Older adults in psychedelic-assisted therapy trials: A systematic review

Older adults (65+) account for less than 1.4% of participants in psychedelic clinical trials, despite these compounds showing potential for conditions common in this age group, such as depression, anxiety, and existential distress. A systematic review of 36 trials involving 1,400 patients found only 19 were aged 65 or older. Safety data for 10 of these older adults showed no serious adverse events; only transient mild-to-moderate effects like anxiety, gastrointestinal upset, and hypertension occurred during dosing sessions. The authors conclude that psychedelic-assisted psychotherapy appears safe and well tolerated in older adults and warrants more rigorous investigation for psychiatric treatment in this population.

Study at a glance

Abstract

Background: Growing clinical interest in psychedelic-assisted therapies has led to a second wave of research involving psilocybin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA) and other substances. Data suggests that these compounds have the potential to treat mental health conditions that are especially prevalent in older adults such as depression, anxiety, existential distress, and posttraumatic stress disorder. Aims: The goal of this study was to quantify the prevalence of older adults enrolled in psychedelic clinical trials and explore safety data in this population. Methods: A systematic review was conducted following the 2020 PRISMA guidelines. Search criteria included all trials published in English using psychedelic substances to treat psychiatric conditions, including addiction as well as existential distress related to serious illness. Articles were identified from literature searches on PubMed, EBSCO, and EMBASE. Results: 4376 manuscripts were identified, of which 505 qualified for further review, with 36 eventually meeting eligibility criteria. Of the 1400 patients enrolled in the 36 studies, only 19 were identified as 65 or older, representing less than 1.4% of all trial participants. For 10 of these 19 older adults, detailed safety data was obtained. No serious adverse events (AEs) occurred in any older adults and only transient mild-to-moderate AEs related to anxiety, gastrointestinal upset, and hypertension were reported during the psychedelic dosing sessions. Conclusions: While existing data in older adults is limited, it suggests that psychedelic-assisted psychotherapy can be safe and well tolerated in older adults. Therefore, psychedelic-assisted psychotherapy should be more rigorously investigated for the treatment of psychiatric conditions in this population.