FDA Clears the Path for Magic Mushrooms. Psilocybin, the psychedelic compound in magic mushrooms, was fast-tracked by the FDA for major depression in November 2019. A phase 2 trial is currently underway by the nonprofit Usona Institute with completion expected by 2021. A separate company, Compass Pharmaceuticals, is testing psilocybin in treatment-resistant depression.

What we know about this serotonin-2 agonist is that it brought rapid relief to treatment-resistant depression in a small open-label trial in 2016. Improvement was seen after 2 doses, and the gains were maintained 6 months later without further dosing. Confirmation of these antidepressant effects has been limited to a small randomized, placebo-controlled trial in patients with depression and terminal cancer.

Psilocybin’s antidepressant effects appear linked to the quality of the spiritual experiences induced by the drug. When it works, it enhances gratitude, forgiveness, death transcendence, religious faith, and closeness to nature and humanity. On the other hand, psilocybin can cause frightening alterations of consciousness. The drug is usually administered in the context of a supportive psychotherapy to foster a safe environment and bring out the positive in its transcendent effects. Similar spiritual experiences have been described on ketamine, and we covered those reports in our July 8, 2019 podcast, “The Secret History of Ketamine.”