Acute and Sustained Reductions in Loss of Meaning and Suicidal Ideation Following Psilocybin-Assisted Psychotherapy for Psychiatric and Existential Distress in Life-Threatening Cancer
Stephen Ross, Gabrielle Agin-Liebes, Sharon L. Lo, Richard J. Zeifman, Leila Ghazal, Julia Benville, Silvia J. Franco-Corso, Christian Bjerre-Real, Jeffrey Guss, Anthony P. Bossis, Sarah E. Mennenga
ACS Pharmacology & Translational Science March 18, 2021 DOI: 10.1021/acsptsci.1c00020 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Population | People with advanced cancer |
| Intervention | Psilocybin-assisted psychotherapy |
| Duration | 6.5 months post-dosing for suicidal ideation; 4.5-year follow-up for loss of meaning |
| Topics | Psilocybin End-of-life distress Psychedelic-assisted therapy |
| Keywords | Suicide prevention Suicidal ideation Distress Clinical psychology Cancer Depression economics Randomized controlled trial Population Intervention counseling Clinical trial Psychotherapist Poison control Hallucinogen |
| Citations | 133 |
| Key findings | Psilocybin-assisted psychotherapy reduced suicidal ideation and loss of meaning in cancer patients with elevated baseline suicidal ideation, with effects persisting up to 4.5 years. |
Abstract
People with advanced cancer are at heightened risk of desire for hastened death (DHD), suicidal ideation (SI), and completed suicide. Loss of Meaning (LoM), a component of demoralization, can be elevated by a cancer diagnosis and predicts DHD and SI in this population. We completed a randomized controlled trial in which psilocybin-assisted psychotherapy (PAP) produced rapid and sustained improvements in depression, demoralization, and hopelessness in people with cancer. Converging epidemiologic and clinical trial findings suggests a potential antisuicidal effect of this treatment. To probe our hypothesis that PAP relieves SI through its beneficial impacts on depression and demoralization (LoM in particular), we performed secondary analyses assessing within- and between-group differences with regard to LoM and an SI composite score. Among participants with elevated SI at baseline, PAP was associated with within-group reductions in SI that were apparent as early as 8 h and persisted for 6.5 months postdosing. PAP also produced large reductions in LoM from baseline that were apparent 2 weeks after treatment and remained significant and robust at the 6.5 month and 3.2 and 4.5 year follow-ups. Exploratory analyses support our hypothesis and suggest that PAP may be an effective antisuicidal intervention following a cancer diagnosis due to its positive impact on hopelessness and demoralization and its effects on meaning-making in particular. These preliminary results implicate psilocybin treatment as a potentially effective alternative to existing antidepressant medications in patients with cancer that are also suicidal, and warrant further investigation in participants with elevated levels of depression and suicidality.
In the evidence
This study is part of the evidence base for 2 syntheses in the library. Here is how each one recorded it.
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Among participants with elevated baseline suicidal ideation, psilocybin-assisted psychotherapy was associated with within-group reductions in suicidal ideation apparent as early as 8 hours and persisting 6.5 months, plus large reductions in loss of meaning sustained to 4.5 years.
Synthesized
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Among participants with elevated suicidal ideation at baseline, psilocybin-assisted psychotherapy was associated with within-group reductions in suicidal ideation as early as 8 hours and persisting 6.5 months, plus large reductions in loss of meaning sustained at 3.2 and 4.5 years.
Synthesized
Comparable studies
Other randomized controlled trials on end-of-life distress, most cited first.