Psilocybin-assisted psychotherapy: Exploring new treatments for distress at end of life
An article written by Dr Marg Ross, Senior Clinical Psychologist, St. Vincent’s Hospital Melbourne
For some people living with a life-limiting illness, feelings of anxiety, depression, or loss of meaning can be overwhelming. While palliative care offers vital medical, emotional, and spiritual support, not all distress responds to existing treatments. Emerging research suggests that psilocybin-assisted psychotherapy may provide a new option for easing psychological and existential suffering.
What is psilocybin-assisted psychotherapy?
Psilocybin is a naturally occurring psychedelic compound found in psilocybe mushrooms. When administered in a medical research context, it has been shown to evoke intense, and sometimes quite transformative personal introspection that can help alleviate anxiety and depression associated with living with a life-threatening illness.
In clinical studies, psilocybin is not given in isolation. It is combined with a carefully structured psychotherapeutic process that includes:
- Preparation: time spent with trained therapists to build trust and prepare for the experience.
- The dosing session: a carefully supported session in which the participant takes psilocybin in a safe environment. This takes several hours.
- Integration: follow-up therapy sessions to reflect on the experience and apply insights in daily life.
Safeguards such as thorough medical and psychiatric screening, therapist support, and close monitoring are essential, and the treatment remains experimental outside of clinical trials.
Psilocybin affects the brain’s serotonin system and produces an altered state of consciousness. For some, psilocybin-assisted psychotherapy can be very intense and even anxiety provoking, but can also bring a profound sense of peace, connection, or acceptance.
What does the research say?
International trials in people with cancer have shown that psilocybin-assisted psychotherapy can lead to rapid and sustained reductions in depression and anxiety. Participants often report a renewed sense of meaning, less fear of death, and improved wellbeing.
In Australia, we recently completed the country’s first trial of psilocybin-assisted psychotherapy for people with life-limiting illness at St. Vincent’s Hospital Melbourne. [1] Participants included people with stage 4 cancer, motor neurone disease, advanced cardiac failure, cystic fibrosis and other serious conditions, all of whom were experiencing significant anxiety or depression.
The study found that one psilocybin session, when combined with psychotherapy, produced significant improvements in mood and reduced distress compared with placebo. Many participants described the session as profoundly meaningful. The treatment was safely completed under clinical conditions, with no serious adverse events reported.
These results are promising, but more research is needed to understand long-term outcomes, how to best integrate psilocybin into palliative care, and which patients are most likely to benefit.
Current access in Australia
Since July 2023, authorised psychiatrists have been able to administer psilocybin- assisted psychotherapy for people living with treatment-resistant depression under the Therapeutic Goods Administration’s (TGA) Authorised Prescriber Scheme. To be eligible, a person must have tried at least two standard treatments for depression without success.
For people with a life-limiting illness, this means psilocybin-assisted psychotherapy may be possible if they also meet the criteria for treatment-resistant depression, and if they are considered suitable from both a medical and psychiatric perspective.
Research is ongoing, and interest in the role of psychedelic therapies in palliative care is growing locally and abroad.
Looking ahead
Palliative care is about more than managing physical symptoms. It is about relieving the fear, depression, and loss of meaning that can accompany a life-limiting illness. While psilocybin-assisted psychotherapy is still experimental, early research offers hope that new options may emerge to ease these forms of suffering at the end of life.
References:
-
Ross ML, Iyer R, Williams ML, Boughey M, O'Callaghan C, Hiscock R, et al. Psilocybin-assisted psychotherapy for depression and anxiety associated with life threatening illness: A phase 2b randomized controlled trial. Gen Hosp Psychiatry. 2025.
Author
Dr Margaret Ross
Senior Clinical Psychologist
St. Vincent’s Hospital Melbourne