Magic mushrooms are one of the psychedelics that show real medicinal potential
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A single dose of psilocybin — the active ingredient in magic mushrooms — produces rapid reductions in obsessive-compulsive disorder (OCD) symptoms, according to the first placebo-controlled trial to test the psychedelic for mental health conditions. The effects also appear to persist for at least 12 weeks, suggesting that psilocybin may provide lasting relief.
“If we give you a ride, we think we can break the cycles of obsessive thinking and behavior,” says David Nutt of Imperial College London, who was not involved in the research. “The whole point of OCD therapy is to teach people to behave differently. So instead of checking the lights 15 times, you check them twice.”
About 1 to 3 percent of people have OCD, a condition characterized by obsessions and compulsions, which can be overwhelming. Treatments tend to include talk therapy and antidepressants, but between 40 and 60 percent of people with OCD do not respond to them.
Psilocybin – and other psychedelics such as ketamine – have shown promise for mental health conditions. To get a more robust idea of its potential, Christopher Pittenger of the Yale School of Medicine and his colleagues decided to test psilocybin for OCD in the first randomized, placebo-controlled trial.
The team recruited 28 adults who had lived with OCD for an average of two decades and who had tried at least two different treatments without success. They all had the severity of their symptoms rated using a standard scale, which gives a score between 0 and 40. They were then randomly assigned either a single oral dose of psilocybin (0.25 milligrams per kilogram of body weight) or niacin (250 milligrams), also known as vitamin B3, which served as a placebo.
The psilocybin dose was enough to give participants a psychedelic trip, which tends to involve major changes in perception, thoughts and feelings. “It’s pretty intense, although it varies from person to person,” says Pittenger.
After 48 hours, the symptom scores of the 14 people who received psilocybin decreased by an average of 9.76 points, while those who took niacin remained about the same. “The speed and durability of the improvement seen after a single dose of psilocybin is remarkable,” says Alex Kwan of Cornell University in Ithaca, New York.
One week later, about 70 percent of those taking psilocybin still had a symptom score reduction of about 35 percent, and the benefits persisted at a 12-week follow-up. “It’s definitely better and faster than other medications for OCD,” says Nutt, who was involved in a recent study, without a placebo group, that similarly found a small dose of psilocybin reduced OCD symptoms.
Kwan says that seeing such improvement in people who have already tried several standard treatments suggests that psilocybin engages the brain in a fundamentally different way, but the exact mechanism by which it helps with OCD is unclear. “If we can uncover that biology, it could change how we think about treating many psychiatric disorders, not just OCD,” he says.
One idea is that psilocybin increases plasticity in the brain, so that thoughts that seemed rigid and dominant can become less powerful. It is profound with all psychedelics, says Nutt, who recently showed that one dose of the psychedelic DMT reduces symptoms of depression. “Previously, depressive thoughts dominated their thinking, but after the psychedelic, their brains are more flexible and they put them aside instead of agreeing with them,” he says.
Another idea is that psilocybin recalibrates the relationship between the brain’s default mode network, which is involved in rumination and self-esteem, and its other areas, Pittenger says. We also know that a single dose of psilocybin can rewire the brain, and it can also boost mental health by reducing inflammation.
But the drug may have safety issues. During the Yale study, a person who already had persistent suicidal thoughts began to actively plan it. The danger passed after standard monitoring, but Pittenger says this highlights the need for clinical safeguards to be in place when administering psilocybin medically. Larger studies must also confirm the drug’s effect and safety, the best dose and who is most likely to benefit or be at risk, he says.
Another recurring problem with psychedelic research is that the effects of these drugs often allow subjects to measure whether they have received them or a placebo. The team tried to mitigate this by using a dose of niacin that can cause psychedelic-like events, such as flushing and increased heart rate. Nevertheless, Pittenger says that most of the participants still had a clear idea of what they had received. “This is a weakness of the study, as it is for most such work in the field,” he says.
Do you need a listening ear? British Samaritans: 116123; US 988 Suicide & Crisis Lifeline: 988; hotlines in other countries.
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