Patient perspectives and experiences with psilocybin treatment for treatment-resistant depression: a qualitative study
Alistair Niemeijer, Erwin Krediet, Jeanine Kamphuis, Eric Vermetten, Joost J. Breeksema, T.l. Karsten, Wim van den Brink, Robert A. Schoevers
Scientific Reports February 5, 2024 DOI: 10.1038/s41598-024-53188-9 via OpenAlex
Summary
AI-generated from the abstractPatients with treatment-resistant depression who received psilocybin in a clinical trial described challenges with trust-building and expectation management, the need to navigate intense experiences often guided by music, and a desire for a more comprehensive treatment including multiple psilocybin sessions and sustained therapy. Distrust in mental healthcare generally, but trust in study therapists, was a key subtheme. The findings suggest that optimizing psilocybin treatment for this population requires individualized preparation, investment in trust-building, additional sessions, and access to ongoing psychotherapy with trusted therapists.
Study at a glance
| Characteristics | Qualitative study nested in a double-blind randomized clinical trial Peer reviewed |
|---|---|
| Sample size | 11 |
| Population | Patients with treatment-resistant depression (TRD) participating in a psilocybin clinical trial |
| Intervention | Psilocybin |
| Dose | 1, 10 or 25 mg |
| Duration | Single session |
| Topics | Psilocybin |
| Keywords | Distrust Psychotherapist Qualitative research Psychology |
| Citations | 50 |
| Key finding | Patients with TRD emphasized the importance of trust-building, individualized preparation, multiple psilocybin sessions, and sustained psychotherapy for optimizing psilocybin treatment. |
Abstract
Abstract Psilocybin is the most researched classic psychedelic for Treatment-Resistant Depression (TRD). While optimizing set and setting are considered essential for efficacy and safety, patient perspectives on these aspects have rarely been investigated. To address this knowledge gap, the current paper explored the experiences of 11 TRD patients (8 women, 3 men) participating in a double-blind randomized clinical trial with a single session of oral (1, 10 or 25 mg) psilocybin treatment. After qualitative analysis, three major themes were identified: (1) challenges with trust-building and expectation management; (2) navigating the experience; and (3) the need for a more comprehensive treatment. Subthemes of the first theme include a general distrust in mental healthcare, trust in study therapists, limited time for preparation, and managing expectations. The second theme included the following subthemes: trusting to surrender, profound and overwhelming experiences, and music as a guide. The third theme addressed a desire for multiple psilocybin sessions, and challenges with sensemaking. Patients’ perspectives provided important insights into potential optimization of psilocybin treatment of TRD, including individualized preparation, investment in trust-building, offering additional psilocybin sessions, providing access to sustained (psycho)therapy with trusted therapists, and personalizing treatment approaches, which may also enhance real-world adaption of these treatments.