The use of psychedelics — including psilocybin — to treat depression, anxiety and other mental health conditions is a topic of rising interest and popularity.
“Through all the work I’ve done, I’ve never seen anything like this crazy, frankly unrealistic, explosion of interest,” said Dr. Charles (Chuck) Raison, the director of Vail Health Behavioral Health’s Innovation Center.
Raison is at the forefront of this research through the numerous hats he wears.
As part of the latter position at Usona, Raison served as a lead author on a study that delved into the efficacy and safety of psilocybin as a treatment for major depressive disorder. Published in JAMA, a peer-reviewed medical journal, an article explaining the study was one of the site’s most viewed articles of 2023.
While this study was not part of Raison’s work with Vail Health, it will help inform future psilocybin studies in Eagle County.
Studying single-dose psilocybin treatment
The study referenced in the JAMA article was a “randomized, placebo-controlled, 6-week trial in 104 adults” in which “a 25-mg dose of psilocybin administered with psychological support was associated with a rapid and sustained antidepressant effect, measured as change in depressive symptom scores, compared with active placebo.”
The study was designed to “begin the process of getting FDA approval for psilocybin,” Raison said.
To get FDA approval for a drug, there are a series of studies that must be conducted. This one was what Raison called a “phase two” study in which “you do a rigorous, randomized, blinded, controlled trial in the patient population that you want to study.”
Ultimately, the results further demonstrate that “a single, in this case, 25-milligram dose of psilocybin produces very rapid, very profound and sustained antidepressant responses in people with depression,” he added.
While not directly related to his work in Vail, “it’s important because it provides further rationale and support for the fact that the work we’re getting ready to do in Vail with psilocybin is not coming out of the blue,” Raison said.
Preparing for Vail Health’s study
Dr. Charles Raison, wearing the EEG cap, serves as a test subject for a study that is part of the UW-Madison/Vail Health Behavioral Health Innovation Center Consortium. The study is aiming to understand the role of consciousness in the therapeutic benefits of psilocybin.
The Vail Health Innovation Center is expected to start its own psilocybin research sometime this summer and will seek to answer some of the outstanding questions from Raison’s study for Usona.
“For instance, are there ways to make the psilocybin treatment more effective? To make a single treatment last longer? Can we get a better take on the adverse events? Can we better identify people likely to respond or not respond?” Raison said.
The center is calling the psilocybin research the OPT-in study. In contrast to the Usona work, it will not be directly related to the FDA approval of the drug as a treatment for depression. The FDA will regulate the OPT-in study.
However, this information will still be “influential” in terms of informing “how to optimally use psilocybin, in this case, for depression,” Raison said.
In addition to the above questions, the work will seek to answer: “How well does (psilocybin) actually work in the real world of patients that are coming to get help in Vail,” Raison said.
This is especially critical in Colorado following the recent legalization of psilocybin.
Raison said the study will look to engage 140 people and will likely take three to four years to conduct.
“By the time the opt-in results are done people will be widely using psilocybin in Colorado, but what the study will do would be to suggest ways that they might be able to use it better and safer,” Raison added. “I think it’ll be even more relevant then because it’s going to be the Wild West in Colorado with psychedelic use for a while, so this is going to provide real guidance on how to do it as best as possible.”
Riding the wave
While different in intent and procedure, both studies are “riding atop a wave of increasing data suggesting that psychedelics, in general, and psilocybin in particular, really show massive promise of being radically different and potentially transformative ways of treating a whole bunch of mental illnesses, but in this case, especially depression,” Raison said.
The rise of this research — and the increased attention to it — could be attributed to two factors, Raison hypothesized.
One reason Raison hypothesized is that “a lot of the people now that are in power positions did psychedelics when they were younger people.”
“Psychedelics are not like some brand new thing,” he added. “There’s a historical, cultural aspect where people had valuable experiences with these agents back 30, 40, 50 years ago, and then they just put it away because there was no place to talk about.”
However, predominantly behind this increased attention and allocation of resources toward psychedelics is the fact that “we have not made advances really in our treatment of mental illness over the last 30 (to) 40 years,” he said.
While billions of dollars have been spent on neuroscience research and many drugs created, rates of depression, anxiety, suicide and other mental health conditions have steadily increased.
Psychedelics and psilocybin represent “a completely different mechanism of action,” Raison said.
“There is a desperate need in the mental health field, both amongst clinicians who want to be more effective in helping to treat patients, and in patients, there is a desperation to get more benefit, to find something new,” Raison said. “The need is overwhelming.”