Psilocybin-Induced Brain Changes May Explain Therapeutic Effects

Researchers at University of California, San Francisco and Imperial College London have shown that a single dose of psilocybin, the psychedelic compound found in magic mushrooms, causes likely anatomical brain changes that last for up to a month after the experience.

The study, involving healthy volunteers who had never taken a psychedelic, links temporary shifts in brain “entropy”—which is the diversity of neural activity occurring in the brain—to insight. This suggests the psychedelic trip itself is important to the drug’s longer term therapeutic effects.

The researchers found that a high dose of psilocybin led to increased entropy in the minutes and hours after taking the drug. The degree of entropy predicted how much insight, or emotional self-awareness, the participants felt the next day; and this, in turn, forecasted improvements in their sense of wellbeing a month later.

The findings may help to explain psilocybin’s therapeutic effects on conditions such as depression, anxiety, and addiction. “Psychedelic means ‘psyche-revealing,’ or making the psyche visible,” said senior author Robin Carhart-Harris, PhD, the Ralph Metzner distinguished professor of neurology at UCSF. “Our data shows that such experiences of psychological insight relate to an entropic quality of brain activity and how both are involved in causing subsequent improvements in mental health. It suggests that the trip—and its correlates in the brain—is a key component of how psychedelic therapy works.”  Carhart-Harris is senior and corresponding author of the team’s published paper in Nature Communications, titled “Human brain changes after first psilocybin use.”

“Psychedelics have robust effects on acute brain function and long-term behavior but whether they also cause enduring functional and anatomical brain changes is largely unknown,” the authors wrote. Psilocybin is the precursor of the compound psilocin, a serotonin receptor agonist. “Converging evidence supports a role for serotonin 2A receptor  (5-HT2AR) agonism in eliciting the characteristic brain and subjective effects of this and related psychedelics in humans,” the team continued.

For their newly reported study, Carhart-Harris and colleagues carried out an exploratory, placebo-controlled, within-patient study in 28 psychedelic-naïve participants who each received a single, high-dose (25 mg) of psilocybin. The researchers used an assortment of brain imaging and brain measurement techniques, some of which were carried out during the peak of the psychedelic experience, as well as before and one-month after drug administration. “This was an exploratory, hypothesis-generating mechanistic study in healthy volunteers,” the authors noted. None of the 28 people in the study had a diagnosed mental health condition, which gave the scientists greater freedom to do more testing.

In the first part of the experiment the subjects were given a 1 mg dose of psilocybin, which the researchers regarded as a placebo, and were then monitored with EEG, which records brain activity from electrodes on the scalp.  Over the next few weeks, the researchers measured their subjects’ psychological insight, wellbeing, and cognitive ability. They examined brain activity with functional MRI (fMRI) and brain connectivity with diffusion tensor imaging (DTI).

One month after the placebo, the subjects were given 25 mg of psilocybin, a dose capable of eliciting a strong psychedelic trip. During the experience, researchers again measured the subjects’ brain activity with EEG, and in the following weeks they repeated the same tests they had given after the 1 mg dose.

This enabled the scientists to compare the effects of the psychedelic trip on the brain and mind to the effects of the placebo. “The multimodal neuroimaging design allowed us to observe changes in brain function and (potential) anatomy from 1-h (EEG) to 1-month (DTI) after high-dose psilocybin,” they explained.

The investigators found that within 60 minutes of taking the 25 mg dose of psilocybin, EEG revealed higher entropy, suggesting that the brain was processing a richer body of information under the psychedelic. A month later, the researchers looked at their subjects’ brains using DTI, which measures the diffusion of water along neural tracts in the brain, and found that they were denser and had more integrity. This is the opposite of what happens in aging, which makes these tracts more diffuse.

The researchers cautioned that more work needs to be done to better understand the meaning of this finding, but the result is a never-before-seen sign of how psychedelics can change the brain. ”The inclusion of DTI enabled us to test for long-term changes in the integrity of white matter tracts post psilocybin,” the authors stated. “Results revealed decreased axial diffusivity in prefrontal-subcortical tracts 1-month post 25mg psilocybin.”

The day after the 25 mg dose, all but one of the 28 subjects rated the trip as the “single most” unusual state of consciousness they had ever experienced. The remaining person rated it as among their top five. The study participants said they had experienced more psychological insight after taking the 25 mg of psilocybin than they had after the 1 mg placebo.  The subjects also reported increased wellbeing two and four weeks after the study. This was measured from responses to statements such as, “I’ve been feeling optimistic about the future,” and “I’ve been dealing with problems well.”

As the scientists noted in their paper, “A predictive relationship was also found between brain entropy and longer-term mental-health changes—namely, improved wellbeing. Improved wellbeing could be predicted directly from acute increases in brain entropy as early as 1-h post dosing.”

A month after the study the study individuals also scored better on a test of cognitive flexibility.  “Psilocybin seems to loosen up stereotyped patterns of brain activity and give people the ability to revise entrenched patterns of thought,” said first author Taylor Lyons, PhD, a research associate at Imperial College London. “The fact that these changes track with insight and improved well‑being is especially exciting.”

The scientists found that the subjects who had experienced the largest increases in brain entropy in the minutes to hours after taking psilocybin were the most likely to have increased insight the next day and increased wellbeing a month later. The researchers concluded that improved wellbeing was driven by the experience of insight.

The authors suggest that the study findings could improve treatment for people with mental illness using psilocybin, for example, by ensuring that the right dosage is used to produce the right amount of brain entropy to promote insight. “We already knew psilocybin could be helpful for treating mental illness,” Carhart-Harris said. “But now we have a much better understanding of how.”

In their paper the team concluded, “The present multi-modal neuroimaging study in healthy participants sheds light on the brain effects of first-time high-dose psychedelic use and the therapeutic action of psilocybin-therapy, suggesting that therapeutically relevant changes—i.e., improved wellbeing—can be forecast via an acute human brain action, i.e., an entropic brain effect, that is well-known to relate to the psychedelic experience … Results support a role for psychological insight in mediating the causal association between the entropic brain effect and potentially enduring improvements in wellbeing.”

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Genotype-Guided Antidepressants Could Have Long-Term Benefits

Prescribing antidepressants according to a patient’s genetic makeup could help manage depressive symptoms in the long-term, a clinical trial suggests.

The findings, in JAMA Network Open, suggest pharmacogenetic guidance could have extended benefits, which may not be apparent early on.

Primary results did not indicate that genotype-guided SSRI treatment was better than usual care at three months in A Depression and Opioid Pragmatic Trial in Pharmacogenetics (ADOPT PGx).

However, significantly more patients receiving genotype-guided therapy achieved the secondary endpoint of depression remission at six months.

“Although outcomes were similar early in treatment, differences emerged over time,” noted Kathryn Blake, PharmD, from Nemours Center for Pharmacogenomics and Translational Research in Jacksonville, Florida, and colleagues.

“These findings suggest a possible longer-term clinical benefit and indicate that future studies should focus on evaluating the durability and long-term impact of genotype-guided prescribing in the management of depressive symptoms.”

SSRIs are the most common pharmacotherapy for depression and variants in cytochrome P450 enzymes CYP2D6 and CYP2C19 can affect their metabolism, influencing exposure to this medication.

Indeed, guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC) provide recommendations for SSRI prescribing when genotype information is available.

However, most psychiatry experts and practice guidelines for treating depression have not yet endorsed pharmacogenetic-informed therapy, citing insufficient evidence.

ADOPT PGx was a set of three randomized clinical trials, designed to test whether routine use of pharmacogenetic testing improves medication response among patients with depression, acute pain, or chronic pain.

The ADOPT PGx Depression trial included 221 children and 1239 adults, aged eight years or older who had experienced depression for three months or longer.

A total of 692 patients (47.4%) had an actionable phenotype, of whom 351 (50.7%) were assigned to the intervention, and 341 (49.3%) to usual care.

Among this group, two-thirds reported having depressive symptoms for more than two years, and three quarters were female. The vast majority were on pharmacologic treatment, at 87.1%, with just over half receiving nonpharmacologic treatment.

Participants were randomly assigned to genotype-guided SSRI prescribing or usual care to examine whether pharmacogenetic guidance improves depression over six months.

At three months, there were no significant differences between the intervention and usual care groups in the primary endpoint of change in Patient-Reported Outcomes Measurement Information System (PROMIS) depression T scores among patients with an actionable phenotype.

At this timepoint, there were also no differences in the secondary outcome of adverse effect severity.

However, another secondary endpoint of depression remission according to a PROMIS depression T-score of 16 or less was more likely with the intervention than usual care, at 48.3% (153 of 317 patients) versus 39.4%. (122 of 310 patients).

Based on this, the authors proposed: “These findings suggest that pharmacogenetic testing, including evaluation for CYP2D6 enzyme inhibition (phenoconversion), may offer meaningful benefit with longer follow-up.”

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Brief report: joint trajectories of anxiety and depression symptoms in an inception cohort of autistic youth

Background and AimsAnxiety and depression symptoms are common among autistic youth, yet little is known about the pattern and relationship of their trajectories from childhood into adolescence, a period of increasing social and academic demands.MethodsThis study used parallel process latent growth curve models to examine joint trajectories, including initial levels and rate of change in caregiver-reported depression and anxiety symptoms across age 7–16 within an inception cohort of autistic youth with varied communication abilities. We also examined autistic traits, sex assigned at birth, emotional reactivity and communication ability as potential predictors. Child anxiety and depression symptoms were estimated from Child Behavior Checklist Anxiety and Affective Problems subscales, completed by caregivers approximately annually.ResultsWhereas anxiety symptoms were relatively stable from childhood into adolescence, depression symptoms increased on average; significant heterogeneity of individual trajectories underlaid these overall trends. Findings indicated cross-sectional and longitudinal co-occurrence of anxiety and depression symptoms. Greater autistic traits and emotional reactivity correlated with greater initial anxiety and depression symptoms, but not their trajectories. Stronger communication ability correlated with more initial anxiety, but decreasing anxiety symptoms over time.ConclusionsFindings indicate group-level changes in depression symptoms and synchronous evolution of anxiety and depression symptoms in autistic youth across childhood and adolescence. This indicates the importance of joint monitoring of anxiety and depression symptoms in this period, with changes being potentially informative for early detection and intervention. Considering how anxiety symptom presentation may evolve across development may be a helpful next step to identifying at-risk subgroups.

Impact of COVID-19 pandemic on autism spectrum disorder service providers in Qatar: challenges, insights, and lessons learned

PurposeThe COVID-19 pandemic disrupted essential services, posing unique challenges for individuals with Autism Spectrum Disorder (ASD) who depend on consistent, specialized support. Service providers faced unique challenges in adapting to remote delivery methods, highlighting the fragility of existing systems during crises. This study explored the experiences of ASD service providers in Qatar during the COVID-19 pandemic.MethodsAn online survey of 66 ASD service providers in Qatar was conducted. Data were analyzed using descriptive statistics, chi-square, and likelihood ratio tests, with qualitative responses assessed through thematic analysis.ResultsMost service providers (90.9%) worked remotely during the pandemic, with 81.8% engaging in online services. Providers reported significant skill regression in individuals with ASD. Stress levels were notably high (42.4%) and significantly associated with emotional tolls [p = 0.017, LR = 4.887], financial strains [p = 0.008, LR = 4.337], and personal challenges [p = 0.008, LR = 3.203]. Thematic analysis revealed decreased therapy effectiveness and difficulties in balancing work with family responsibilities.ConclusionThese findings suggest the importance of adaptive service delivery systems that maintain continuity of care during crises. Strengthening autism service infrastructure and developing resilient models are essential to safeguard autism support for future emergencies.

Real-world use of brexpiprazole during inpatient treatment for schizophrenia: continuation, discontinuation, and concomitant psychotropics

IntroductionIn the treatment of schizophrenia, antipsychotics used during acute inpatient care must control acute symptoms while remaining sufficiently tolerable to support treatment beyond the acute phase. Brexpiprazole, a serotonin-dopamine activity modulator may be one such option; however, its real-world use and short-term continuation in acute inpatient settings remain insufficiently characterized.MethodsWe conducted a retrospective observational study of inpatients with DSM-5 schizophrenia treated with brexpiprazole at a university hospital in Japan between June 2018 and July 2024. The index date (week 0) was defined as the date of brexpiprazole initiation during the index hospitalization. The primary outcome was brexpiprazole continuation at week 8. We compared baseline demographic and treatment-related variables between the continuation and discontinuation groups and summarized reasons for discontinuation from electronic medical records. As a secondary exploratory analysis, we examined longitudinal changes in Clinical Global Impressions–Severity scale (CGI-S) and Brief Psychiatric Rating Scale (BPRS) total scores (weeks 0/4/8) in the continuation group using a linear mixed-effects model including time, concomitant psychotropic medication status, and their interaction.ResultsSixty-seven patients were included. Baseline illness severity was substantial (median CGI-S 5.0 [IQR 5.0–6.0]; mean BPRS total 58.5 ± 9.6). Concomitant psychotropic medications were common. Thirty-six patients continued brexpiprazole to week 8 (53.7%). In unadjusted exploratory comparisons, continuation was associated with the female sex (p = 0.036), lower prior chlorpromazine-equivalent dose (p = 0.015), and shorter duration of untreated psychosis (p = 0.003), with a trend toward shorter duration since onset (p = 0.073). The most frequent reason for discontinuation was adverse events (n = 10, 32.3%), most commonly akathisia (n = 6), followed by insufficient efficacy (n = 9, 29.0%) and patient preference/refusal (n = 7, 22.6%). In exploratory mixed-effects analyses within the continuation group, CGI-S and BPRS total scores decreased over time, with significant group-by-time interactions by concomitant medication status. However, between-group differences should be interpreted cautiously.DiscussionThis study describes 8-week continuation and reasons for discontinuation of brexpiprazole in acute inpatient schizophrenia care. Given the retrospective single-center design and potential selection/information bias and unmeasured confounding, further studies are warranted to clarify its clinical positioning in real-world practice.

Addressing the Psychological Needs of Adolescents During the Wait Time for Mental Health Treatment: Service Design Study

<strong>Background:</strong> Adolescents waiting for mental health treatment often experience significant unmet psychological needs, including severe psychological distress, increased use of maladaptive coping strategies, and feelings of abandonment. However, current wait time support offerings across the mental health sector are sparse and lack clear evidence of effectiveness. <strong>Objective:</strong> Using design thinking, this early report describes the development of a service blueprint for a new model of care (<i>While We Wait</i>) designed to address the psychological needs of adolescents during the wait time for mental health treatment in Australia through targeted support from general practitioners (GPs) and brief, self-directed digital interventions. <strong>Methods:</strong> In partnership with health service designers from Deloitte Digital Australia, we conducted a rapid 6-week health service design sprint. This industry-led methodology involved iterative weekly activities, including the development of service user personas and service experience principles, consultation sessions with 12 youth with lived experience experts (aged 18 to 20 years) and 15 GPs, insight synthesis, and service blueprint development. <strong>Results:</strong> The design sprint produced a service blueprint anchored in 5 service experience principles: “I’m never alone,” “It’s for me,” “I’m in control,” “It’s easy to use,” and “It lifts me up.” The proposed service model incorporated a five-stage service journey: (1) recognition (the adolescent acknowledges the need for support), (2) initial consultation and onboarding with the GP, (3) support and monitoring, (4) preparation for treatment, and (5) transition to specialist care and follow-up. Key adolescent service outcomes included uptake, acceptability, self-advocacy, mental health and well-being, perceived quality of care, and help seeking intentions and behaviors. For GPs, outcomes included uptake, feasibility, acceptability, and confidence in supporting adolescents during the wait time. <strong>Conclusions:</strong> This work demonstrates that a rapid, industry-led design thinking approach may help identify priorities for developing services that address adolescents’ needs during the wait time for mental health treatment. The project also highlights the value of co-designing mental health services with lived experience experts and service providers. Together, these findings suggest that the wait time may represent an important opportunity for early therapeutic engagement rather than a passive delay before treatment.

Older Adults’ Experiences Navigating Setup of Digital Health Technology: Implementation Report

<strong>Background:</strong> Digital health and connected technologies may support better health outcomes among older adults, including those with multiple chronic conditions or low engagement in health behaviors. However, initial experiences with technology, including during unboxing, setup, and first use, can influence emotional reactions and perceptions and can ultimately determine sustained, meaningful use. Older adults with low technology experience or poor health may be particularly vulnerable to frustration, stress, or abandonment of devices when early interactions are negative. <strong>Objective:</strong> The purpose of this implementation study was to closely observe the initial engagements with a telehealth treatment app and connected blood pressure monitor (BPM) among a group of older adults with low prior technology use and reported low health behavior engagement. The goal was to identify setup “pain points” that may influence initial impressions and intention to use the technology over time. <strong>Methods:</strong> A total of 24 older adults (aged ≥65 years) were recruited for a 4-week trial of a telehealth app. Participants were provided with a box containing a tablet preloaded with the app, paper instructions, and a BPM and cuff. Researchers first conducted in-home ethnographic interviews with participants to observe the unboxing and setup process, documenting experiences with reading instructions, using the BPM, and engaging with customer support. Weekly check-in calls and a final exit interview captured ongoing experiences and likelihood of continued use. Interview recordings were transcribed and independently coded, guided by the unified theory of acceptance and use of technology. <strong>Results:</strong> Most of the sample were White (20/24, 83%) and female (14/24, 58%). Negative experiences with the app’s customer support were the top challenge for participants, with representatives providing confusing steps or conflicting terminology. Other common challenges were understanding instructions, connecting to Bluetooth, and correctly using the BPM. While 67% (16/24) of the participants indicated that they were likely or very likely to continue to use the app after the study ended at the end of week 1, this number dropped to 54% (13/24) by the end of the 4 weeks. Participants who reported lower technology self-efficacy at the beginning of the study also experienced frustration, anxiety, and embarrassment as friction with the setup process continued. <strong>Conclusions:</strong> First impressions of digital health apps play a critical role in influencing older adults’ emotions and perceptions regarding the technology and may impact the likelihood of longer-term engagement. Those with lower technology self-efficacy are particularly susceptible to experiencing negative emotions such as frustration, stress, or shame. Mobile health apps and interventions targeting older adults should incorporate simplified instructions with clear, consistent terminology and well-trained customer support staff to improve the onboarding experience.

Curiosity in a Novel Virtual Reality Scenario and Its Association With Symptoms of Depression: Observational Pilot Investigation

Background: Curiosity plays a fundamental role in human learning, development, and motivation, and emerging evidence suggests that reduced curiosity is linked to poorer mental health outcomes, including depressive symptoms (DS). However, to date, the majority of curiosity research relies on self-report assessments and thus risks biased reporting. Virtual reality (VR), a novel tool increasingly used within mental health research and treatment, might represent a potent tool for offering ecologically valid insights into curiosity-driven behaviors while circumventing issues related to self-report assessments, including demand characteristics and recall bias. Objective: The study aimed to enhance the assessment of curiosity by using a novel VR environment and to examine its relevance to DS. Specifically, we tested 2 hypotheses using a novel VR environment: first, that curiosity, as assessed through spontaneous exploratory interactions and behaviors in VR, positively correlates with self-reported curiosity, and second, that VR-based curiosity is inversely associated with DS. Methods: This exploratory study used an observational design that included 100 volunteers. All participants completed self-reported assessments of DS and curiosity before engaging in a novel VR scenario. Although progression in the virtual environment required solving cognitive tasks, these were embedded as structural elements rather than framed as the primary objective. Instead, participants’ free explorations and interactions with objects formed the basis for the 4 curiosity metrics used in this study. After VR exposure, participants completed a questionnaire assessing cybersickness symptoms. Results: Hypothesis 1 was not supported, as only one curiosity metric, namely object interactions, was positively associated with one aspect of curiosity relating to motivation to seek new knowledge and experiences. Further, diminishing significance after correction for multiple testing warranted caution. Results relating to hypothesis 2 indicated partial support, in that object interaction was significantly associated with DS while controlling for age, sex, and cybersickness levels. Sensitivity analyses showed no associations between object interactions and self-reported anxiety and stress symptoms. Conclusions: VR may be a potent tool for assessing exploratory behaviors in a controlled, yet ecologically valid, environment that avoids issues related to self-report. However, whether such motivations translate to established curiosity constructs warrants further research. This study also provided preliminary insights into how assessing exploratory interactions in VR may be a promising avenue that could enhance the understanding of the etiology and assessment of DS—particularly its early stages.
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Biomarker of Epigenetic Aging Could Signal Depression

Research led by New York University suggests a marker of epigenetic aging could be linked to depression.

The team found that accelerated aging of a type of white blood cell called a monocyte was significantly associated with the psychological and cognitive expressions of depression in a group of women with and without HIV.

“Depression is not a one-size-fits-all disorder—it can look really different from person to person, which is why it’s so important to consider varied presentations and not just a clinical label,” said lead researcher Nicole Beaulieu Perez, PhD, assistant professor at NYU Rory Meyers College of Nursing, in a press statement.

“Our study reveals unique biological underpinnings of mental health that are often obscured by broad diagnostic categories.”

As reported in The Journals of Gerontology Series A, the researchers analyzed blood samples and depression scores from 440 women, 261 living with HIV and 179 without, from the Women’s Interagency HIV Study. They tested women with HIV as people with this disease and others affecting the immune system are at greater risk of depression than the general public.

The team looked at biological aging using two epigenetic clocks: a broad multi-tissue clock and a monocyte-specific clock that measures chemical modifications to DNA in these cells.

Depression was measured using the CES-D questionnaire, which separates physical, bodily expressions of depression such as fatigue, appetite loss, and agitation from psychological and cognitive expressions of the disorder such as hopelessness, anhedonia, and feelings of failure.

Accelerated monocyte aging was significantly associated with the psychological and cognitive expressions of depression and with anhedonia specifically, even after adjusting for HIV status, race, and ethnicity. The broader multi-tissue Horvath clock showed no association with any depression domain, suggesting it is the monocyte-specific aging signal, not generalized biological aging, that tracks with mood and cognitive symptoms.

Diagnosis of depression relies largely on self-reported symptoms and not a specific physiological test. The finding that monocyte aging maps onto cognitive and mood symptoms rather than physical ones is counterintuitive, since monocytes are inflammatory cells that one might expect to track physical, inflammation-driven complaints like fatigue.

The study is small and cross-sectional, so causality cannot yet be established, but if the claims of the study were validated it could help to personalize treatment for depression in the future.

“The dynamics of monocyte aging and depression warrant further study to clarify mechanistic links,” conclude the authors.

“Our findings bring us a step closer to this goal of precision mental health care, especially for high-risk populations, by providing a biological framework that could guide future diagnosis and treatment,” adds Beaulieu Perez.

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