Recent findings published in the journal ACS Pharmacology & Translational Science suggest that psilocybin, in conjunction with psychotherapy, reduces suicidal ideation and loss of meaning among patients with life-threatening cancer. These mental health improvements were maintained months to years following treatment.
Cancer patients are at increased risk of suicidal ideation and completed suicide, particularly those with advanced illness. Such patients often experience existential distress and a loss of meaning in life, and little is known about pharmacological treatments that might alleviate these effects.
Researchers Stephen Ross and his colleagues say that there is some evidence that the hallucinogenic drug psilocybin, also known as “magic mushrooms,” might alleviate suicidal ideation. The researchers were motivated to study whether psilocybin-assisted psychotherapy might produce sustained reductions in suicidal ideation among patients with life-threatening cancer.
Ross and his team analyzed data from a previous crossover study where they randomly assigned a sample of individuals with advanced cancer to one of two dosing sequences in conjunction with psychotherapy. Participants in one condition were given psilocybin on the first dosing session and niacin seven weeks later, while participants in a second condition were given niacin first and psilocybin seven weeks later. The niacin served as an active control.
For the current study, the researchers focused on participants who presented with suicidality at baseline, resulting in a sample of 11 participants with an average age of 60. At baseline, participants completed assessments of suicidal ideation, loss of meaning, hopelessness, and spiritual well-being. They then partook in various follow-up assessments throughout their psychotherapy treatment. Assessments for suicidal ideation were taken 8 hours after dose 1, 2 weeks after dose 1, 7 weeks after dose 1, and 6.5 months after dose 2. Assessments for loss of meaning, hopelessness, and spiritual well-being, were taken 2 weeks after dose 1, 6.5 months after dose 2, and 3.2 years and 4.5 years after baseline.
For the group who received psilocybin first, suicidal ideation and loss of meaning scores dropped significantly at every assessment point compared to baseline levels. This was not true for the group that received niacin first. Furthermore, when comparing the two groups, the psilocybin-first group had lower average loss of meaning scores compared to the niacin-first group at 2 weeks following dose 1.
According to the follow-up assessments, these changes were somewhat long-term. Within-subject decreases in suicidal ideation and loss of meaning (compared to baseline) were still apparent when assessed 6.5 months later. Moreover, reductions in loss of meaning were maintained at the 3.2-year and 4.5-year assessments.
Importantly, reductions in suicidal ideation were correlated with decreases in loss of meaning, hopelessness, and demoralization. While the study design does not allow causal inferences, the authors suggest that loss of meaning might mediate the link between suicidal ideation and a cancer diagnosis. They say that psilocybin-assisted psychotherapies that include existential components might lower suicidal thinking by “enhancing meaning-making” — a hypothesis that could be tested in future trials.
“These preliminary results suggest that psilocybin-assisted psychotherapy could be a novel pharmacological−psychosocial treatment modality for advanced-cancer-related suicidality,” Ross and colleagues say. “Further empirical research is needed to definitively establish its efficacy and potential mechanisms of action.” If such treatment proves effective, the implications are far-reaching. Similar therapies might be introduced to treat suicidality among patients with major depressive disorder (MDD) or patients with other life-threatening illnesses than cancer.
The study, “Acute and Sustained Reductions in Loss of Meaning and Suicidal Ideation Following Psilocybin-Assisted Psychotherapy for Psychiatric and Existential Distress in Life-Threatening Cancer”, was authored by Stephen Ross, Gabrielle Agin-Liebes, Sharon Lo, Richard J. Zeifman, Leila Ghazal, Julia Benville, Silvia Franco Corso, Christian Bjerre Real, Jeffrey Guss, Anthony Bossis, and Sarah E. Mennenga.