Serotoninergic antidepressants combination in psilocybin-assisted psychotherapy: a case report
André Do, Vanessa Michaud, Jean-François Stephan, Miltiadis Moreau, Élise Benoît, Alain Taillefer, Philippe Vincent, Felix-Antoine Berubé, Antoine Bibaud-De Serres
Frontiers in Psychiatry July 16, 2024 DOI: 10.3389/fpsyt.2024.1394962 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Adult patient with difficult-to-treat depression |
| Interventions | Psilocybin-assisted psychotherapy duloxetine vortioxetine |
| Topics | Anxiety Depression Psilocybin Serotonin Psychedelic-assisted therapy |
| Keywords | Adverse effect Vortioxetine Duloxetine Antidepressant Discontinuation Mirtazapine Hallucinogen |
| Citations | 3 |
| Key findings | Combining psilocybin-assisted psychotherapy with serotoninergic antidepressants (duloxetine and vortioxetine) appeared safe, and discontinuing duloxetine was associated with worsened anxiety and depressive symptoms. |
Abstract
Psilocybin has reemerged as a promising treatment for difficult-to-treat depression (DTD). Although there is limited evidence regarding interactions between psilocybin and other psychotropic drugs, clinical trials require that patients discontinue their antidepressants before study entry to isolate the benefits of psilocybin and to minimize the risk of adverse events. We present the first case of an adult patient with DTD who received psilocybin-assisted psychotherapy (PAP) in combination with two serotoninergic antidepressants (duloxetine and vortioxetine). Since he displayed a partial response after the first PAP session, he agreed to discontinue duloxetine (but refused to stop vortioxetine) before the second PAP session to see if it could improve the therapeutic efficacy of psilocybin. However, his anxiety and depressive symptoms worsened. Psilocybin was well-tolerated in both PAP sessions; mild headaches were the main adverse effects experienced by the patient, and there were no cardiovascular safety concerns. This case report suggests that serotoninergic antidepressants combination with psilocybin appears to be safe and that antidepressant discontinuation prior to PAP may not be necessary. Since the continuation of antidepressants during PAP has the potential to improve treatment acceptability and accessibility, future research should assess whether psilocybin can be administered concurrently with antidepressants.
Comparable studies
Other case reports and case series on psilocybin and psychedelic-assisted therapy, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Prolonged adverse effects from repeated psilocybin use in an underground psychedelic therapy training program: a case report | 2025 | Case study | |
| Suicide of a patient shortly after psilocybin-assisted psychedelic therapy: A case report 60-year-old man with recurrent depression and history of delusions | 2025 | Case study | n = 1 |
| Refractory CRPS pain treated with psilocybin: A case report A patient with refractory complex regional pain syndrome | 2024 | Case study | n = 1 |
| Underground small-group therapy of treatment-resistant depression and complex post-traumatic stress disorder (C-PTSD) with psilocybin—A retrospective case study A woman in her early forties with early complex trauma and treatment-resistant depression | 2023 | Case report | n = 1 |
| Psilocybin-assisted psychotherapy for methamphetamine dependence: a case report involving daily methamphetamine use A 36-year-old transwoman who was a daily methamphetamine user | 2024 | Case study | n = 1 |