Expert opinion on pharmacotherapyNov 10, 2023

Psychedelics and their potential in hard-to-treat depression

Psychedelic Science Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Apr 2, 2026

Abstract

Psilocybin may induce a rapid antidepressant effect sustained for some responders for at least 3 months.

Emerging evidence indicates that psychedelics may exert antidepressant effects through various neurobiological and psychological mechanisms.
A systematic search revealed a lack of comprehensive reviews on psilocybin's efficacy in treatment-resistant depression (TRD).
Psychedelic therapy is associated with maximizing therapeutic benefits while minimizing potential risks in TRD treatment.
Initial findings suggest that psilocybin could be a significant advancement in TRD therapy.
Further adequately powered, double-blind, comparator-controlled trials are needed to investigate the mechanisms of action and long-term effects of psychedelics.

Simplified

INTRODUCTION: A new era of treatment for adults with treatment-resistant depression (TRD), which involves psychedelic substances, is dawning. Emerging evidence indicates that psychedelics can exert antidepressant effects through multiple neurobiological and psychological mechanisms. However, it remains to be seen if these new treatments will revolutionize the treatment of TRD.

AREAS COVERED: The present review focuses on the efficacy of serotoninergic psychedelics psilocybin, lysergic acid diethylamide (LSD), N,N-dimethyltryptamine (DMT), ayahuasca, 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) and mescaline (3,4,5-trimethoxyphenethylamine), as well as 3,4-methylenedioxymethamphetamine (MDMA), for TRD. A systematic search was conducted for psilocybin in TRD as emerging trials had not yet been subject to review. A narrative review summarized findings on other psychedelics.

EXPERT OPINION: Psychedelic therapy has created a paradigm shift in the treatment of TRD, as it can maximize therapeutic benefits and minimize potential risks. Psilocybin holds promise as a potential game-changer in the treatment of TRD, with initial evidence suggesting a rapid antidepressant effect sustained for some responders for at least 3 months. Nevertheless, further adequately powered, double-blind, comparator-controlled trials are required to explore and clarify the mechanisms of action and long-term effects of psychedelics in TRD. Psychedelics also hold promise for other psychiatric conditions, such as bipolar depression and post-traumatic stress disorder.

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Psychedelics and their potential in hard-to-treat depression

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