Efficacy of psilocybin on death anxiety in terminal patients: a narrative review

This narrative review synthesized the use of psilocybin-assisted therapy as a promising treatment for alleviating death anxiety in terminally ill patients. The insights presented are derived from findings reported in previous studies. Therefore, this review aimed to assess the efficacy, pharmacology, and mechanisms by which psilocybin alters brain function by affecting 5-HT2A receptors and disrupting the default mode network (DMN), helping to reduce existential fear. Recent randomized controlled trials (RCTs) demonstrated substantial progress in therapy, with results showing standardized mean differences in anxiety reduction ranging from −0.70 to −1.08, with effects lasting up to six months after a single dose. This review examines the implications for clinical practice, highlighting psilocybin’s favorable safety profile and its potential to fill therapeutic gaps left by conventional treatments, and also addresses the ethical issues surrounding the use of psilocybin in terminally ill patients. The findings support the integration of psychedelic-assisted methods with standard palliative care to enhance end-of-life care and also highlight potential directions for further studies.