Lexapro vs Psilocybin
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https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00378-X/fulltext
Six-week intensive treatments with either psilocybin or escitalopram (with psychological support) for MDD (major depressive disorder) were associated with long-term improvements in depressive symptom severity. The greater degree of improvement in the PT arm at follow-up on psychosocial functioning, meaning in life, and psychological connectedness suggests warrant future research. However, these results are descriptive and should be interpreted with caution. Key limitations of the study include its suboptimal power to detect small but meaningful differences between treatments, missing data, the potential use of additional interventions during the follow-up period, and reliance on self-reported treatment assessments. These factors may affect the interpretation of the study findings and should be considered when evaluating the results.
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Commenting on the research for Medscape Medical News, Johan Lundberg, MD, PhD, adjunct professor of psychiatry at the Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden, said the study addresses a key outstanding question about the long-term effects of one or two doses of psilocybin.
"It's a 6-month follow-up of a short treatment intervention, so in that sense, it's of high interest. It has been talked about that psilocybin might have a long-term effect, but this is the first study that has followed this for a longer term."
But Lundberg also pointed out that one shortcoming of the study is the diversity of treatments following the intervention.
"They didn't have control over whether patients received other treatments or when they started. So, that is a key concern. But they transparently reported that, and we do know there was a difference in reported ability to perform activities of daily life, and that is important."
He added that if psilocybin is eventually approved, it would likely come with an education package for providers — "which is already the case with other treatments like ECT [electroconvulsive therapy] or TMS [transcranial magnetic stimulation] — you have to learn how to do it."
James Rucker, MD, PhD, psychiatrist and senior clinical lecturer at King's College London, London, England, who was not involved in the research, also noted that they have tended to attribute differences observed in this study to comparative differences between the drugs themselves.
However, he noted, it is also possible that the results reflect biased reporting between groups. This is more likely here because studies involving psilocybin tend to attract those with positive preconceptions about psilocybin and negative preconceptions about conventional antidepressants, and study participants were unblinded during the long-term follow-up phase, so knew which condition they were allocated to.
"This said, the nature of depression varies hugely between individuals, and this calls for the development of a similarly varied suite of treatment paradigms. Psilocybin therapy is certainly a different paradigm of treatment to escitalopram. The observation of similar levels of effectiveness to antidepressants here is encouraging to see alongside the much larger trials of psilocybin currently underway here in the UK, Europe, and the US," Rucker added.
