Many doctors and nurses suffered severe mental health impacts after working through the worst days of the COVID-19 pandemic, including depression, “burnout” and post-traumatic stress disorder (PTSD). Newly published trial results indicate that psilocybin was able to help a small group of them to recover.
Researchers ran a double-blind, randomized trial in Washington State from February-December 2022. Their study was published in the Journal of the American Medical Association (JAMA) on December 5.
The 30 trial participants included doctors, nurses and advanced practice practitioners, all of whom had been frontline COVID responders. None had mental health diagnoses before COVID. But having cared for unprecedented numbers of suffering and dying patients during the pandemic, all had moderate-to-severe depression symptoms by the time they were enrolled in the trial.
“I feel more disposable than a used COVID-19 swab.”
The researchers wanted to test whether psilocybin could help a population that had faced traumatic situations—exacerbated by factors like long working hours and a politicized environment, with many patients skeptical of recommendations like mask wearing and vaccines.
“I feel more disposable than a used COVID-19 swab,” one trial participant said at an initial session.
“I found myself waking up in the middle of the night and logging on … to see if anyone I’d sent home had come back and died or gone to the ICU,” said another.
Each participant was matched with two therapists, and initially received two “preparation” counseling sessions.
At their next session, they then received either 25 milligrams of psilocybin or—for the control group—a placebo. Participants and facilitators engaged in what the researchers described as “secular ceremony,” in order “to reinforce the participant’s belief that they could change and to incorporate their own spirituality.” Participants could choose to sit or lie down, and to wear eyeshades. Music was played, and therapists offered the choice of touch.
Finally, all participants received three further “integration” counseling sessions.
The participants given psilocybin showed more than twice as much improvement as the placebo group, according to scores in a depression questionnaire.
The researchers measured changes in participants’ symptoms—of depression, PTSD and burnout— from the first preparation session (day 1) until day 28, after they had taken the drug or placebo.
The 15 participants who’d been given psilocybin showed more than twice as much improvement as the 15 in the placebo group, according to scores in a depression questionnaire after 28 days. While the placebo group’s average depression score fell by 9.33 points on the rating scale, that of the psilocybin group fell by 21.33 points.
The psilocybin group also showed greater improvement in measures of burnout, but the researchers concluded it wasn’t statistically significant. Similarly, PTSD scores improved in the psilocybin group, but researchers were unable to confirm statistical significance without conducting further analysis.
“For doctors and nurses who feel burned out or disillusioned or disconnected from the patient care they want to provide, this study shows that psilocybin therapy is safe and can help these clinicians work through those feelings and get better,” Dr. Anthony Back, the lead investigator, said in a press release.
Back, a professor at University of Washington School of Medicine in Seattle and a specialist in oncology and palliative care, elaborated on the nature of burnout and its relationship with depression.
“It’s not as well established as a mental health diagnosis,” he told Filter, but “Burnout is a combination of three things: You feel emotionally exhausted, like ‘I can’t do this anymore.’ Another is a feeling of cynicism, like, ‘No matter what I do, it always turns out bad.’ The third part is low personal accomplishment: ‘I’m working and working, but not accomplishing anything.’”
“It starts at work, but over time it bleeds into your whole life,” Back continued. “That turns into depression. Nowadays it’s thought of as a precursor.”
Burnout is frequently observed in “helping professions,” he noted.
“We did not make people [in the placebo group] wait until the study was over to have access to psilocybin.”
After the initial 28 days, all participants in the placebo group were given the option of receiving psilocybin, effectively unblinding them. Back explained that though this decision prevented the researchers from comparing the two groups beyond that point, it was taken because of a desire to actually treat everyone who wanted it. His team gathered data after two, three and six months.
“We did not make people wait until the study was over to have access to psilocybin,” Back said. “I felt that people would not put up with it if … they couldn’t get psilocybin for a year and a half. The idea was to give people early access, even if they [initially] got a placebo.” As a result, “I don’t have a statistical comparison between the two groups at six months.” But depression symptoms in the placebo group would otherwise have been unlikely to improve, he said.
Some of the quotes recorded from participants after psilocybin treatment were far more positive than previously.
“I’m reaching out and leaning on others … and trusting that the people around me can support me,” said one. “I don’t have to carry it all by myself.”
“I was shown my tendency to be a superhero [during treatment],” said another, “messaging that ‘It’s not about you’—that was done with grace, love and accountability.”
Participants also did not experience severe adverse events from taking psilocybin, though there was one instance of nausea requiring medical attention. Another participant, weeks after receiving the drug, expressed the thought that they would be “better off dead;” the person did not show suicidal ideation, however, and didn’t repeat the thought at later dates.
The participants’ challenges reflect a growing crisis in the medical field. A Vital Signs report from the CDC, published in 2023, showed health workers in a mental health crisis. This has led to an increase in workers looking to change profession.
That’s a broader challenge for the United States, when studies project a significant shortage of doctors and nurses as the population ages and needs more care. The US is projected to face shortages of over 400,000 home health aides and 29,000 nurse practitioners by 2025, and of up to 86,000 doctors by 2036.
The researchers acknowledge a couple of limitations in their trial, primarily relating to its small sample. Over 2,200 people applied to participate, but only a tiny fraction could be selected. Future trials, the researchers said, should repeat the protocol with a larger sample.
An additional limitation is that participants were able to accurately “unblind” themselves—being able to tell from the effects whether they took psilocybin or a placebo. Sometimes known as the “expectancy effect,” this is a widespread challenge in psychedelic research.
Photograph (cropped) by Anna Shvets via Pexels