Psilocybin for End-of-Life Anxiety Symptoms: A Systematic Review and Meta-Analysis

Summary & key facts

Researchers combined results from five clinical trials to see if psilocybin helps people with anxiety near the end of life. They found that, compared with a placebo, psilocybin reduced short-term anxiety within a day and two weeks, and it reduced longer-lasting anxiety up to six months in some measures. Psilocybin did raise blood pressure briefly, but it did not lead to more serious medical problems or more people stopping the studies. The studies were small and the long-term results varied a lot, so bigger trials are still needed to be sure.

Key facts:

• The review looked at five clinical trials that tested psilocybin against a placebo for anxiety in people near the end of life.
• Psilocybin reduced "state" anxiety, meaning how anxious people felt at the moment, both one day after treatment and two weeks after treatment.
• Psilocybin also reduced "trait" anxiety, meaning a person’s general tendency to feel anxious, at one day, two weeks, and up to six months after treatment in the combined results.
• Taking psilocybin was linked to a short, temporary rise in blood pressure — about 19 mm Hg higher in systolic pressure and about 9 mm Hg higher in diastolic pressure — compared with placebo.
• There were no clear differences between psilocybin and placebo in how many people stopped the studies, in serious medical problems, or in heart rate.
• Because the included studies were small and the long-term findings were inconsistent, the authors say larger, well-designed trials are needed before we can be confident about psilocybin’s long-term safety and benefits.

Abstract

OBJECTIVE: To systematically examine the effectiveness and tolerability of psilocybin for treating end-of-life anxiety symptoms. METHODS: The Medline, Embase, CENTRAL, and PsycINFO databases were searched up to November 25, 2020. We enrolled clinical trials investigating psilocybin for treating end-of-life anxiety symptoms. Meta-analysis was conducted using random-effects model. RESULTS: Overall, five studies were included, revealing that psilocybin was superior to the placebo in treating state anxiety at 1 day (Hedges' g, -0.70; 95% confidence interval, -1.01 to -0.39) and 2 weeks (-1.03; -1.47 to -0.60) after treatment. Psilocybin was more effective than placebo in treating trait anxiety at 1 day (-0.71; -1.15 to -0.26), 2 weeks (-1.08; -1.80 to -0.36), and 6 months (-0.84; -1.37 to -0.30) after treatment. Psilocybin was associated with transient elevation in systolic (19.00; 13.58-24.41 mm Hg) and diastolic (8.66; 5.18-12.15 mm Hg) blood pressure compared with placebo. The differences between psilocybin and placebo groups with regard to allcause discontinuation, serious adverse events, and heart rates were nonsignificant. CONCLUSION: Psilocybin-assisted therapy could ameliorate end-of-life anxiety symptoms without serious adverse events. Because of the small sample sizes of the included studies and high heterogeneity on long-term outcomes, future randomized controlled trials with large sample sizes are needed.

Topics

Pain Management and Placebo Effect Paranormal Experiences and Beliefs Psychedelics and Drug Studies

Categories

Clinical Psychology Psychology Social Sciences

Tags

Adverse effect Alternative medicine Anxiety Confidence interval Discontinuation Hallucinogen Internal medicine Medicine Meta-analysis Pathology Placebo Psilocybin Psychiatry Randomized controlled trial Tolerability

Substances

Psilocybin

Conditions & symptoms

Anxiety Anxiety or worry