Esketamine and Psilocybin—The Comparison of Two Mind-Altering Agents in Depression Treatment: Systematic Review
Dominika Psiuk, Emilia Magdalena Nowak, Natalia Dycha, Urszula Łopuszańska, Jacek Kurzepa, Marzena Samardakiewicz
International Journal of Molecular Sciences September 28, 2022 DOI: 10.3390/ijms231911450
Summary
Remarkably, psilocybin, a naturally occurring hallucinogen and alkaloid, offers antidepressant effects lasting up to eight months. A review of 12 key articles, from 617 initial drug studies, highlights its potential in modern psychiatry. Its impact on depression symptoms can rival or surpass conventional medicine like Escitalopram. Chemically synthesized Ketamine also rapidly reduces depressive symptoms and suicidal ideation, maintained for a month. This pharmacology, explored in the context of psychological treatment, suggests powerful new avenues for medicine, potentially influencing neurotransmitter receptor behavior and offering hope for treatment-resistant depression.
Abstract
This publication discusses two compounds belonging to the psychoactive substances group which are studied in the context of depression treatment—psilocybin and esketamine. The former is a naturally occurring psychedelic. The latter was invented in the laboratory exactly 60 years ago. Although the substances were controversial in the past, recent studies indicate the potential of those substances as novel antidepressant agents. The PubMed/MEDLINE database was used to identify articles for systematic review, using the following search terms: (depression) AND (psilocybin) OR (ketamine). From 617 items, only 12 articles were obtained in the final analyses. Three articles were devoted to psilocybin in depression treatment and nine to esketamine. In most studies, esketamine showed a significant reduction in both depressive symptoms and suicidal ideation shortly after intake and after a month of treatment compared to baseline and to standard-of-care antidepressant agents. Psilocybin’s antidepressive effects occurred one day after intake and after 6–7 weeks of treatment and were maintained for up to 6 or 8 months of follow-up. One study indicated that psilocybin’s effects are comparable with and may be superior to escitalopram treatment. Both esketamine and psilocybin demonstrated rapid and long-term effects in reducing depression symptoms and, after overcoming some limitations, may be considered as novel antidepressant agents in future.