Almost all RCTs involving depression throw a bunch of people diagnosed with "depression", but suffering a variety of conditions, all given that label, in a tank together. The treatment may help a few, harm others, and have no effect on the rest, and the treatment is then labeled "ineffective".

RCTs depend for validity absolutely upon precise, accurate diagnosis for validity. Bad diagnostics => meaningless results. RCTs are not magic. They can be as wrong as anything stupidly performed.

RCTs around depression are worse than most.

> The study, a small trial run at Imperial College London

I'm puzzled how a small trial run can derail decades of larger-scale evidence?

The larger-scale evidence is of much lower quality than an RCT.

I don't think the study is dispositive, but it's strong evidence, much stronger than a message board axiomatic derivation of why psilocybin should work.

RCTs are not magic. They are not always strong evidence, and not always any sort of evidence. The details always matter.

I don't disagree with any of this.

I'd probably take that choice compared to the cost and daily dosing of the pharmacy alternative.