Public and clinical interest in psychedelics is growing, with many studies underway for depression, anxiety, PTSD, and substance use disorders. This paper focuses on psilocybin, explaining its mechanism, psychedelic effects, and dosing. It reviews treatment studies, primarily for treatment-resistant depression and cancer-related anxiety, and discusses future directions and potential limitations in studying and regulating psilocybin and other psychedelics.
Three case reports illustrate challenges in treating treatment-resistant depression (TRD). A 73-year-old man with a liver transplant 26 years earlier responded well to 9 bitemporal electroconvulsive therapy (ECT) sessions despite his transplant history. A 28-year-old woman with chronic TRD who had only partial response to antidepressants and maintenance ECT achieved remission after twice-weekly 90-minute heated yoga sessions. A 52-year-old woman with TRD and chronic migraines, already on antidepressants and migraine medication, presented with agitation and paranoia after receiving intranasal ketamine from multiple providers, suggesting misuse; her symptoms resolved without prescribed antipsychotics. ECT remains safe even after organ transplantation, heated yoga shows promise as an adjunctive treatment, and esketamine requires careful monitoring to prevent misuse.