Psilocybin, a serotonergic psychedelic, produces lasting antidepressant effects, but its mechanism is unclear. Empathy and prosocial behavior may play a key role. This review examines how psilocybin affects empathy and prosocial behavior and proposes that it initiates a positive feedback loop involving these social processes, which could explain its enduring antidepressant benefits.
Intramuscular (IM) ketamine is as effective as intranasal (IN) esketamine for treatment-resistant depression, with comparable safety and a dramatically lower cost. In a retrospective cohort of 179 Veterans, the difference in depression symptom improvement was only 0.04 points on the PHQ-9, well within the non-inferiority margin. PTSD symptom reductions were also similar, and rates of emergency department visits or hospitalizations did not differ significantly. The cost per eight-treatment course was $6069 for IN esketamine versus $647 for IM ketamine, driven primarily by the cost of the nasal spray. These results indicate that IM ketamine could be a high-value alternative that expands access to care.
Mindfulness-based interventions reduce chronic pain, and a secondary analysis of two randomized controlled trials (480 patients on long-term opioid therapy) suggests that nondual awareness—a state of attenuated self-other distinction—partly explains this effect. Participants in an 8-week mindfulness program (MORE) showed significantly lower pain severity and interference than a supportive therapy control group, along with greater increases in nondual awareness. Path analyses indicated that gains in nondual awareness mediated the reductions in pain severity and interference, and nondual awareness was a stronger mediator than the mindfulness facet of nonreactivity. The findings link mindfulness-induced nondual awareness to chronic pain relief, and future work should explore neurobiological mechanisms and other interventions that foster nondual awareness.