People are becoming increasingly interested in classic psychedelics as potential interventions to treat a range of mental health conditions, including depression, anxiety, PTSD, end-of-life distress, and substance use disorders.
Psilocybin is a classic psychedelic that is showing promising results in producing positive therapeutic outcomes in a controlled setting.
Benjamin Lewis, MD, director of the Ketamine-Assisted Psychotherapy (KAP) Clinic at University of Utah Health’s Park City Behavioral Health Clinic and an assistant professor of psychiatry at the Huntsman Mental Health Institute, provides information about the potential intervention.
What is psilocybin?
Psilocybin is a psychoactive compound found in certain mushroom species—also known as magic mushrooms. It acts on a specific subtype of serotonin receptor in the brain, which can result in alterations to mood, cognition, and perception. It is possible that these changes in consciousness may enable therapeutic growth.
“People taking psilocybin often have experiences of significant insight into aspects of their lives, their relationships, and their sources of meaning—who they are as a person and how that has shaped their lives,” Lewis says. “That kind of experience is an important component of treating people with depression.”
Psilocybin is currently a Schedule I drug and not approved by the Food and Drug Administration for clinical use.
What does the research show?
The study and research of psilocybin began in the 1940s as a psychedelic medicine to treat various psychiatric conditions such as depression, substance use disorders, and alcohol use disorders. All research and clinical use of psilocybin was shut down in the 1970s after it was declared a Schedule I drug, ultimately becoming illegal.
“There are misconceptions of psychedelics, what they do or don’t do, and what the risks are,” Lewis says. One of these misconceptions is the potential for abuse of psychedelic drugs. “Classic psychedelics like psilocybin or LSD don’t really have abuse potential in the same fashion as other drugs like alcohol, nicotine, cocaine, and opioids,” Lewis says.
It wasn’t until recently—in the last ten years—that new research has looked into psilocybin and other psychedelics as potential mental health treatments. A recent study from Johns Hopkins showed that psychedelic treatment with psilocybin relieved major depressive disorder symptoms for patients for up to a month.
“There’s a lot of promise based on early studies, but those studies to date have been pretty small and limited in certain regards,” Lewis says.
Some of these research studies have looked at psilocybin as treatment for major depressive disorder and for treatment-resistant depression. While the studies are promising, Lewis says these studies are small, have limitations, and involved participants that are extensively screened and monitored through the process.
While research of psilocybin is ongoing, data to date have shown promising results in treatment of:
- Major depressive disorder
- Treatment resistant depression
- Alcohol use disorder
- Anxiety at end of life, or existential distress
- Tobacco use disorder
- OCD
“There’s a lot of potential for conditions that are otherwise very difficult to treat and for which we have limited tools to address,” Lewis says.
What are the side effects?
Side effects of psilocybin can be mild or intense. Mild symptoms include:
- Headache
- Nausea
- Changes in body temperature
- Elevation of heart rate and blood pressure
Psilocybin can also cause a range of psychological reactions that may be difficult or challenging for some people. These symptoms include:
- Anxiety
- Paranoia
- Disorientation
Patients who have a personal or family history of psychosis may also be at increased risk for experiencing a prolonged episode of psychosis. Those with a history of manic episodes may also be at increased risk.
How would psilocybin therapy work?
In clinical studies, administering psilocybin involves an intense psychotherapeutic preparation before taking the substance. This involves being supported during an eight-hour session with two therapists who are present the entire time. Following this session, the therapists and patient would engage in integration sessions that explore how to translate those experiences to a patient’s life.
“It’s not just taking a pill or substance to treat symptoms,” Lewis says. “It’s about the therapeutic approach, the intentions behind it, and the support that you have in doing so in a therapeutic way.”
Lewis points out he wouldn’t recommend psilocybin to patients at this time due to legal issues, lack of data, and the need for ongoing research.
Why psychedelics?
Approximately 30% of people treated with standard antidepressants don’t achieve remission. Psychedelics like psilocybin could be another option for those who are suffering.
“As someone who’s investing my career in terms of pursuing and investigating the therapeutic potentials of these compounds, there’s a lot of promise here,” Lewis says.
While psilocybin could be a new treatment option for mental health in the future, Lewis advocates for more research and data. “While there are many people that are suffering that we would love to help as quickly as possible, it’s important to do that carefully and not put people at risk,” he says.