Psilocybin & OCD: Can psychedelics treat obsessive compulsive disorder?

A new review from neuroethicist Eddie Jacobs, and published in the Journal of Psychedelic Studies, is suggesting psilocybin may have great potential as a treatment for obsessive-compulsive disorder (OCD). Jacobs, from King’s College London and the University of Oxford, says it is surprising how little focus has been on the therapeutic potential of psilocybin in treating OCD, and he points to a number of new clinical trials that are finally exploring this promising treatment.

Psilocybin, a natural psychedelic compound found in magic mushrooms, has been granted Breakthrough Status designation by the FDA on two occasions in recent years for treatment-resistant depression and major depressive disorder. The Breakthrough Therapy status is an indication early clinical evidence is strong and clinically meaningful. Alongside depression, psilocybin therapy is also seen to be effective in helping terminal cancer patients deal with end of life anxiety.

How can psilocybin help OCD?

OCD is the fourth most common mental illness, after depression, substance abuse and specific phobias. Affecting more than 2 percent of people at some point in their life, OCD can be profoundly distressing and disruptive.

Eddie Jacobs’ interest in psilocybin for OCD arose when he discovered how little research attention had been directed at this particular therapeutic outcome. He suggests that, although much excitement surrounds the results of psilocybin therapy for conditions such as depression and anxiety, the treatment should hypothetically also be effective for OCD.

… psychedelics can interrupt rigidly repeating patterns of thought and behavior that people want to escape, but struggle to

Eddie Jacobs

Jacobs’ new review article set out to fill a gap in our body of knowledge, effectively summarizing what we know about OCD and psilocybin therapy, while also offering an outline of what research has been done up till now.

“There are reports from back in the first age of psychedelic therapy that suggested OCD symptoms were amenable to this sort of treatment,” says Jacobs. “Frustratingly, a lot of the research from those days doesn’t match up to modern standards of rigor, so we’re probably best to consider them clues pointing in a direction, rather than firm evidence in and of themselves. The other evidence for psilocybin in OCD – case reports and (quite a lot!) of anecdotal reports, are the same.”

Alongside these anecdotal reports and case studies there are several strong mechanistic hypotheses to explain how psilocybin could be useful in treating OCD. One of those hypotheses, for example, relates to a large-scale interconnected collection of brain regions, known as the default mode network (DMN).

The DMN is essentially the state of our brain when we are at rest, not sleeping, but instead the “default” mode of brain connectivity when we are not performing active tasks. DMN activity is linked with self-reflection and daydreaming, and dysfunction in one’s DMN has been associated with depression and anxiety.

Psilocybin has been found to serve a little like a reset button for a dysfunctional DMN. Imaging studies have revealed a single dose of psilocybin can temporarily disintegrate resting state networks such as the DMN. And many researchers hypothesize this pharmacological action plays a part in the positive therapeutic outcomes seen in psilocybin therapy.

“The disruption and reintegration ‘reset’ in DMN activity that is seen with psilocybin may, in OCD patients, allow the easing of an overly strong, top-down filtering bias, thereby re-establishing normal responsiveness towards the environment,” explains Jacobs in the published review.

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