World-first trial investigating psilocybin psychotherapy for anorexia commencing in US
Scientists from the Johns Hopkins Psychedelic Research Unit are commencing a landmark human clinical trial to explore the effects of psilocybin in persons with chronic anorexia nervosa (AN). The new trial adds to a growing body of evidence finding psychedelic psychotherapy effective for depression, addiction and obsessive-compulsive disorder.
Last year the FDA granted Breakthrough Therapy status to psilocybin-assisted psychotherapy for severe treatment-resistant depression. The designation was a quiet but extraordinary step forward in legitimizing the field of psychedelic science, particularly following a similar designation granted to MDMA treatment for PTSD.
Psilocybin is the primary psychoactive compound found in what are commonly referred to as magic mushrooms. In the human body the compound is rapidly converted in psilocin, which subsequently generates the drug’s mind-altering effects.
The team at the Johns Hopkins Psychedelic Research Unit has been at the forefront of the modern psychedelic science renaissance, exploring the effects, and potential medical uses, of a number of psychoactive compounds including LSD, DMT and MDMA. But, the team has primarily been leading a lot of work into the clinical possibilities of psilocybin, from exploring the drug’s potential as a smoking cessation aid, to its uses in helping treat depression and anxiety, particularly in patients suffering from life-threatening cancer.
The latest therapeutic target for the psychedelic science researchers is severe eating disorders. In an email to New Atlas, Natalie Gukasyan, a post-doctoral research fellow at Johns Hopkins, explains the goal of this novel human trial.
“This open-label study will test the effects of two moderate to high doses of psilocybin given in combination with motivational interviewing-based psychotherapy,” says Gukasyan. “Our goal is to determine whether psilocybin can be safely administered in a supportive setting to people with anorexia nervosa (AN), and whether this intervention can produce improvements in mood, quality of life, and cognitive and behavioral symptoms of the disorder.”
Gukasyan believes there are several reasons why eating disorders, and AN in particular, are strong targets for psilocybin treatment research. With the highest mortality rates of any psychiatric disorder, it is fair to say AN is difficult to effectively treat, and in need of new therapeutic strategies. Based on prior work from the Johns Hopkins team, Gukasyan suggests the meaningful experiences produced by psilocybin therapy should effectively translate to those with AN.
“We seek to determine if psilocybin can have similar effects in those suffering with AN,” explains Gukasyan. “The pathophysiology of AN remains obscure but some evidence suggests that the serotonin 2A (5-HT2A) receptor system may be involved. The action of psilocin, the active metabolite of psilocybin, is mediated by stimulation of these receptors. AN also shares phenomenological parallels to anxiety and addiction, both of which have been shown to improve with psilocybin-assisted interventions.”
The research is not without a small volume of interesting precedents. A compelling 2017 study investigated the therapeutic value of ayahuasca, a traditional Amazonian psychedelic brew, in helping individuals with eating disorders. The study was obviously not a rigorous clinical trial, but instead an investigation into the experiences of 16 subjects with previously diagnosed eating disorders who embarked upon ceremonial ayahuasca consumption.
A number of anecdotal reports have also suggested substances such as LSD and MDMA can be beneficial for eating disorders. MDMA in particular may be well suited to treating eating disorders considering its proven success with PTSD, and while some researchers are working on getting trials underway, there are suggestions it may not be the right drug for this condition. As Timothy Brewerton, a professor of psychiatry at the Medical University of South Carolina, told Vice in 2018, some individuals suffering from eating disorders can use MDMA to “specifically help them not eat”.
Gukasyan suggests her team’s focus on psilocybin is more related to their experience and expertise using this particular psychoactive compound. The new trial also will be working closely with the experienced clinicians from the Johns Hopkins Eating Disorders Program.
“…our team has a strong track record of safely administering psilocybin in hundreds of volunteers, making it a natural choice for our study drug,” Gukasyan tells New Atlas. “MDMA has a different mechanism of action and risk profile; others in the field are developing protocols to investigate its safety and utility in the treatment of eating disorders.”
The research team is only at the earliest recruitment stage of the trial and is currently looking for participants. This phase 1 trial will be modest, but is expected to take between two and three years, primarily due to the challenges in finding appropriate subjects to participate.
Gukasyan says those interested in the research can explore details of the trial and potential participants can find an online screening form at www.hopkinspsychedelic.org.
“If our intervention is effective the next steps would be to further clarify the mechanism by which it works, perhaps with brain imaging or other neurocognitive measures,” says Gukasyan on the future of the research. “Phase 2 and 3 studies with larger sample sizes and placebo-controlled conditions would be necessary to further establish this as a viable treatment for AN.”