Can substances that induce mind-bending “trips” help treat eating disorders? Psychiatric science is beginning to weigh in. In recent years, psychedelic-assisted psychotherapy has received a lot of attention in the media. Psychedelic substances are those known to be associated with a “consciousness-expanding” experience. Researchers across the US – and here at Columbia – are studying psychedelics like psilocybin and ketamine to better understand whether they may help with a range of different psychiatric symptoms, such as low mood, anxiety, and post-traumatic stress. Early results from the research tell us that psychedelic-assisted therapy might be effective for some people with depression and PTSD. Scientists are eager to discover whether people with other disorders, including those with eating disorders, may similarly benefit.
For adults with anorexia nervosa who have not responded to more traditional evidenced-based treatments, psychedelics may offer a promising new approach. But as researchers, we are hesitant to jump to any quick conclusions before taking a peek into the history of psychedelic medicine.
Why Study Psychedelics?
Psychedelic research may seem like a booming new science, but it’s actually grounded in a long and winding history. Indigenous peoples in South America have engaged in ceremonial drinking of ayahuasca – a plant-based psychedelic – for centuries and were the first to report on its potential medicinal and therapeutic effects. These groups observed improvements in mood and anxiety following rituals that used psychedelics.
In the 1950s and 60s, psychedelic drugs such as LSD made their way into mainstream clinical trials in the field of psychiatry; however, this era came to a halt in the early 1970s, when an ever-changing political landscape led to strict regulation of psychedelics as substances of abuse. In the past few decades, it has become clear that more research is needed to determine whether there are any benefits to using psychedelics in a therapeutic context. These substances have slowly (and safely) been making their way back into psychiatric research, paving the way for psychedelic studies in the eating disorders field as well.
Psilocybin-Assisted Therapy for Eating Disorders
One substance in particular – psilocybin, the psychoactive ingredient found in “magic mushrooms” – is being increasingly studied as a potential treatment for anorexia nervosa. When administered in a supportive therapeutic environment, there is reason to believe that psilocybin might help people:
- Break down negative thought patterns,
- Accept and learn to cope with intense emotions, and
- Reduce rigid thinking and behavior.
When applied to those with anorexia nervosa, researchers are curious about whether this might lead to:
- Changes in negative beliefs about one’s own body and shape,
- Shifts away from unhealthy eating disordered coping mechanisms, and
- Loosening of strict rules related to eating and exercise.
Psilocybin also appears to affect connectivity in the brain, meaning that it may influence the ways in which different parts of the brain communicate with each other. Anorexia nervosa is a brain-based illness, so it’s possible that the short-term effects of psilocybin on brain functioning might lead to longer-term changes in eating disorder symptoms – but we still need a lot more evidence before making any conclusions.
What is the Research Telling Us?
In June, our colleagues at UC San Diego published results from the first-ever clinical trial of psilocybin therapy for anorexia nervosa. When administered one time in a supportive environment (and with an experienced team of clinicians), psilocybin was found to be safe for participants, with only mild side effects like headache and fatigue. Some study participants experienced slight decreases in body image concerns after a single dose of psilocybin; others did not report any major changes in their symptoms.
Participants’ body mass index (BMI) did not change significantly, meaning that the medication did not appear to help this particular group of folks with gaining weight. Weight restoration is an essential component of treatment for anorexia nervosa, and people who achieve greater weight gain during treatment report better long-term outcomes. It will be important for future studies to address this, and to investigate whether psilocybin can help promote weight restoration under different scientific and therapeutic conditions.
Caution is Key
As studies of psilocybin-assisted therapy for anorexia nervosa become more prevalent, new questions emerge about the best way to integrate this experimental approach into existing, evidence-based treatments. A survey of eating disorder providers suggested that both patients and clinicians stay aware of:
- Who might benefit from psilocybin-assisted therapy, and when it should (and should not) be recommended
- How primary care providers and therapists can communicate with study teams to best support patients who participate in these trials
- Short-term and long-term negative effects of the medication that may arise
By keeping these practices at the center of the science, we can ensure that psilocybin-assisted therapies – and psychedelics more broadly – are studied and implemented in a safe way.
Research in Action
In the coming months, our team here at the Columbia Center for Eating Disorders will begin recruiting individuals for a larger, multi-site trial of psilocybin-assisted therapy for anorexia nervosa. You may be eligible to participate if you are:
- Between 18 and 65 years old
- Have a 3+ year history of anorexia nervosa
- Willing to complete research assessments and in-person visits for 12 weeks over the course of the study
For more information about the trial and whether you may be eligible, please contact edru@nyspi.columbia.edu.
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