Volume 113, Issue 4 p. 757-759
Editorial
Free Access

Mush Room for Improving Therapeutic Approaches in Psychiatry

Piet H. van der Graaf

Corresponding Author

Piet H. van der Graaf

Certara, Canterbury, UK

University of Leiden, Leiden, The Netherlands

Correspondence: Piet H. van der Graaf ([email protected])Search for more papers by this author
First published: 15 March 2023

In the televised fictional drama “Nine Perfect Strangers,” based on a novel with the same name,1 nine people gather for a retreat in a wellness resort which promises to heal and transform them. The guests discover that as part of the program the charismatic owner of “Tranquillum” has been feeding them smoothies spiked with psilocybin-containing mush room extract without their knowledge. After the initial obvious outrage over the absence of informed consent, the guests are then left with the question whether to continue with this unconventional therapeutic approach, which at least for some of them seemed to have had beneficial effects. Or had it? Although single-blinded at the start, this fictional experiment of course suffered from so many shortcomings that it was impossible to tell. This is perhaps somewhat reflective of the limitations of many actual psilocybin trials in the real world (133 were listed in ClinicalTrials.gov at the time of writing this Editorial2): small n numbers, absence of placebo and/or comparator, short duration, and lack of objective end points to name a few. Recently, however, a year after the release of the series, results were reported of the most extensive phase II clinical trial investigating psilocybin in treatment-resistant major depressive disorder.3 The results (which can be summarized as “both intriguing and sobering”4) were widely reported in the media along the lines of “magic mush room for depression” and triggered the start of a phase III study,2, 5 which should provide the most conclusive results about psilocybin's potential therapeutic benefit to date.

The clinical pharmacology of psilocybin was already reviewed in this journal six decades ago ago,6 but interest from the scientific and clinical community seems to have gathered serious momentum only in the last 5 years (Figure 1). This has occurred alongside a broader resurgence of research into therapeutic applications of psychedelic agents.8, 9 As in every other area of drug development, the involvement of clinical pharmacology will be a key determinant of success and Clinical Pharmacology & Therapeutics (CPT) expects to see an increase in submissions and publications in this area. Recent examples are the reports on pharmacokinetics–pharmacodynamics (PKPD) of lysergic acid diethylamide (LSD) microdosing10 and PKPD interactions between psilocybin and escitalopram.11 In this issue of CPT (Figure 2), the same group from the University of Basel now describes the PKPD of psilocybin in healthy volunteers and the impact of covariates, specifically body weight.12 Such studies are essential to support the optimal design of further clinical studies of psilocybin and other therapeutic psychedelics. They illustrate the critical role of clinical pharmacology as an enabler to convert medical hypotheses into safe and effective therapeutics to improve patients' lives.

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Number of publications referring to psilocybin per year as identified by PubMed.7
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Clinical Pharmacology & Therapeutics April 2023 cover image: Mush room for improving therapeutic approaches in psychiatry.

FUNDING

No funding was received for this work.

CONFLICT OF INTEREST

The author declared no competing interests for this work.