According to the Uberfacts Instagram account, which has a not insignificant 2.1 million followers, psilocybin appears to relieve the brains of people with severe depression in a way that other antidepressants do not. Are they right? That's the topic of this week's Healthcare Triage.

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In a recent series on mental health treatments, we dedicated an episode to the evidence on psilocybin, or mushrooms, for treating mental health.

In that episode we referenced two recent studies that compared the ability of psilocybin- the active ingredient in mushrooms- with the common antidepressant escitalopram to treat depression.

The first study, published in April of 2021, consisted of a phase two double-blind randomized controlled trial that enrolled patients with moderate to severe major depressive disorder.

The second study, published in April of 2022, appears to be reporting on that same trial. On one measure of depression, the "16-item Quick Inventory of Depressive Symptomatology- Self-Report," the 2021 paper reported no significant change in depression scores between the group taking psilocybin and the group taking antidepressants. However, when using the "Beck Inventory of Depression," a significant change in scores was found between groups.

The 2022 paper references this latter significant finding, and also describes the results of brain imaging in each of these groups. They report better connectivity and communication between brain regions in individuals who received psilocybin compared to those who received escitalopram, and they suggest that these brain changes are how psilocybin may help with depression.

Keep in mind, there were only 22 people in the psilocybin group and 21 in the antidepressant group, which is on the low end for a phase two trial.

As supportive as we are of double-blinded randomized placebo-controlled trials, we'll need one with more participants before we can make any bold claims.

This may be particularly relevant for fMRI studies, which have long suffered from low sample sizes that limit their translation. In fact, a 2022 study published in the journal Nature suggests that fMRI studies examining associations between behavior and brain function require thousands of participants to produce reliable, reproducible data.

That feels like the biggest caveat for the study at hand, but it's not the only one. Brain imaging took place at baseline before any treatment was given, and then again approximately six weeks later.

This timeline may limit our ability to compare changes between the groups and how that relates to treatment effects because escitalopram can take up to 6 to 8 weeks to relieve some of the major symptoms of depression.

Understanding whether escitalopram is better or worse than psilocybin at relieving depression and understanding if these particular brain changes might be necessary for that to happen would require that we allow a sufficient amount of time for escitalopram to kick in before measuring and comparing its effects.
This, the low sample size, and the conflicting measures of depression in the first paper make it hard to be definitive about psilocybin's potential role in depression treatment.

We do, however, definitively feel concerned about those 2.1 million people getting their info from Uberfacts Instagram account.

Hey did you enjoy this episode? You might enjoy this previous episode on psilocybin for treating depression! Yay!

We'd also like it if you'd like the video and subscribe to this channel- not the Uberfacts Instagram account- down below, and consider going on over to patreon.com/healthcaretriage where you can help support the show, make it bigger and better. We'd like to especially thank our research associates, James Glasgow, Joe Sevits, Edward Liljeholm, and Brian Nam, and of course, our Surgeon Admiral Sam.