To ease depression, cancer patients will get group therapy — and a psychedelic drug
As medical director of the Aquilino Cancer Center, Dr. Manish Agrawal has seen the progress made possible by cancer research.
Death rates from cancer have declined steadily among men and women, and for most common cancers, including lung, breast, and prostate cancers.
“The longer you’re in practice. you realize that we do a really good job with cancer-directed treatment,” Dr. Agrawal says.
But Dr. Agrawal has also seen patients struggle with depression and anxiety. Some cannot get the help they need.
“There’s so much emotional and psychological suffering that cancer patients and their families go through,” he says, “We never fully address that.”
Now, a small group of patients at Aquilino, an outpatient treatment center at Shady Grove Adventist Hospital in Rockville, MD, will have the chance to try something new — treatment that combines group therapy with a single dose of psilocybin, a psychedelic drug that is the active ingredient in so-called magic mushrooms. Psilocybin is illegal, but the government gives select researchers permission to use it in controlled clinical settings.
“We already have a waiting list of patients,” Dr. Agrawal told me, via Zoom, last week. “This trial could transform the way we help cancer patients cope with the psychological impact of life-threatening disease.”
The clinical trial is funded by Compass Pathways, a UK-based startup that will supply the synthetic psilocybin and train the therapists. Compass Pathways, which is seeking FDA approval for psilocybin-assisted therapy as a treatment for depression, says it is conducting clinical trials at 20 study centers in the US and Europe. Thirty patients will be enrolled in the study at Aquilino.
Compass Pathways went public just last week, with a valuation of close to $1b billion at the end of its first day of trading. Its investors include ATAI Life Sciences, a global biotech company focused on mental health and Thiel Capital, an investment firm started by PayPal co-founder Peter Thiel.
A son-and-father team
The lead therapist on the Aquilino trial will be Brian Richards, a clinical psychologist, who will work alongside his father, Bill Richards, a psychologist at the John Hopkins Center for Psychedelic Research, who has been studying psychedelic medicines since the 1960s. [See my story, A minister, a rabbi and the man who gave them psilocybin.] Psychedelic research is, for the moment, a small world.
Perhaps surprisingly, treating depression in cancer patients with psychedelic drugs and talk therapy is by no means a new idea. In the 1960s and 1970s, Not long after, scientists including Bill Richards administered LSD and a synthetic compound called DPT to cancer patients at the Maryland Psychiatric Research Center in Baltimore. The results were encouraging, although the studies did not meet today’s standards for evidence.
“Some of the most meaningful work I’ve done over the years has been with end-of-life issues,” Bill Richards told me. “A psychedelic experience can transform family dynamics and enable a terminally ill person to enjoy the remainder of his or her life.”
In recent years, researchers at the Johns Hopkins and NYU medical schools gave patients with life-threatening cancers doses of psilocybin, accompanied by therapy. [Michael Pollan reported on their work in The Trip Treatment, his seminal 2015 story in The New Yorker.] NYU says its treatment protocol “produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual well being, and increased quality of life.” Remarkably, the effects persisted for years.
The Aquilino trial will be the first to see if group therapy can generate similar results. While Hopkins and NYU gave psilocybin to one patient at a time — and each patient was guided by two therapists — Aquilino will give simultaneous doses to as many as four patients, who will be assisted by five therapists in all.
Each patient will have a private room located in a 2,700 sq. ft. care center specifically designed for psilocybin therapy. Gensler, the architecture firm that designed the space, says it sought to create “a serene aesthetic within which patients could disconnect from the characteristically chaotic hospital environment, feel safe and supported, and successfully undergo treatment.”
There are two reasons for working with groups, Dr. Agrawal says. First, it saves money; in the long run, psychedelic-assisted therapy will only become widely available if it is covered by insurance. Second, peer support can ben helpful. “There’s a lot of data that says that group therapy is beneficial for patients,” he says.
Easing the fear of death
Precisely how the combination of psilocybin and therapy helps with depression is hard to know. Some cancer patients reported that their fears of death had been eased. Scientists using fMRI scans say the drug trip quiets parts of the brain associated with the ego and self-control, and enables people to feel closer to others. A landmark Johns Hopkins study in 2016 found that psilocybin occasions “mystical-type experience” and “prosocial attitudes and behaviors.”
Dr. Agrawal, who is 51, is interested in the deeper questions raised by psychedelics. He had planned to major in philosophy in college until he was discouraged by his father, an immigrant from India. He studied electrical engineering and worked briefly for a computer manufacturer before switching to medicine because he wanted to work more closely with people.
Later, Dr. Agrawal earned a masters in philosophy at Georgetown which, unexpectedly, turns out to have on-the job value. He told me: “Every day, my patients ask me, what’s the meaning of life? What am I here? What’s death?”
He can’t provide answers, of course, but he can invite them to dig deeper into themselves — with or without the help of psychedelics.