Assessing expectancy and suggestibility in a trial of escitalopram v. psilocybin for depression
Open accessAbstract
Background: To investigate the association between pre-trial expectancy, suggestibility, and response to treatment in a trial of escitalopram and investigational drug, COMP360, psilocybin, in the treatment of major depressive disorder (ClinicalTrials.gov registration: NCT03429075). Methods: We used data (n = 55) from our recent double-blind, parallel-group, randomized head-to-head comparison trial of escitalopram and investigational drug, COMP360, psilocybin. Mixed linear models were used to investigate the association between pre-treatment efficacy-related expectations, as well as baseline trait suggestibility and absorption, and therapeutic response to both escitalopram and COMP360 psilocybin. Results: Patients had significantly higher expectancy for psilocybin relative to escitalopram; however, expectancy for escitalopram was associated with improved therapeutic outcomes to escitalopram, expectancy for psilocybin was not predictive of response to psilocybin. Separately, we found that pre-treatment trait suggestibility was associated with therapeutic response in the psilocybin arm, but not in the escitalopram arm. Conclusions: Overall, our results suggest that psychedelic therapy may be less vulnerable to expectancy biases than previously suspected. The relationship between baseline trait suggestibility and response to psilocybin therapy implies that highly suggestible individuals may be primed for response to this treatment.
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The potential confounding effect of high positive expectancy has been seen in previous studies of PAT.
“The potential confounding effect of high positive expectancy has been seen in previous studies of PAT [58,59].”
From Psilocybin‐assisted psychotherapy for methamphetamine use disorder: A pilot open‐label safety and feasibility study. (2025) · cites this paper as [58]
The Introduction says positive expectancy may affect responses in psychedelic studies, and the Discussion reports an expectancy-related bias in the trial’s comparison of psilocybin with escitalopram. But the Discussion explicitly attributes that bias to low expectancy in the escitalopram arm, not to patients benefiting from high positive expectancy for psilocybin. (LLM, conf=0.87)
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- Authors
- Szigeti, B., Weiss, B., Rosas, F. E., Erritzoe, D., Nutt, D., & Carhart-Harris, R.
- Affiliations
- University of California, San Francisco (US)
- Imperial College London (GB)
- University of Sussex (GB)
- Corresponding author
- Szigeti, Balázs
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2024-01-22
- Volume
- 54
- Issue
- 8
- Pages
- 1717-1724
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W4391109410
- Cited by
- 89
- References
- 45
- Citations by year
- 2026: 36 · 2025: 35 · 2024: 18
- FWCI
- 44.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychological Medicine (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- expectancy, suggestibility, psilocybin, escitalopram, major depressive disorder, depression treatment response, placebo response, psychedelic therapy, absorption, treatment outcome prediction
- MeSH terms
- Escitalopram, Adult, Major Depressive Disorder, Double-Blind Method, Female, Hallucinogens, Humans, Male, Middle Aged, Psilocybin, Suggestion, Citalopram, Treatment Outcome, Anticipation, Psychological
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