229. PSILOCYBIN WITH PSYCHOTHERAPEUTIC SUPPORT FOR TREATMENT-RESISTANT DEPRESSION: A PILOT CLINICAL TRIAL

A small pilot trial of psilocybin with psychotherapy for treatment-resistant depression found a clinically meaningful reduction in depressive symptoms three weeks after the second dose, with an average improvement of 7.14 points on the depression scale and a large effect size. However, individual responses varied widely: two participants showed lasting improvement, three relapsed, and two saw no substantial benefit. Mindset before dosing and spiritual or perceptual experiences during the session predicted treatment trajectory, but prior expectations did not. The study supports further research into tailoring psychedelic therapy to individual differences.

Study at a glance

Abstract

Abstract Background Depressive disorders are a major global health challenge, with many individuals unresponsive to existing treatments or left with residual symptoms such as impairments in cognition and social functioning. Emerging psychedelic therapies show promise for treating depression but require further research. Aims & Objectives This pilot study aimed to evaluate the feasibility, safety, and preliminary efficacy of psilocybin with psychotherapeutic support for treatment-resistant depression (TRD). It also sought to investigate potential predictors of treatment outcomes, explore the broader effects on cognition and social processing, and deepen understanding of individual variability in participant experiences. Method Treatment consisted of two 25mg psilocybin sessions, with three preparatory and six integration sessions. Depression severity was assessed using the Quick Inventory of Depressive Symptomatology (QIDS) at 3-weeks post-dose 2 (primary endpoint) and at 20 weeks post-dose 2 (long-term follow-up). Potential predictors of clinical outcomes were evaluated using questionnaires, and qualitative interviews were used to capture individual experiences. A comprehensive task battery assessed processing speed, verbal fluency, learning and memory, executive function, cognitive flexibility, emotion identification, affect sharing, and self-other differentiation, alongside self-report assessments of broader socio-emotional functioning (pending analysis). Results We observed a clinically meaningful reduction in depressive symptoms at the primary endpoint (mean change = -7.14; p = 0.02; Hedge’s g = 1.41; 95% CI [0.10, 2.71]), and the long-term follow-up. Examining individual participant data (n=7) revealed diverse response patterns. Two participants displayed a sustained treatment response, three relapsed, and two exhibited no substantial improvement (figure 1; green, blue and purple, respectively). Mindset prior to dosing, and spiritual experiences and perceptual shifts during dosing were identified as possible predictors of treatment trajectory - further supported by qualitative data, while treatment expectations did not influence outcomes. Discussion & Conclusions Findings add to the growing evidence base for psilocybin therapy and provide direction for further research focusing on individual variability in response to better tailor treatments and enhance efficacy. Outcomes related to cognition and social functioning will provide insights the potential of psilocybin therapy to target a wider spectrum of symptoms and enhance understanding of its mechanisms.