Psilocybin Therapy as Depression Treatment: Lessons Learned

Rosalind Watts, PhD, Clinical Director, Synthesis Institute, London, England, discussed the therapeutic relationship in psilocybin treatment for depression during a virtual presentation at Sana Symposium.

Dr Watts, who has been working with psilocybin as a treatment for depression since 2015, focused her presentation on 5 key lessons learned through her experiences in this field.

Dr Watts has worked on an open-label study testing psilocybin on treatment-resistant depression and as a clinical leader in an additional randomized control trial comparing psilocybin to a selective serotonin reuptake inhibitor antidepressant on patients with major depressive disorder.

Lesson 1 was “connectedness is key,” a concept developed following the first study, where participants received 10MG and 25MG of psilocybin a week apart. Dr Watts conducted interviews with participants, where she found “that participants tended to describe that after psilocybin therapy they shifted from a state of disconnectedness to self, others, and world, to a state of connectedness to self, others, and world. So, they were going from being stuck in kind of a mental prison of rumination and self-attack to opening up to the self, others, and the world around them.”

The “connected state” was recorded to last a few weeks to months and a temporary reduction in depression scores was noted during this time.

“Witnessing this phenomenon gave rise to the hypothesis that depression can be linked with fundamental disconnectedness and that psychedelic therapy can bring about a temporary but important increasing connectedness,” Dr Watts said.

Lesson 2 was “it’s not a brain reset,” emphasizing that while the connecting experience of psychedelic therapy can bring feelings of peace to patients, it can also be a painful experience similar to working through trauma in traditional therapy.

Lesson 3 was “beautiful boring boundaries.” Dr Watts described an intimacy that is not seen in standard therapy, where patients and guides often hug or embrace following or during a session. Unlike standard therapy, it is standard practice for the psychedelic guide to hold the patient’s hand during sessions.

Dr Watts said it is important for the therapist to be a “co traveler” and their authentic self, however, they must “also ensure that your tenderness and care is not misconstrued or fixated upon, and when they are discharged, they won't feel abandoned by someone they secretly hoped would be a lifelong friend.” Adding, “they need to feel safe enough with you to experience this connection with themselves, that's all, you don't need to be their savior and healer.”

Lesson 4 was “Psychedelics can have side effects.” The side effect noted during the studies was a headache, however, a return of depression and anxiety was cited a few months after treatment.

The final lesson was, “We need to create the container,” which Dr Watts described as a need “to build structures so that when psychedelic therapy becomes part of our communities, people receive the grounded care and wisdom ongoing that they might need to navigate the integration…I'm thinking of peer-led community integration support networks.”

Dr Watts concluded by sharing the Synthesis Institute’s year-long integration program called The Connectedness Program, which is designed for patients who have received psychedelic care for depression in clinical trials. As of now, the program does not include additional psychedelic treatment, but focuses on building connectedness to self, each other, and nature.

Reference

Watts R. Lessons learned: featuring Dr Rosalind Watts. Presented at: Sana Symposium; September 17-19, 2021; Virtual.