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Psilocybin and end-of-life patients

When a patient is terminally ill and facing the end of their life, it can be a massive assault on one’s sense of identity. The life that these patients know is suddenly dissolved and the sense of the future is shortened. In caring for their terminal disease, they often have to undergo dramatic treatments to their bodies. This might mean that their body is dramatically altered by the disease itself or even the treatment. 

All of this can combine into truly complicated feelings about themselves and their bodies, their relationships, and their future. One psychologist has stated the following as a way to understand the grief one goes through in this type of situation: think about what it’s like when you lose one person in your life. Now imagine you know that you’re going to lose every single person in your life at once. That is a huge psychological strain, so therapies like psilocybin-assisted therapy can be hugely beneficial in coping with terminal diagnoses. 

What is the connection between a terminal diagnosis and mental health?

25 to 30% of cancer patients will meet the criteria for a diagnosis of depression, anxiety, or adjustment disorders. That is a significantly higher rate of depression and anxiety than the general population. It makes sense, given the stress a cancer patient must go through, whether they have a terminal diagnosis or not. Continued stress on the body and mind can lead to depression for anyone! 

What is the difference between anticipatory grieving and depression during end-of-life care?

Anticipatory grieving is a healthy adaptive response. It is similar to the normal process of mourning, but happens before death occurs. In this way, terminal patients are part of the process of grieving their own life. However for some patients, the distress becomes so terrifying or preoccupying that they’re unable to experience any kind of pleasure. They become withdrawn, not interacting in their usual ways. Or they become preoccupied and ruminative. Everyday life feels quite terrifying for them. 

This level of anxiety or preoccupation means that these individuals are being robbed of the time they have left with their loved ones. That time is already punctuated by sudden reminders that their life is coming to an end, and there will be psychological distress – but the intensity of that distress can increase a patient’s experience of pain. Anguish literally makes the physical symptoms of their disease worse as well. For those who don’t respond to traditional treatments, psilocybin therapy can be life-changing. 

When was psilocybin first used as a medical treatment?

Psilocybin has a rich history of Indigenous use and sacramental use in healing ceremonies prior to and during colonization. In its modern conception, an anaesthesiologist in the 1960s was looking for a new treatment to treat pain in advanced cancer. He had heard that LSD could potentially disrupt some pain signals, so he began giving some of his terminal cancer patients LSD without telling them. Questionable research methodology aside, the LSD actually did disrupt pain signals, but more interestingly, an unintended side effect was shifting people’s attitudes towards death.

This anaesthesiologist found that people he treated with psychedelics experienced a rapid reduction in distress around their anxiety around dying. They reported increased sense of connection to others, and they were much more present and mindful with their families rather than ruminating about their illness. The Controlled Substances Act brought all of that research to a grinding halt and began the war on drugs.

When did psilocybin therapy for terminal patients start again?

In the early 2000s, researchers at UCLA conducted a study which achieved remarkable findings. People were dosed with 0.2 milligrams per kilo of body weight, which was quite a small dose, and they were still able to get amazing findings. 

Similar studies were conducted at Johns Hopkins and NYU, demonstrating the positive effect of psilocybin on patients with depression and anxiety. Around 70 to 80% of patients were able to achieve remission of depression and anxiety symptoms after a single therapeutic dose. This cure was maintained at the six month follow up and an even more recent follow up. 

How does psilocybin help patients who are experiencing terminal illness?

Psilocybin is quite similar to antidepressants in how it acts on the body, binding to the 5HT2A receptors and flooding them. Psilocybin down-regulated the default mode network, which is a network of brain regions that tend to be more active when we’re at rest and when we’re engaged in self-referential thinking. Ruminating, like we see with anxiety and depression, is this type of self-referential thinking. Down-regulating the default mode network allows for more expanded and deepened perspective. It allows you to look at old problems in your life in a new way. 

For a terminally ill person, these altered perspectives can offer them an opportunity to look at the ruptured relationship with their self, their body, their illness, and their trajectory towards death in a very different way. A very expanded and deepened way. Mushroom trips are often marked by experiences of the mystical or transcendent variety, along with expanded sensory perception. For someone who is terminally ill, accessing their body in this completely different way also contributes to the therapeutic effects of psilocybin.

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