Psychedelic Therapy and Suicide: A Myth Busted? – Medscape

A commonly held belief that classic psychedelic therapy can trigger suicidal thoughts, actions, or other types of self-harm is not supported by research, and, in fact, the opposite may be true.

Results from a meta-analysis of individual patient data showed that psychedelic therapy was associated with large, acute, and sustained decreases in suicidality across a range of clinical patient populations.

"This is the first analysis to synthesize suicidality outcome data from recent clinical trials with psychedelics. It gives us a better understanding of the effects of psychedelics on suicidality in the context of clinical trials," study investigator Cory Weissman, MD, Department of Psychiatry, University of Toronto, Canada, told Medscape Medical News.

The evidence suggests psychedelic therapy "may reduce suicidal ideation when administered in the appropriate setting and offered to carefully screened patients," Weissman said.

The findings were published online January 18 in The Journal of Clinical Psychiatry.

The analysis included seven psychedelic therapy clinical trials that had data on suicidality. Five of the trials used psilocybin plus psychotherapy, and two used ayahuasca plus psychotherapy. All seven trials had a "low" risk of bias.

Patients included in the trials had treatment-resistant major depressive disorder (MDD), recurrent MDD, AIDS-related demoralization, and distress related to life-threatening cancer.

The meta-analytic results showed significant decreases in suicidality at all acute time points (80 to 240 minutes post administration) and at most post-acute time points (1 day to 4 months post administration).

Effect sizes for reductions in suicidality were "large" at all acute time points, with standardized mean differences (SMD) ranging from -1.48 to -1.72, and remained large from 1 day to 34 months after therapy (SMD range, -1.50 to -2.36).

At 6 months, the effect size for reductions in suicidality with psychedelic therapy was "medium" (SMD, -0.65).

Large effect sizes for reductions in suicidality occurred across the different patient populations represented in the trial, the investigators note.

No study reported any suicide-related adverse events because of administration of a psychedelic. There were also "very few" acute (6.5%) or post-acute (3.0%) elevations in suicidality, "providing support for the safety of psychedelic therapy within controlled contexts," the researchers write.

They caution, however, that large controlled trials that specifically evaluate the effect of psychedelic therapy on suicidality are needed.

In an accompanying editorial, Daniel Grossman, BS, and Peter Hendricks, PhD, Department of Health Behavior, University of Alabama at Birmingham, note that results of this review warrant "optimism" for use of psychedelics for treatment of suicidality.

Based on this study and others, classic psychedelic therapy for suicidality appears to be a "promising avenue" for further investigation, they write.

However, research and anecdotes about increased suicidality and other self-harm attributed to psychedelic therapy, "though evidently rare, remain a critical concern" for further research to address, Grossman and Hendricks add.

The hope is that future research "clarifies who is most subject to these risks, what factors best identify them, and how best to navigate their treatment safely," they write.

The meta-analysis had no funding. Weissman receives funding from the Brain and Behavior Research Foundation and serves on the advisory board of GoodCap Pharmaceuticals. Hendricks is on the scientific advisory board of Bright Minds Biosciences Ltd, Eleusis Benefit Corporation, and Rest Pharmaceuticals Inc.

J Clin Psychiatry. Published online January 18, 2022. Abstract, Editorial

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Psychedelic Therapy and Suicide: A Myth Busted? - Medscape