Psychiatrist Wilson Gonzaga explains why substances that were previously viewed with suspicion are now emerging as hope for severe cases of resistant depression
Resistant depression is one of the biggest challenges facing modern psychiatry today. Millions of people spend years trying different antidepressants without achieving significant improvement. In many cases, symptoms persist despite multiple therapeutic attempts, compromising work, relationships and the meaning of life itself.
In this scenario, substances such as psilocybin and ketamine have been attracting increasing interest from the scientific community as they present rapid and promising results in patients who have not responded to conventional treatments.
Rapid results draw attention from science
Traditional antidepressants usually take weeks to produce a clinical effect. Ketamine can reduce depressive symptoms and suicidal ideation in a few hours or days, something particularly relevant in serious situations.
Psilocybin, a substance present in certain mushrooms, has also demonstrated important therapeutic potential. Studies conducted at universities such as Johns Hopkins University and Imperial College London suggest significant benefits in cases of resistant depression, anxiety associated with serious illness and existential suffering.
In addition to their speed of action, these substances appear to act by stimulating mechanisms linked to neuroplasticity – the brain’s ability to create new neural connections and reorganize rigid emotional patterns. In other words, they can help the patient get out of repetitive circuits of suffering, hopelessness and mental rumination.
Another aspect that draws attention is that the therapeutic effects do not seem to depend only on brain chemistry, but also on the subjective experience lived during treatment. Many patients report experiences of deep emotional reconnection, reviewing traumas and changing perspectives on themselves and life.
What is already reality – and what is still under study
Ketamine is already used clinically in Brazil, especially in cases of resistant depression, under specific medical protocols. Its derivative version, Esketamine, has regulatory approval for certain depressive conditions.
Psilocybin remains in the experimental phase in most of the world, although studies are progressing quickly. The most promising results appear in research involving resistant depression, post-traumatic stress disorder, cancer-related anxiety and chemical dependency.
Despite the growing enthusiasm, it is essential to avoid simplifications. Neither ketamine nor psilocybin should be seen as a “miracle cure” or used without specialized supervision. These substances can produce intense psychological effects and are not recommended for all patients, requiring rigorous medical evaluation and an appropriate therapeutic environment.
A new way of understanding mental suffering
Contemporary psychiatry is beginning to recognize that mental health is not just about suppressing symptoms, but also restoring meaning, connection, and emotional flexibility. In this context, psilocybin and ketamine perhaps represent not only new medications, but the beginning of a deeper transformation in the way we understand psychological suffering.
Dr. Wilson Gonzaga – CRM-SP 39269 | RQE 2557
Psychiatrist
