What effect will Psilocybin have on the treatment of depression?

A recent press release from Compass Pathways indicates positive results from its phase IIb trial of the psilocybin containing compound COMP360, and from what can be determined from its marketing materials, these data may eventually pave the way for the FDA approval of a unique treatment for Major Depressive Disorder.  Interestingly, Wall Street seems not to be very impressed, as Compass Pathways stock has been trading significantly lower in the days after its announcement, but as this is not a financial blog, I will not discuss that any further!

From a psychiatrist's perspective, the more interesting data regarding psilocybin were released in the April 15th, 2021, issue of the New England Journal of Medicine. 

Although this is a relatively small study, it indicates that psilocybin offers results that are on par with the antidepressant medication Lexapro, but with very unique properties that could make psilocybin an alternative for many people who suffer from depression and either do not respond to medications like Lexapro or find the side effects of medications like Lexapro intolerable. 

In my opinion, the most interesting aspect of this study, was that psilocybin achieved these results in only two dosages given 3 weeks apart, while Lexapro was administered as a daily medication.  If this dosing schedule holds up as beneficial and tolerable in large scale trials, psilocybin may prove to be a true gamechanger in the way that treatment is offered for Major Depressive Disorder, as every other treatment that is currently offered requires much more frequent administration for comparable results to be achieved. 

Given preliminary results, it is my expectation that psilocybin will eventually find its way into mainstream psychiatric treatment.  However, it is not clear if it will be offered early on, or if it will be reserved only for people who do not respond to currently available treatment options.  Fortunately long term studies are already underway, so we may not have to wait very much longer to find out.