The rebirth of psychedelic psychiatry

A 65-year-old man with a long history of major depressive disorder, generalized anxiety, and social phobia, whose personality is high in neuroticism, had been treated for decades with psychotherapy and various antidepressants, finding bupropion most helpful. After being diagnosed with advanced pancreatic cancer and given six months to live, he quickly developed severe depressive symptoms and suicidal thoughts despite continuing bupropion. His psychiatrist referred him to a trial of psilocybin for anxiety and depression in terminally ill patients. Recent research suggests psychedelic agents might help treat anxiety, depression, and other disorders.

Study at a glance

Abstract

M r.P, age 65, has a history of major depressive disorder (MDD), gen- eralized anxiety disorder, and social phobia.Mr. P's personality is high in neuroticism and he has often responded to new situations with feelings of impending doom.For him, fear, anxious rumination, helplessness, and catastrophizing are familiar mental processes.When he was in his 30s, Mr. P had a severe major depressive episode with suicidal ideation and sought care from a psychiatrist.He began a treatment program of psychotherapy and concomitant psychopharmacotherapy with consecutive trials of fluoxetine, sertraline, and amitriptyline, each of an adequate dose and duration.With each medication, Mr. P experienced new adverse effects, including nausea, constipation, tremors, and headache.His psychiatrist transitioned him to bupropion, which helped Mr. P most.For the next several decades, Mr. P continued to experience low-grade depressive symptoms with intermittent exacerbation to mildto-moderate major depressive episodes, but he remained adherent to his medication and continued psychotherapy.Shortly after his 65th birthday, Mr. P experiences progressively worsening nausea and abdominal pain.Initially, he assumes the symptoms are secondary to anxiety.Taking his psychiatrist's advice, Mr. P visits his primary care physician.A work-up reveals that Mr. P has advanced pancreatic cancer, and an oncologist estimates Mr. P has 6 months of life remaining.Following his cancer diagnosis, Mr. P quickly develops symptoms of MDD despite continuing to take bupropion.Within a week he becomes withdrawn and hopeless, and thinks about ending his life "before God does."His psychiatrist urges Mr. P to contact the local academic medical center because it is conducting a trial of a "new" drug, psilocybin, to treat anxiety and depression in patients with terminal illness. The rebirth of psychedelic psychiatryRecent research suggests psychedelic agents might help treat anxiety, depression, other disorders