When the end is near, psychedelics may ease the anguish

Psychedelics could significantly alleviate the anguish, debilitating depression and death-anxiety often experienced by the terminally ill but its implications could be much more profound, clinicians say.

In an Australian-first, a near three-year clinical trial examined the use of psilocybin - a naturally occurring compound found in some species of mushrooms - in combination with psychotherapy for dozens of people living with crippling, life-threatening illness.

Psychologist Margaret Ross and psychiatrist Justin Dwyer, who co-led the study, said the drug was able to ease the debilitating death-related anxiety and depression experienced by many palliative care patients.

"When you're told you're going to die, your entire world collapses ... it's the final unknowable frontier," Dr Dwyer told AAP.

"Many people find themselves stranded in this endless moment of waiting to die, just waiting for the axe to fall ... with that, comes crushing feelings of despair."

There are few treatments available for people experiencing distress around dying.

Between January 2020 and October 2023, 35 terminally ill participants were given psilocybin over two eight-hour treatment sessions several weeks apart at St Vincent's Hospital in Melbourne.

Both sessions were accompanied by nine psychotherapy sessions before and after dosing.

The trial's findings have been published in General Hospital Psychiatry.

Those in the study reported significant reductions in depression and anxiety as well as sustained gains in mood, outlook, and wellbeing within 24 hours of treatment.

But Dr Dwyer said these results only touched the surface.

"Many patients reported having a transformational experience," he said.

"They felt they had a sense of being back in life in a richer, more vibrant way.

"One patient said they felt saturated with a divinity that wasn't there before."

While results are promising, the clinicians emphasised psychedelic-assisted therapy is still in its early stages.

"It didn't work for everyone," Dr Dwyer cautioned.

"And it shouldn't be a treatment open slather for all."

Melbourne psychiatrist Eli Kotler is among a handful of Australian doctors able to prescribe psychedelic medication and agreed the treatment needs to used cautiously.

Dr Kotler said psychedelics such as psilocybin help with human suffering, a condition he believes is at the heart of the St Vincent's study for those confronting dying.

"In many ways mental health has lost it's heart and soul and runs the risk of treating psychiatric diagnoses rather than helping humans heal," he told AAP.

Psilocybin appears to work by changing the way parts of the brain connect and interact.

But Dr Dwyer says whilst there are theories, nobody really knows how the drug works.

In recent years, there has been an explosion of interest in its therapeutic effects with half-a-dozen studies underway in Australia, and many more in the pipeline.

Psilocybin and MDMA have been able to be prescribed by approved psychiatrists for certain mental health conditions since July of 2023.

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