and 4.5 years following psilocybin administration.
Results: Reductions in anxiety, depression, hopelessness, demoralization, and death anxiety were sustained at the first and second follow-ups. Within-group effect sizes were large. At the second (4.5 year) follow-up approximately 60–80% of participants met criteria for clinically significant antidepressant or anxiolytic responses. Participants overwhelmingly (71–100%) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives.
Conclusion: These findings suggest that psilocybin-assisted psychotherapy holds promise in promoting long-term relief from cancer-related psychiatric distress. Limited conclusions, however, can be drawn regarding the efficacy of this therapy due to the crossover design of the parent study. Nonetheless, the present study adds to the emerging literature base suggesting that psilocybin-facilitated therapy may enhance the psychological, emotional, and spiritual well-being of patients with life-threatening cancer.
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