After a long and complicated past, psychedelic testing in the modern clinical setting is firmly back. For three years between 2020-2023, St Vincent’s Hospital Melbourne has run a trial that looked into the results of psilocybin in human participants living with significant illness. Psilocybin is an organically present compound that exists in a few species of mushrooms. The trial paired the use of this substance with psychotherapy for 35 people, finding that the treatment could yield swift and maintained declines in anxiety and depression for those with advanced, life-threatening illnesses, with further benefits named as elevated quality of life and spiritual wellbeing.
Tackling the debilitating
Noted as Australia’s first clinical trial of psychedelic-assisted therapy, doctors Margaret Ross and Justin Dwyer, a psychologist and psychiatrist respectively, worked with participants presenting, “non-malignant, life-threatening conditions such as motor-neurone disease and advanced heart disease, as well as cancer.”
Tackling what humans have been wrestling with since the dawn of time, that is at some point, the certain and steadily approaching reality of death. The trial squarely focused on acknowledging and pivoting towards supporting the oftentimes overwhelming anxiety and depression stemming from facing this reality. Palliative care patients received two treatment sessions spaced a few weeks apart. The first dose being randomized, involved either a closely controlled ingestion of psilocybin, or a placebo, with the second dose being psilocybin for all. Book-ending the application of each dose, participants were led through a structured program of psychotherapy.
Rapid positive results can lead policy
The findings published detail a compelling rapidity of observed results. Patients were assessed to have elevated mood, perception on their situation and surroundings, and wellbeing, as long as six months post treatment.
Dr Ross details that the study provides both clinical importance in the modern medical setting, as well going beyond what is easily articulatable for science, that of positively supporting and meeting the “profound personal relevance for those receiving end of life care.”
She says, “We often see people in palliative care carrying an immense emotional burden: distress, hopelessness, and a deep sense of anticipated loss,” explaining, “in this trial, we saw reductions in depression and anxiety, but also improvements in quality of life, relationships, and a renewed sense of connection to the world. For some, it touched the very core of their fears about death.”
For executive and clinical leadership across aged care providers, the impetus for management excellence across logistical, financial and routine clinical is addressed, sustained and adequately resourced for many. When it comes to the deeper parts of the human condition, it is worthwhile for leadership to be in proximity to the profound situation that all humans face, particularly seniors nearing end of life. To underpin what it is to provide full quality care, is to not only fully comprehend quarterly in-goings and outgoings, latest wound-care and nutritional needs but to hold space for what it is to face the reality of death. In this space leadership may be well positioned to construct care strategies that helpfully encompass and support the complexity and weightiness of approaching death for residents.
Sustained impact
Both doctors highlight the prolonged nature of the trial benefits. Dr Ross states, “At two months, and again at six months, many participants were still reporting the same positive shifts they had felt shortly after treatment, even though most were very unwell.” However she asserts that the treatment cannot be distilled to the ingestion of the drug.
Dr Dwyer supports the comprehensive nature of the treatment, “Psilocybin on its own is not the therapy, it works in combination with psychotherapy.”
He further stresses that the process is far from straightforward and moderate, clinicians and care must take significant care in managing the process, detailing the emotionally challenging nature of many of the sessions.
He says, “It’s not a passive treatment. Patients often confront powerful emotions and memories. The safety, structure, and support of the therapeutic setting are essential to making it beneficial.”
Further research needed
As evidenced by the fitful decades of psychedelic treatment over the last century, the questionable conduct of many early researchers and the potency of the substances involved, significant care and further testing is required in this area of research. Ross and Dwyer dually note that while the results of their study are encouraging, psychedelic-assisted therapy remains in its infancy as a medical treatment.
Ross notes, “for people facing advanced illness with few treatment options for their psychological distress, this approach offers something potentially life-changing” it must still be discerned that, “it’s not suitable for everyone, and we need more research to understand how to deliver it safely and effectively.”
Furthering this research will take the best of the clinical village. Required is the global research community to assist with furthering the collective body of accredited international evidence. Transparently detailing the thoughtful and clinically managed psychedelic-assisted therapy trails may lead to profound ground gained in the complex, weighty and highly deserving area of mental health challenges in palliative care.
