A meta-analysis of five clinical trials found that psilocybin is superior to placebo for reducing end-of-life anxiety symptoms. Psilocybin reduced state anxiety at 1 day and 2 weeks after treatment, and trait anxiety at 1 day, 2 weeks, and 6 months after treatment. Psilocybin caused a temporary increase in systolic and diastolic blood pressure compared with placebo. There were no significant differences between psilocybin and placebo in rates of stopping treatment, serious adverse events, or heart rate. The authors conclude that psilocybin-assisted therapy can improve end-of-life anxiety without serious side effects, but note the small sample sizes and high heterogeneity in long-term outcomes.
A 62-year-old man with treatment-resistant bipolar II depression and hypertension showed improvement after adding esketamine nasal spray (ESK-NS) in October 2022, nearly remitting during the maintenance phase. However, depression recurred when ESK-NS frequency was reduced to once every 2 months, suggesting dosing frequency should be adjusted cautiously. Common side effects included dissociation, dizziness, and transient hypertension. Nifedipine was given when systolic blood pressure exceeded 160 mm Hg with headache or dizziness. Blood pressure monitoring was essential. This case highlights esketamine's potential for bipolar depression and calls for further studies on its cardiovascular effects and management.