In brief
- The Psychiatric University Hospital of Zurich publishes one of the first retrospective analyses of psilocybin use outside of a clinical trial, in real-world clinical practice.
- 19 people with treatment-resistant depression received between one and four sessions (40 in total), with preparation and integration provided by trained clinicians.
- Depressive symptoms decreased significantly, though with a more modest response than in controlled trials—an expected outcome given the more complex patient profile.
Almost everything we know about psilocybin for depression comes from clinical trials with strict selection criteria. A team from the Psychiatric University Hospital of Zurich (Switzerland) has just published something different in The Lancet Regional Health – Europe: what happens when this therapy is offered, outside of any experimental protocol, to real-world patients with treatment-resistant depression in day-to-day practice.
From the trial room to the real clinic
The study, authored by Johannes Jungwirth and his team, retrospectively reviews the medical records of 19 people with treatment-resistant depression (ranging from mild to severe) treated at the hospital. All patients underwent preparation and integration sessions with specifically trained clinicians before and after each administration. Thirteen reached at least a second session, five a third and three a fourth; these are cumulative counts, totaling 40 dosing sessions with doses ranging from 20 to 35 mg. According to the authors, this is one of the first systematic records of how this approach functions when it leaves the laboratory and enters a conventional psychiatric service, involving patients who would have been excluded from many clinical trials precisely because of their complexity.
Real improvement, though more modest than in trials
Depression scores evaluated by the clinical team dropped, on average, from about 31 out of 60 before treatment to 20 out of 60 in assessments within 42 days after the final session; median MADRS timing was 4.5 days, not uniform six-week follow-up. The patients themselves reported a similar decline, from 32 to 23 out of 63 on their self-assessment scale. Event documentation covered 30 of the 40 sessions; at least one was reported in 24 of those 30, almost always mild and transient: fatigue, headache, and crying during the experience, with no serious or persistent adverse effects. However, response and remission rates were lower than those in several randomized clinical trials published to date, a fact the authors attribute to the higher degree of treatment resistance and clinical complexity of those referred to this service—the very type of patient that trials often exclude.
What this implies
This is a small study (19 people), retrospective and without a comparison group, so its conclusions are necessarily preliminary: it does not allow for establishing causality with the same strength as a randomized trial, and there is no long-term follow-up data to confirm whether the improvement is maintained. The authors themselves call for larger studies in real-world clinical settings. But the value of this work lies not so much in the sample size as in the context: it shows that psilocybin can be administered in a structured way, with appropriate clinical support, in a public hospital and with patients that academic research often leaves behind. It is a practical step toward understanding how this therapy would function if it were integrated into real healthcare systems, beyond the artificially controlled environment of a trial.
Source
- Jungwirth J, et al. Real-World Psilocybin Therapy for Treatment-Resistant Depression: A Retrospective Observational Study. The Lancet Regional Health – Europe, June 2026.
Educational content written from a harm reduction perspective and with respect for individual freedom. It is not a substitute for advice from a healthcare professional and is not intended to encourage or condemn any drug use.
