Psychedelics Shown to Ease Psychological Distress in the Dying
Doctors can’t yet write a prescription for psychedelics to treat fear, depression, and anxiety in dying people, but if research in the next several years continues to show the same amazing results of recent studies, that may become possible. This article discusses the rationale for the use of psychedelics in this limited way and the substantial and sustained benefits of one to two doses as part of a treatment regimen.
Of all the symptoms that burden people facing death, perhaps depression has the greatest impact on all areas of functioning and is the most predictive of poor quality of life. According to a study conducted in 2001 by Dr. Robert L. Fine of Baylor University Medical Center, up to 77 percent of people with a terminal illness exhibit signs of depression. Other studies indicate that clinical depression affects anywhere from 15-50 percent of terminal patients. Regardless of the statistics, it is clear that depression has a major impact on people with a terminal illness and is under reported and under diagnosed.
In my work as a doula and a hospice social worker, I have seen depression in most people at some point in their dying process. Of course, depression is a common and expected response to loss, and what greater loss is there than the anticipated loss of life. But this natural response to loss is amplified in our society by the portrayal of death as a dreaded enemy that steals from us everything we love.
Depression leads to increased sadness, a flattening of mood, less capacity for pleasure, loss of the sense of meaning, and diminished connection to other people. As uncomfortable as those symptoms are in and of themselves, depression also exacerbates physical symptoms. Terminally ill people who suffer with depression experience worse pain and increased physical symptomology. Depression also leads to less cooperation with treatment, less well considered decisions, more time spent in the hospital, less work around separating and saying good-bye to loved ones, a poorer quality of life overall, and a shortened time before death.
The traditional treatments for depression and anxiety involve the use of antidepressants and psychotherapy. Sometimes alternative treatments like yoga, acupuncture, and massage are used to complement or in place of the pharmacologic approaches. While studies indicate that these traditional treatments can be somewhat effective, the degree of effectiveness is not clear and severe depression seems resistant to all of these methods.
Some studies using antidepressants with terminal patients showed they were effective for only 40 percent of the participants, which is about the same as a placebo. Even more importantly, all these approaches can take months to lessen the depression and the pharmacological treatments may have unpleasant side affects.
In recent years researchers have achieved amazing results in FDA approved trials using the psychedelic medication psilocybin. Part of what makes this approach so promising is that it requires only one to two doses to produce incredibly beneficial results that last for at least six months. And there are no observable side effects beyond a headache or slight upset stomach that some people experience, and which disappears within hours of taking the medication.
“Our study (with psilocybin) at New York University and one conducted at John Hopkins showed immediate, substantial, and sustainable positive results for anxiety and depression the likes of which have not been seen in the history of psychiatry,” says Dr. Anthony Bossis, one of the principle researchers for the New York University (NYU) study. “Up to 80 percent of the 29 participants maintained their improvement in depression and anxiety at the six-month follow-up appointment,” he added, “which shows how effective this treatment is.”
The study at John Hopkins University that involved 50 participants showed the same kind of results. At the six-month mark, 78 percent of participants continued to feel a dramatic improvement in their depression; 65 percent were almost fully recovered, based on several psychological scales used to measure depression. 83 percent of participants continued to feel much less anxious, with 57 percent almost fully recovered.
Both of these studies were conducted with people suffering a terminal cancer diagnosis. Similar studies conducted at major academic medical centers during the early 1960s to early 1970s, using primarily LSD with people having a terminal illness, also showed dramatically positive results. Those earlier studies had a total of several hundred participants who reported marked improvement in existential and psychological distress.
In one of those studies conducted by Dr. Stanislav Grof at Spring Grove State Hospital, near Baltimore, participants had sustained relief from the “terror” of dying. One person said: “I realized that all of this negative fear and guilt was such a hindrance to making the most of and enjoying the time left.” There was a visceral understanding that there is a present, a now, and it was there for people to live their dying free of fear and depression.
The studies with LSD and other psychedelics ended in the early 1970s when Congress passed the Controlled Substance Act, which made all psychoactive medications highly regulated. Research on the use of psychedelics for dying patients started up again in a limited way about six years ago. One of the two studies from that time used LSD, the other used psilocybin. Most of the participants were cancer patients, but one of the studies included people with other terminal diagnoses. The results showed again that there were immediate and sustained psychological benefits to those medications.
The two recent studies at NYU and Johns Hopkins were reported on in the Journal of Psychopharmacology in December 2016. They were both conducted under the rules and guidelines of FDA Phase 2 clinical trials. The method of these double blind studies involved preparing the participants through a number of counseling sessions prior to administration of the psilocybin. The session with the medication lasted about eight hours and had a guide present for the entire experience. Six months after the psilocybin session there was a follow-up session. What makes these recent studies so important is the scientific rigor with which they were conducted and the substantiation of results from earlier studies.
During the session with the medication the participant is told to “trust, stay open, and let go.” Dr. Bossis also tells people: “Even if what you are seeing is weird or dark, just relax and move into it, because moving through the experience will generally be very helpful and the images will change in time.” Some people actually experienced their death and saw the peace and light that wait on the other side of it.
In addition to the impact on depression and anxiety, participants in the recent studies reported that their experience on psilocybin was one of the top five experiences of their life. 87 percent reported increased life satisfaction, wellbeing, and sense of meaning. There was a corresponding decrease in their sense of demoralization and hopelessness.
Dr. Bossis connects these results to the fact that participants have a “mystical” experience on psilocybin, which allows them to see their death from a spiritual perspective. “Many participants spoke of experiencing love as the essential nature of life and that which awaits them after death,” said Dr. Bossis. “One participant, who said she didn’t believe in god or an afterlife prior to the session (on psilocybin), spoke about seeing and feeling that there is something larger than herself,” he said, “even though her feelings about god didn’t change.” Another person who reported experiencing their death during the eight-hour session, said paradoxically: ”I died, but I never felt more alive.”
The immediate descriptions of their experiences had a deep impact on Dr. Bossis, who personally acted as a guide throughout about a third of the psilocybin sessions. He remembers well one participant in particular whom he visited months later, knowing that it would be the last time he saw him before he would die. “I became emotional as I was saying goodbye,” Dr. Bossis said. “He (the dying person) smiled from ear to ear, stood up even though that was difficult, and told me not to worry, ‘It’s going to be okay.’ There he was reassuring me.”
The next step in this research with the dying is hopefully to conduct FDA approved Phase 3 clinical trials. If that happens those trials would involve many more participants at a number of sites. Phase 2 trials, such as the ones reported on last year, are primarily about the safety of the medication, although they also studied how effective the medication is in treating depression and anxiety in the dying. Phase 3 trails would be primarily focused on the efficacy of the approach and determining how easy it is to replicate the results.
Already some people are preparing to become psychedelic psychotherapists in anticipation of the day that this treatment is legally permitted for patients with a terminal illness. One program that awards a certificate in psychedelic-assisted therapies and research is the California Institute of Integral Studies. Dr. Bossis is one of the many presenters in this program.
It would seem only natural that a treatment approach showing such stunningly positive results would one day be available to any dying person. When one to two doses of a medication can make such a difference existentially and psychologically it would seem almost unethical to withhold it from people who are dying.