A National Opportunity

The UK has the chance to become a world leader in a breakthrough treatment for depression

 
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Imperial College London
Imperial’s Centre for Psychedelic Research is just one of the UK’s world-leading psychedelic research groups

Current approaches to the treatment of depression are largely based on pharmaceutical interventions or talking therapies. Although these can work well for some patients, around half of people with depression don’t find relief from typical treatments (Thomas et al, 2013), and side effects can be debilitating.

Suicide as a result of depression is the leading cause of death for adults aged 20-34 in the UK (ONS, 2017), and around 1.5 million people in the UK are currently diagnosed with depression (Adult Psychiatric Morbidity Survey, 2014).

The good news is that psilocybin is showing huge promise as an effective and lasting antidepressant. However, its Schedule 1 status is currently slowing down research that could bring the treatment to those who need it. 

The UK government now has an opportunity to expedite groundbreaking new research that could revolutionise the treatment of depression by rescheduling psilocybin.

The Mental Health Statistics

Contemporary treatments for depression almost always involve pharmaceutical interventions. The most common antidepressant medications work by altering the balance of serotonin in the brain; an important neurotransmitter that regulates mood.

However, we don’t know much about the role of the serotonin system in depression, or even how the most common antidepressants work. Unsurprisingly, our current treatments aren’t ideal:

A large number of patients don’t respond to medication at all. One large survey in the US found that over 50% of people with severe depression did not find a treatment that worked for them within a 12-month period (Kessler et al, 2003). Similarly, in the UK, over 50% of patients don’t respond to antidepressants after at least six weeks of treatment (Thomas et al, 2013).

Some antidepressants can be even worse than placebo. In one study, the common medication fluoxetine made over 30% of participants experience a significant worsening of their depressive symptoms during the first few weeks of treatment (Cusin et al, 2007).

The side effects can be truly debilitating. The most common side effects of medications include suicidal ideation, insomnia, and mania. As many as 1 in 3 people drop out from medications due to an adverse event (Rohden et al, 2017).

Even if medication does start working, it’s likely that patients will be taking it for many years. In the UK, half of patients with depression take antidepressants for over two years, and those long-term patients stay on medication for a mean of 5.5 years (Johnson et al, 2012). 

Talk therapy is not used often, and has mixed results. In the UK, medication is more likely to be used than therapy in the treatment of severe depression (Wiles et al, 2018). When therapy is offered to patients, it is usually labour-intensive and costly, and around half of patients don’t respond positively (Lepping et al, 2017).

Depression is a major problem in the UK. It is the leading cause of death for adults aged 20-34 in the UK (ONS, 2017), and in 2014, almost 20% of adults showed symptoms of anxiety or depression (ONS, 2016). Around 1.5 million people in the UK are currently diagnosed with depression (Adult Psychiatric Morbidity Survey, 2014), and it wreaks havoc on families.

Depression has a huge impact on the UK economy, leading to lower employment and loss of productivity that costs our country £42 billion a year (OECD, 2018, Health at a Glance: Europe). If treatment and social support costs are accounted for, this number rises to more than £94 billion and takes 4% of our GDP every year.

Where Psilocybin Fits In

Research so far suggests that psilocybin can treat the source of depression in the brain, where typical antidepressants can only act on the symptoms.

One theory of how depression works in the brain suggests that two main receptors are responsible for helping people recover from depression: 5-HT1A and 5-HT2A receptors (Carhart-Harris & Nutt, 2017). 

This theory states that typical antidepressant medications only work through the 5-HT1A receptor, and help to treat the surface symptoms of depression such as rumination and anxiety. This is known as “passive coping.” 

The other receptor, 5-HT2A, helps with something called “active coping.” The activation of this receptor helps the brain become more flexible to change, and could allow depressed patients to get bigger benefits from therapy.

This is where psilocybin comes into the picture.

Psilocybin powerfully stimulates the 5-HT2A receptor, and could help us fill in the missing gaps in our treatment options for depression. Current research has shown that psilocybin could be a more effective treatment than any currently available medications.

The UK has been one of the few countries that have contributed to psilocybin research, yet costs of this research have been ten times what they should be. The UK could be at the forefront of psilocybin-assisted psychotherapy if we reassess the laws that are prohibiting research. 

Psilocybin was prohibited by the UK government (along with many other substances) in a blanket ban following the UN Convention of 1971, before any research had been carried out. The UK followed the lead of the US in placing the harshest penalties and restrictions on this molecule, and in 2001 classified it as a Schedule 1 substance, hindering researchers from studying psilocybin.

Now, our country has the opportunity to reverse these unfounded restrictions, and is in the perfect position to bring a fresh innovation to the global healthcare community. We are calling on our government to take this opportunity to remove the restrictions on our scientists, enabling them to produce world-leading research on psilocybin.

References

Carhart-Harris & Nutt (2017) Serotonin and Brain Function: A Tale of Two Receptors. J Psychopharm, 31(9), p1091-1120.

Cusin et al. (2007) Early Symptomatic Worsening During Treatment With Fluoxetine in Major Depressive Disorder: Prevalence and Implications. J Clin Psychiatry, 68(1), p52-57.

Johnson et al. (2012) Reviewing Long-term Antidepressants Can Reduce Drug Burden. Br J Gen Pract, DOI: 10.3399/bjgp12X658304

Kessler et al. (2003) The Epidemiology of Major Depressive Disorder. JAMA, 289(23), p3095-3105.

Lepping et al. (2017) Clinical Relevance of Findings in Trials of CBT for Depression. European Psychiatry, 45, p207-211.

Rohden et al. (2017) Dropout Prevalence and Associated Factors in Randomized Clinical Trials of Adolescents Treated for Depression: Systematic Review and Meta-analysis. Clinical Therapeutics, 39(5), p971-992.

Thomas et al. (2013) Prevalence of Treatment-resistant Depression in Primary Care. Br J Gen Pract, DOI: 10.3399/bjgp13X675430

Wiles et al. (2018) Management of Treatment-resistant Depression in Primary Care. Br J Gen Pract, DOI: 10.3399/bjgp18X699053