Effects of psilocybin versus escitalopram on rumination and thought suppression in depression

Abstract

Background Major depressive disorder is often associated with maladaptive coping strategies, including rumination and thought suppression. Aims To assess the comparative effect of the selective serotonin reuptake inhibitor escitalopram, and the serotonergic psychedelic psilocybin (COMP360), on rumination and thought suppression in major depressive disorder. Method Based on data derived from a randomised clinical trial (N = 59), we performed exploratory analyses on the impact of escitalopram versus psilocybin (i.e. condition) on rumination and thought suppression from 1 week before to 6 weeks after treatment inception (i.e. time), using mixed analysis of variance. Condition responder versus non-responder subgroup analyses were also done, using the standard definition of ≥50% symptom reduction. Results A time×condition interaction was found for rumination (F(1, 56) = 4.58, P = 0.037) and thought suppression (F(1,57) = 5.88, P = 0.019), with post hoc tests revealing significant decreases exclusively in the psilocybin condition. When analysing via response, a significant time×condition×response interaction for thought suppression (F(1,54) = 8.42, P = 0.005) and a significant time×response interaction for rumination (F(1,54) = 23.50, P < 0.001) were evident. Follow-up tests revealed that decreased thought suppression was exclusive to psilocybin responders, whereas rumination decreased in both responder groups. In the psilocybin arm, decreases in rumination and thought suppression correlated with ego dissolution and session-linked psychological insight. Conclusions These data provide further evidence on the therapeutic mechanisms of psilocybin and escitalopram in the treatment of depression.

Efficacy of psilocybin for treating symptoms of depression: systematic review and meta-analysis

“…The Cochrane RoB 2 tools were used to evaluate the included studies ( table 3 ). RoB 2 for randomised trials was used for the five reports of parallel randomised trials (Carhart-Harris et al 63 and its secondary analysis Barba et al, 64 Goodwin et al 18 and its secondary analysis Goodwin et al, 65 and von Rotz et al 66 ) and RoB 2 for crossover trials was used for the four reports of crossover randomised trials (Griffiths et al, 14 Grob et al, 15 and Ross et al 17 and its follow-up Ross et al 67 ). Supplementary Appendix G provides a detailed explanation of the assessment of the included studies.…”

From Taboo to Treatment: The Emergence of Psychedelics in the Management of Pain and Opioid Use Disorder

“…49 As a result, it is possible that psychedelics might also have the potential to lessen these negative emotions associated with pain. This is supported by evidence suggesting that psilocybin may mitigate similar affective phenomena, such as depressive rumination and obsessive thinking, 50 which can resemble the fear of movement seen in chronic pain. Given that depressive and anxiety disorders often co-occur with chronic pain, 51 psychedelics may provide a more comprehensive treatment strategy by targeting these affective aspects, which can often be equally hard to discern and equally debilitating for these patients.…”

Psilocybe cubensis extract potently prevents fear memory recall and freezing behavior in short- but not long-term in a rat model of posttraumatic stress disorder.

“…Other clinical study has reported that psilocybin-assisted therapy facilitates psychosocial-spiritual growth in cancer patients (Shnayder et al, 2023). Psilocybin also significantly decreases thought suppression and rumination in patients with major depressive disorder (Barba et al, 2022). It has been reported that oral administration of 10–25 mg psilocybin may be effective for the treatment of PTSD (Krediet et al, 2020).…”