What Psychedelics Could Mean for Eating Disorders
Chrissy Sandwen’s final wake-up call for her binge-eating disorder came in an unforgettably putrid yet poetic form. All-too-familiar waves of depression and anxiety became magnified during an extended and profoundly lonely stint as a social worker in rural Costa Rica. To top it off, Sandwen found herself overwhelmed by uncontrollable binge-eating episodes, which ignited feelings of self-loathing.
“It felt like my body had been taken over by a demon,” Sandwen recalls. After a friend’s ill-advised decision to flush paper down Sandwen’s toilet led to a sewage flood in her apartment, the ensuing detonation morphed into a teachable moment. “I was like, ‘This is a fucking metaphor for my life. I’m a beautiful, incredible, amazing person, but I am ankle-deep in my own fucking shit.’”
A few days later, Sandwen learned about an ayahuasca retreat near her through Google. From there began a nonlinear, yet ultimately rewarding, path to healing currently being contemplated by a unique subset of those who study and those who struggle with eating disorders.
Between the antipodes of anorexia nervosa, whose sufferers compulsively pursue weight loss through various mortifications, to the endless binge-and-purge cycles of bulimia nervosa lies a spectrum of variants, all characterized by unique combinations of self-destructive eating behaviors, and one can transform into another within the same person over time. Relapses are common, dropout rates are high, and while recoveries are achievable, an estimated 50% of those with anorexia will live with their illnesses for the rest of their lives. In the worst case scenario, an estimated 10% of anorexics will die from their disease. Short of opioid addiction, eating disorders writ large are considered the most fatal mental health disorder, a grim statistic ED specialists live with daily.
Enter psychedelics, which hold the potential to unravel many of the comorbid mental illnesses, such as depression, anxiety and obsessive-compulsive disorder, underpinning many eating disorders. For psychologist Adele Lafrance, who learned about ayahuasca’s therapeutic effects after two patients at an eating disorder treatment center where she worked died, psychedelic and psychedelic-adjacent medicines such as psilocybin, MDMA and ketamine may extend a powerful lifeline to the most refractory of cases. “Though some of our [established] treatments work well for some people, there’s a significant number of individuals who really continue to struggle,” she says.
Previously unfamiliar with psychedelic medicine, Lafrance watched a documentary about Vancouver physician Gabor Maté’s work with ayahuasca, and eventually reached out to him personally. Encouraged by what she learned, she later co-wrote a paper on the impact of ceremonial ayahuasca experiences on the eating disorders of 13 women in 2018. Since then, academic and independent researchers alike have followed in her wake.
A Johns Hopkins University study on anorexia nervosa and psilocybin briefly began volunteer intake before it was paused by COVID. (In the meantime, it is still recruiting for patients, according to Johns Hopkins psychiatrist Natalie Gukasyan). Imperial College will embark upon its own 20-patient anorexia/psilocybin study early next year, COVID permitting. MAPS is preparing its own MDMA-assisted study for the treatment of anorexia nervosa and binge-eating disorder. At the University of California-San Diego, researchers Stephanie Knatz and Walter Kaye are finalizing the funding for a safety and tolerability study on psilocybin and its effects on psychopathology, anxiety, depression and weight in anorexia. And Lafrance is currently undertaking an independent study with Utah psychiatrist Reid Robison to pair ketamine with a treatment modality she calls emotion-focused ketamine-assisted psychotherapy for anorexia nervosa at Cedar Psychiatry.
Researchers anticipate each psychedelic serving different purposes in treatment. Ketamine’s fast-acting relief on depression has led to the FDA approval of the closely-related esketamine, and Robison acknowledges its usefulness in treating the depression of eating disordered patients. Robison also points to ketamine’s ability to afford “the individual a time-out from what some might call the ordinary mind… to see the forest for the trees.”
Classical psychedelics like psilocybin have interested clinical psychiatrist Timothy Brewerton for decades due to their activity on serotonin broadly, and the 5-HT2A receptor specifically. ”Serotonin dysregulation can be linked to all of these co-occurring phenomena that we see associated with eating disorders,” he says, referring to OCD and other disorders that fall on the impulsivity-compulsivity spectrum, as well as suicide. “Psilocybin binds very tightly to these 5-HT2 receptors. These drugs appear to have an effect on cognitive rigidity, which is certainly seen in anorexia and in the eating disorder spectrum of disorders.”
As for MDMA, Brewerton has co-written an as-yet unpublished paper with Lafrance on the potential treatment of people diagnosed with eating disorders and PTSD with MDMA. For a “significant portion of people with EDs, trauma is the rule rather than the exception,” says Brewerton. “I think it’s a major factor in severe and enduring eating disorder stories. Those are the ones who don’t get better because they still have undigested, unresolved trauma issues.”
“If I was a betting man,” Brewerton adds, “I’d say psilocybin is going to be more powerful for anorexia and MDMA will be more powerful for those who have PTSD.”
Unfortunately, psychedelics share a strong cultural stigma with eating disorders, which Brewerton has confronted throughout his career within the ED community. “[Lafrance and I] proposed a workshop two years ago by [the Association of Eating Disorders] and it was rejected. She has proposed other workshops on her own. They have been rejected,” he says. “There’s stigma to being involved with this research because of preconceived notions.” However, he does believe the stigma will fade with an expanded research base. Robison has already noticed a shift in public opinion. “Every time I speak about psychedelics and eating disorders or in other conditions, I’m always very pleasantly surprised and hopeful because of how welcome they are by the individuals and families,” he says.
In the meantime, a vocal subset of the eating disordered have moved forward on their own, taking their stories to the internet, integration circles and therapists in the absence of standardized treatments. After entering Brown University in 2014, Kylie Fustini began with food restriction and moved onto purging after meals. This was augmented by fat-burning pills and an aggressive focus on her calorie count. Fustini moved from bouts of severe food restriction and excessive exercising toward more purging episodes throughout 2015, and smoked weed “as a way to both manage my anxiety and be disconnected from my body.” Finally, in 2016, she took leave from Brown for three-and-a-half years to treat her eating disorders.
During this time, she self-treated with LSD and mushrooms, and integrated with a therapist. Like Sandwen, Fustini’s experiences have put her on the path to becoming a psychedelic-assisted therapist. “Having healed the way I did from psychedelics, after trying out western medicine, being on various prescribed meds, trying cognitive behavioral therapy, and still just not really making much progress, I am a huge advocate for the therapeutic uses of psychedelics,” she says. “Tripping helped me to get in touch with my soul, and recognize that my body was just a vessel and to not be so cruel to it.” Meg Spriggs, a neuroscientist coordinating the Imperial feasibility study, notes a similar phenomenon in Imperial’s psilocybin/depression trials. “Anorexia is not kind and it’s not very loving. [That’s] something we see in our depression trials, people being able to connect with… that feeling and that love,” says Spriggs.
However, both Sandwen and Fustini say that psychedelics only took them so far. After a welcome pause following her first ayahuasca journey, Sandwen reports her binge-eating returned “with a vengeance,” and was even exacerbated by a mushroom microdosing regimen.
Carol Kan, a ketamine researcher currently preparing a fellowship on ketamine and anorexia, recently conducted a survey to assess how people with eating disorders felt about alternative therapies. Preliminary findings show that less than a third of the eating disordered would resist psychedelic-assisted treatment under any circumstance, and there was a moderate level of concern among the whole group studied.
Fustini says that a more extensive and informed administration of her psychedelic experience would have helped with her treatment: “While [my therapist] was rather open-minded, she has never had a psychedelic experience and I feel that she could not fully understand what I was going through on these trips in my healing process.”
Startups in the psychedelic field have been relatively slow to embrace the treatment of eating disorders. An exception is NeonMind, a majority-owned subsidiary of Better Plant Sciences, Inc. (formerly The Yield Growth Corp.), which has filed a preliminary patent application in the U.S. for the use of DMT for compulsive eating disorders. According to William Panenka, Chair of the NeonMind Scientific Advisory Board, DMT acts on the “same type of serotonin detectors which are known to regulate appetite,” reports Yahoo News.
However, Brewerton remains deeply skeptical of appetite suppressants as treatments for certain eating disorders, psychedelic or otherwise.
“People have looked [at] a whole laundry list of appetite suppressants for the treatment of obesity and binge-type eating disorders, and it’s all a bust. And it’s a bust because people become very rapidly tolerant to the appetite suppressing effects,” Brewerton says. “Back in the 40s after amphetamines were discovered, people were prescribed [them] willy-nilly… And it got a lot of people addicted. It got a lot of people more anxious. It got a lot of people crashing into major mood disorders and suicidality and any appetite-suppressing effects petered out and the people gained all the weight back. So they don’t work and we know that from way back when.”
With or without psychedelics, ED specialists will continue to face daunting challenges in their work. ED research is chronically underfunded, with only $11 million allocated to research by the National Institute of Health, versus $263 million for schizophrenia, according to Science. And while new pharmacological treatments are welcome — Prozac, Vyvanse and Olanzapine are used to treat bulimia, binge-eating disorder and anorexia, respectively — eating disorders are far too complex for any drug to cure it altogether. Sandwen compares her healing process to a “spiral staircase.
“I felt like I was coming up the same spot over and over again, but what I recognized was that it was still a staircase going up,” says Sandwen. “Even if I was still having a problem with eating, I was coming at it from a different level of consciousness every time. Every moment was a way to put it into practice. Psychedelics were a huge component of that.”