Clinical trials of classical psychedelics like psilocybin for mental health conditions face unique challenges that may persist if these treatments enter clinical practice. Four categories of challenges with trial participants are identified: treatment nonresponse, expectancy effects and functional unblinding, post-session psychological difficulties, and contagion effects. Management strategies for study teams to mitigate these risks are described. The National Network of Depression Centers and similar organizations can guide best practices to responsibly advance this promising field.
Psilocybin, a hallucinogen that models acute psychosis, alters brain connectivity in ways similar to psychotic disorders. In a double-blind placebo-controlled trial with 20 healthy subjects, standard coherence analysis showed decreased connectivity in theta, alpha, and beta bands, especially in frontotemporal and frontoparietal regions and between frontal hemispheres. Higher frequencies showed less significant changes, often in the opposite direction. Lagged coherence analysis revealed increased connectivity in high gamma (50-100 Hz) but no changes in lower frequencies. These preliminary findings suggest psilocybin induces brain connectivity changes characteristic of psychosis, supporting its use as a model for studying psychotic symptoms.