You have all probably heard about the famous “magic mushrooms” or “magic truffles'', which are legal in The Netherlands. Since I live in the Netherlands, I have heard way too much information, positive and negative, about these hallucinogens. Prompted by my own curiosity, I did research on the substance contained in these “fungi”, and ended up finding many studies related to psychology! The substance is named psilocybin and although it is dominated by a cultural stigma attached to its hallucinogenic effect, numerous studies have proven that it has potential therapeutic benefits for some mental conditions. Let’s take a closer look.
Note: This article does not prompt anyone to try psilocybin on his/her own. It refers to an overview of recent research on the effects of Psilocybin in the treatment of some mental disorders.
This article will cover:
- What is Psilocybin?
- Research on the effect of this hallucinogen: MDD and AUD
- Key Factors to Successful Therapeutic Outcomes
- Is Psilocybin Safe? What Dangers Exist?
What is Psilocybin?
Psilocybin is considered one of the most well-known psychedelics, according to the Substance Abuse and Mental Health Services Administrations (SAMHSA) [13]. It is a naturally occurring psychedelic prodrug compound, a classic hallucinogen, produced by more than 200 species of mushrooms worldwide. It acts on serotonin receptors (a neurotransmitter that regulates mood and perception) located in numerous areas of the brain, specifically the cerebral cortex and thalamus. Experiments by Timothy Leary at Harvard University in the early 1960s [4] showed that the intensity and duration of the effects of psilocybin can be different for each individual, depending on species of mushrooms, dosage, individual physiology, and setting.
Note that it is NOT the same psychoactive compound present in other hallucinogenic drugs, like LSD, ecstasy, PCP…
Research on the effect of this hallucinogen: Major Depression Disorder (MDD) and Personality and Alcohol Use Disorder (AUD)
During the last years, the prodrug psilocybin has revealed a therapeutic potential for the treatment of some mental disorders. Research institutes in both the US and UK have provided evidence that psilocybin could be a breakthrough treatment for depression and addiction [3]. More precisely, in 2006, a publication by Roland Griffiths [2] reported that “psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance” . Since then, many psilocybin-assisted psychotherapy studies have been carried out
to investigate the therapeutic effects of psilocybin. [2] [3]
In most of these clinical studies, subjects' so-called mystical-type experiences have been correlated with therapeutic outcomes and improvements in various aspects of mental well-being, such as reductions in anxiety and an increase in the personality trait of openness. [3]
Now you will be wondering what a mystical experience is.
It seems that a mystical experience can be different to every individual. However, the core traits include “feelings of unity and interconnectedness with all people and things, a sense of sacredness, feelings of joy, peace and awe”. Moreover, people might get a sense of transcending normal time and space. It feels like the boundaries of human perception are crossed. [3]
Major Depressive Disorder (MDD)
Using psilocybin in the treatment for Major Depressive Disorder (MDD) appears promising. The basis is that inducing these mystical-type experiences may be beneficial in reducing the excessive rumination on the self that characterizes individuals suffering from MDD [3].
Three recent studies conducted by Davis et al (2021), Carhart-Harris et al (2021), and Carhart-Harris et al (2018), showed that the efficacy of psilocybin treatment remained after a six-months follow up [7]. Another investigation by Gukasyan et al (2022), proved that the substantial antidepressant effects of psilocybin-assisted therapy may be durable even after 12 months following acute intervention in some patients. [2]. Even more, a similar study was carried out by a team at Johns Hopkins University (2016), on 51 terminal patients, giving them psilocybin. The results of the study demonstrated important decreases in anxiety and depression scores, and showed that around 80% of participants still had clinically significant improvements after six months. [7]
Personality
Not only might psilocybin decrease symptoms in MDD, but research has also suggested that it can produce positive changes in behavior, thus reflecting personality. These include increased altruism, enhanced nature relatedness, pro-environmental behavior, decreased violent and criminal behavior, reduced suicidal ideation, tempered politically authoritarian views and an increase in the personality domain of openness [3]. Most importantly, psilocybin appears to influence the “ego”: reduced egotistical attitudes and greater prosocial disposition [3]. Users have also reported a sensation of “dissolution of the self” [5].
Alcohol Use Disorder (AUD)
Psilocybin has proven to be effective for the treatment of Alcohol Use Disorder (AUD) when combined with psychotherapy [4]. A very recent study (Bogenschutz et al, 2022) [9] evaluated whether two administrations of high-dose psilocybin improved the percentage of heavy drinking days in patients with AUD undergoing psychotherapy. Those individuals were compared to outcomes observed with placebo medication and psychotherapy. The results showed that psilocybin (in combination with psychotherapy) was associated with significant decreases in drinking compared to placebo subjects [9].
Key Factors to successful therapeutic outcomes
Still, it seems that psilocybin per se is not sufficient to produce entirely successful therapeutic outcomes. Why? The attitudes of participants are of great importance in psilocybin trials. More precisely, participants’ intention toward psilocybin is pivotal to the experience. They must have a desire to improve their condition, demonstrate a “clear intention and an open, enquiring attitude”. In other words, they must be willing to “surrender” to the experience and to whatever will come to them [3].
A second important key factor is the trait absorption. This trait indexes an openness to emotional and cognitive alterations that require full engagement on the part of an individual. In other words, it is related to the facets of openness to experience (readiness to engage in aesthetic and emotional experiences) which obviously differ in everyone [10].
Inducing mystical-type experiences using psilocybin as a form of treatment is more likely to apply and to be efficient to specific groups of people, such as to those included in psilocybin studies. This may happen because those people seek psilocybin treatment since they think it will help them.
Is psilocybin safe? What dangers exist?
Safety
In 2011, Studerus et al (2011), gathered data from eight different studies involving psilocybin administration from 1999 to 2008. This pooled analysis consisted of 110 healthy individuals who received 1 to 4 different doses of psilocybin for a total of 227 psilocybin administrations. Short- and long-term safety was evaluated, and there was no indication of increased drug abuse, persisting perception disorders, prolonged psychosis, or other long-term deficits in functioning that are typically observed in drug-users [4]. Dependence potential was low, acute toxicity was moderate (few mild or severe adverse reactions), chronic toxicity was low, and public health risks were negligible. The safety demonstrated in this study incited more research to be made on psilocybin’s therapeutic effects. It should be noted, however, that the administration of psilocybin in these studies followed strict protocols and therefore may lack external validity to the general population. It did not reflect drug use in everyday life [4].
In a few words, it seems that Psilocybin is safe. There have been no reports of deaths from psilocybin toxicity, and it has no physiological side effects. It is not found to be addictive and does not cause dependence. Moreover, Psilocybin is not related to violence and dangerous behavior leading to suicide or accidental death when under its influence [5].
Dangers
Psilocybin treatment should always be performed under the supervision of a therapist. Psilocybin can produce perceptual alterations that include hallucinations, synesthesia, and alterations in temporal perception, as well as changes in emotion and thoughts. Individuals could experience episodes of bad trips (negative experiences, which may involve mental confusion, agitation, extreme anxiety, fear and psychotic episodes–including bizarre and frightening images, severe paranoia, and loss of sense of reality). Therefore, it is not recommendable for someone to consume psilocybin alone for treatment reasons [12].
Great care should be taken when taking into account psychedelic treatment for individuals with psychotic disorders and with a family history of psychotic disorders or bipolar disorders. Individuals with psychotic disorders have an increased risk of having a psychotic episode while experiencing the effects of psilocybin. This population is currently excluded from the studies of psilocybin trials. [3]
Conclusions
It seems that psilocybin could be partially efficient as an alternative treatment to improve some mental health conditions. Although there are plenty of studies that prove a potential application for psilocybin in a variety of mental health disorders, regulatory authorities continue to consider these compounds to be controversial. [4] In my perspective, specific training for psilocybin therapy must be developed, standardized, and licensed to be considered an Evidence Based Practice (EBP) that is safe for every individual. Evidence-based psychedelic-assisted therapies could bring new opportunities and challenges on the table for existing health care systems.
References
[1] Mertens, L. J., Wall, M. B., Roseman, L., Demetriou, L., Nutt, D. J., & Carhart-Harris, R. L. (2020). Therapeutic mechanisms of psilocybin: Changes in amygdala and prefrontal functional connectivity during emotional processing after psilocybin for treatment-resistant depression. Journal of Psychopharmacology, 34(2), 167–180. https://doi.org/10.1177/0269881119895520
[2] Gukasyan, N., Davis, A. K., Barrett, F. S., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., & Griffiths, R. R. (2022). Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up. Journal of Psychopharmacology, 36(2), 151–158. https://doi.org/10.1177/02698811211073759
[3] James, E., Robertshaw, T. L., Hoskins, M., & Sessa, B. (2020). Psilocybin occasioned mystical-type experiences. Human Psychopharmacology, 35(5), 1–8. https://doi.org/10.1002/hup.2742
[4] Daniel, J., & Haberman, M. (2017). Clinical potential of psilocybin as a treatment for mental health conditions. Mental Health Clinician, 7(1), 24–28. https://doi.org/10.9740/mhc.2017.01.024
[5] Krebs, T. S., & Johansen, P. Ø. (2013). Psychedelics and mental health: a population study. PloS One, 8(8). https://doi.org/10.1371/journal.pone.0063972
[6] Carhart-Harris, R. L., Roseman, L., Bolstridge, M., Demetriou, L., Pannekoek, J. N., Wall, M. B., Tanner, M., Kaelen, M., McGonigle, J., Murphy, K., Leech, R.,
[7]. Griffiths et al. (2016) Psilocybin Produces Substantial and Sustained Decreases in Depression and Anxiety in Patients With Life-Threatening Cancer: A Randomized Double-Blind Trial. Journal of Psychopharmacology, 30(12), p1181-1197
[8] Curran, H. V., & Nutt, D. J. (2017). Psilocybin for treatment-resistant depression: FMRI-measured brain mechanisms. Scientific Reports, 7(1), 1–11. https://doi.org/10.1038/s41598-017-13282-7
[8] Bogenschutz, M. P., Ross, S., Bhatt, S., Baron, T., Forcehimes, A. A., Laska, E., Mennenga, S. E., O’Donnell, K., Owens, L. T., Podrebarac, S., Rotrosen, J., Tonigan, J. S., & Worth, L. (2022). Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients with Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 10016. https://doi.org/10.1001/jamapsychiatry.2022.2096
[9] Bogenschutz, M. P., Ross, S., Bhatt, S., Baron, T., Forcehimes, A. A., Laska, E., Mennenga, S. E., O’Donnell, K., Owens, L. T., Podrebarac, S., Rotrosen, J., Tonigan, J. S., & Worth, L. (2022). Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients with Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 10016. https://doi.org/10.1001/jamapsychiatry.2022.2096
[10] Benning, S. D., Rozalski, V., & Klingspon, K. L. (2015). Trait absorption is related to enhanced emotional picture processing and reduced processing of secondary acoustic probes. Psychophysiology, 52(10), 1409–1415. https://doi.org/10.1111/psyp.12468
[11] Rucker JJ, Marwood L, Ajantaival R-LJ, et al. The effects of psilocybin on cognitive and emotional functions in healthy participants: Results from a phase 1, randomized, placebo-controlled trial involving simultaneous psilocybin administration and preparation. Journal of Psychopharmacology. 2022;36(1):114-125. doi:10.1177/02698811211064720
[12] Bienemann B, Ruschel NS, Campos ML, Negreiros MA, Mograbi DC. Self-reported negative outcomes of psilocybin users: A quantitative textual analysis. PLoS One. 2020 Feb 21;15(2):e0229067. doi: 10.1371/journal.pone.0229067. PMID: 32084160; PMCID: PMC7034876
[13]Krebs TS, Johansen PØ. Over 30 million psychedelic users in the United States. F1000Res. 2013;2:98. doi:10.12688/f1000research.2-98.v1