The goal of this study is to learn how psilocybin delivered with mindfulness-based therapy may help symptoms of posttraumatic stress disorder (PTSD). This is an assessor-blinded, randomized, controlled study in participants with PTSD. The study will investigate the changes in brain activity, connectivity, and microstructural neuroplasticity assessed using EEG/EMG and multimodal MRI measures after administration of one oral dose of psilocybin, accompanied either with standard "psychological support" only; or with standard support plus Mindfulness-based Cognitive Therapy (MBCT).
Many patients with PTSD do not respond or have an incomplete response to treatment with currently available medications that are FDA-approved for PTSD, and/or do not respond to psychotherapies for PTSD. The use of psychedelics (e.g. psilocybin) is being investigated as a new approach to improve symptoms in patients with PTSD and depression, however their mechanism of action is still not well understood. Furthermore, while psychedelics are usually administered in the context of psychological support ("psychedelic assisted therapy", PAT) the kinds of support therapy used and possible interactions with drug with therapy effects is not well understood. This study will investigate the changes in brain activity, connectivity, and microstructural neuroplasticity, assessed using electroencephalography (EEG) / electromyography (EMG) and functional magnetic resonance imaging (fMRI) /diffusion-weighted magnetic resonance imaging (DWI), after administration of one oral dose of 25 mg synthetic Psilocybin delivered in the context of either non-directive psychological support only (the most common approach for PAT) or in combination with psychological support plus an active form of psychotherapy called Mindfulness-based Cognitive Therapy (MBCT). Up to 30 participants will be enrolled altogether. The initial phase of this study will be an open label administration of 25 mg synthetic Psilocybin combined with standard "PAT psychological support" plus MBCT in ten participants with PTSD, to allow us to pilot this new intervention package. In the next phase of the study, we will randomly assign twenty participants with PTSD into two groups: one group receiving 25 mg of synthetic Psilocybin (open label) combined with standard "PAT support" only, and one group receiving 25 mg of synthetic Psilocybin (open label) combined with standard "support" plus active form MBCT psychotherapy. In both groups, psychological support will be provided before, during and after the administration session. The MBCT group will also receive bi-weekly individual MBCT sessions and will be invited to complete daily homework, as per the MBCT protocol. Assessments performed at Baseline and on Day 2 and Day 28 after administration will include EEG/EMG, MRI, clinician-administered scales (CAPS-5, MADRS, C-SSRS) and self-report questionnaires to assess PTSD, depression and anxiety symptoms, cognitive testing, self-report questionnaires to evaluate the psychedelic effects of synthetic Psilocybin administration, and blood collection for the Gsα-AC biomarker assay.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
The experimental arm has psilocybin with support and MBCT sessions.
The active comparator has psilocybin with support only.
Changes in parameter estimate of regional brain activity measured by fMRI after one dose of psilocybin in participants with PTSD
Change in Blood oxygenation level dependent (BOLD) fMRI signal after task comparing PAT with MBCT group vs PAT with support only group
Time frame: Between Baseline and Time point 24 hours and 28 days post-Investigational Product
Changes in region-to-region connectivity measured by fMRI after PAT with one dose of psilocybin in patients with PTSD
Changes in resting state activity of brain areas comparing PAT with MBCT group vs PAT with support only group
Time frame: Between Baseline and Time point 24 hours and 28 days post-Investigational Product
Changes in event related potentials (ERP) after PAT with one dose of psilocybin in participants with PTSD
Change in ERP as assessed by Electroencephalography (EEG) after task comparing PAT+MBCT group and PAT with support only group
Time frame: Between Baseline and Time point 24 hours and 28 days post-Investigational Product.
Changes in acoustic startle electromyographic (EMG) response after PAT with one dose of psilocybin in patients with PTSD
Changes in acoustic startle magnitude measured by EMG after task comparing PAT + MBCT group and PAT with support only group
Time frame: Between Baseline and Time point 24 hours and 28 days post-Investigational Product
Changes in clinician-assessed PTSD Symptoms after PAT with one dose of psilocybin in patients with PTSD
Comparison of Clinician Administered PTSD Scale for DSM-5 (CAPS-5 ) score changes from Baseline to 28 days post IP between PAT + MBCT group vs the PAT with support only group. CAPS-5 scores are minimum 0 and maximum 80, higher scores mean a worse outcome
Time frame: Baseline to 24 h and 28 days post IP
Changes in clinician-assessed Depression Symptoms after PAT with one dose of psilocybin in patients with PTSD
Comparison of Montgomery Ashberg Depression Rating Scale (MADRS) score changes from Baseline to 24 hrs and 28 days post IP between PAT + MBCT group vs the PAT with support only group. MADRS scores are minimum 0 and maximum 60, higher scores mean a worse outcome
Time frame: Baseline to 24 hours and 28 days post-Investigational Product (IP)
Changes in Self-report PTSD Symptoms after PAT with one dose of psilocybin in patients with PTSD
Comparison of PTSD Checklist for DSM-5 (PCL-5) score changes from Baseline to 28 days post IP between PAT + MBCT group vs the PAT with support only group. PCL-5 scores are minimum 0 and maximum 80, higher scores mean a worse outcome
Time frame: Baseline to 24 hrs and 28 days post IP
Changes in Self-report Depression Symptoms after PAT with one dose of psilocybin in patients with PTSD
Comparison of Beck Depression Inventory - II (BDI-II) score changes from Baseline to 28 days post IP between PAT + MBCT group vs the PAT with support only group. BDI-II scores are minimum 0 and maximum 63, higher scores mean a worse outcome
Time frame: Baseline to 24 hrs and 28 days post IP
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