Psilocybin Therapy Eases Clinicians' Depression Post-COVID Frontline Work

Anthony Back, MD

Credit: UW Medicine

A new study showed psilocybin therapy significantly reduced depression symptoms experienced by clinicians after frontline work during the COVID-19 pandemic.¹

“I think psilocybin gave them the opportunity to really see their own feelings and see their own situation in a way that they could have more compassion for themselves and more understanding about what had really happened,” said lead investigator Anthony Back, MD, from the departments of Medicine and Psychiatry at the University of Washington.² “It was effective because it gave them a new perspective on what they were facing, in a way that they could take action.”

Many physicians, advanced practice practitioners, and nurses who worked frontline during the COVID-19 pandemic experienced burnout, depression, and PTSD.1 They had to witness intense suffering and high death rates, as well as make decisions under extreme uncertainty, work long shifts, fear for the safety of themselves and their family, and stay isolated due to self-quarantine.

If working as first responders was not nerve-wracking enough, clinicians became targets of politically motivated attacks.³

Earlier studies had shown administering psilocybin as psychological support or therapy brought improvements in individuals with major depressive disorder (MDD) and treatment-resistant depression.¹ Other studies have shown psilocybin therapy improved depression and anxiety symptoms in patients with cancer, who, like the first responders, developed psychiatric symptoms after a life event.

Investigators wanted to see if psilocybin therapy would also improve symptoms of depression, along with burnout and PTSD, in US clinicians who developed these symptoms when working frontline during the pandemic. The primary outcome was a change from baseline in depression symptoms. Blinded raters measured the change using the clinician-administered Montgomery-Asberg Depression Rating Scale (MADRS).

Secondary outcomes included the change in burnout symptoms, measured with the Stanford Professional Fulfillment Index, and symptoms of PTSD, measured with the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5].

The team enrolled 30 clinicians (50% female; mean age: 38 years) who were either physicians, advanced practice practitioners, or nurses from February to December 2022. Clinicians were included if they did frontline work during the pandemic for > 1 month and presented moderate or severe symptoms of depression at baseline but had no pre-pandemic mental health diagnoses.

“Some people who came into the study were really in despair,” Back said.2 “A number of people said, ‘I feel like a robot. I know I'm doing the right things technically. I know I'm saying the right words, but I say them and I'm talking to families who have a loved one who is dying, and I feel nothing — and I know that something is wrong.’”

Participants were randomly assigned 1:1 to receive psilocybin or niacin.1 The intervention included 2 preparation visits, 1 medication session—either 25 mg of psilocybin or 100 mg niacin, orally—and 3 integration visits. Investigators analyzed the data between December 2023 and May 2024.

Participants in the psilocybin arm had greater reductions in depression symptoms from preparation 1 session to day 28 than the niacin arm (mean change, -21.33 vs -9.33; mean difference between arms, -12.00; 95% confidence interval [CI], -17.67 to -6.33; P < .001).

Participants also had greater improvement in symptoms of burnout in the psilocybin arm than in the niacin arm, but this was not statistically significant (-6.40 vs -2.33; P = .05). After reaching this conclusion, investigators chose to evaluate psilocybin’s effect on PTSD symptoms descriptively, rather than evaluating its statistical significance. The team saw patients on psilocybin had a numerically greater reduction in PTSD symptoms compared to those on niacin (-16.67 vs – 6.73), but again, this was not statistically tested.

Many participants described how psilocybin therapy helped them shift their perspectives on human suffering and their ability to help people. Rachel Drayer, who worked as an emergency department physician assistant in Bellevue during the pandemic, said in a press release that her work left her “feeling frantic and discordant.” Now, she operates a preventive health clinic for menopause in rural Wenatchee, Washington.

“(In) the work that I do now, my body feels calm and quiet. It feels … deeply peaceful,” Drayer said. “This study changed my life.”2

References

1. ^{Back AL, Freeman-Young TK, Morgan L, et al. Psilocybin Therapy for Clinicians with Symptoms of Depression From Frontline Care During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(12):e2449026. doi:10.1001/jamanetworkopen.2024.49026}
2. ^{Psilocybin therapy helps clinicians process COVID despair. UW Medicine. December 5, 2024. https://newsroom.uw.edu/news-releases/psilocybin-therapy-helps-clinicians-process-covid-despair#:~:text=Psilocybin%2Dassisted%20psychotherapy%20resulted%20in,who%20received%20a%20placebo%20instead. Accessed December 5, 2024.}
3. ^{Larkin H. Navigating Attacks Against Health Care Workers in the COVID-19 Era. JAMA. 2021 May 11;325(18):1822-1824. doi: 10.1001/jama.2021.2701. PMID: 33881489.}