Psilocybin, the psychoactive compound in magic mushrooms, is being explored for its therapeutic potential in treating anxiety, depression, and addiction, among other mental illnesses. However, obsessive-compulsive disorder (OCD), a condition that affects over 2% of the American population, has received little clinical attention.
Eddie Jacobs, the author of a new review article published in the Journal of Psychedelic Studies, feels that existing evidence shows psilocybin might be an effective treatment for OCD, and deserves further investigation.
Those suffering from OCD are plagued by “anxiety-laden” intrusive thoughts, images, and compulsions, and engage in repetitive behaviors to temporarily alleviate that anxiety. The obsessive, all-consuming nature of this illness can profoundly disrupt one’s ability to function, and is “associated with significantly compromised quality of life,” writes Jacobs.
In the review, Jacobs, a neuroethicist from King’s College London and the University of Oxford, examines the existing evidence supporting psilocybin’s potential for treating OCD. He writes that evidence from multiple sources (including preclinical investigations, case studies, and one open-label trial), along with what we already know about how psilocybin affects the brain, “lend support to its plausibility as treatment.”
Jacobs notes that OCD has been connected to dysfunctional activity in the brain’s Default Mode Network (DMN), the brain’s state when one is awake but not actively focusing on a task. Psilocybin can disrupt and reintegrate DMN activity, essentially giving it a “reset,” and may allow for “the easing of an overly strong, top-down filtering bias, thereby re-establishing normal responsiveness towards the environment” in OCD patients, writes Jacobs.
A number of studies dating back to the 50s and 60s suggesting psilocybin could alleviate OCD symptoms are cited in the report. But in an interview with New Atlas, Jacob points out that “frustratingly, a lot of the research from those days doesn’t match up to modern standards of rigor,” so new studies need to be done.
The review also refers to considerable anecdotal evidence that attests to psilocybin’s efficacy in alleviating symptoms of OCD, and makes reference to numerous online trip reports. One example discussed in the paper comes from the comedian Adam Strauss, an OCD patient who wrote and developed a one-man show, “The Mushroom Cure,” about how magic mushrooms helped him find relief.
The most significant way magic mushrooms helped Strauss was “facilitating acceptance,” he tells Lucid News. For Strauss, OCD is “an addiction to certainty and safety,” and the compulsive behaviors provide fleeting relief for anxiety.
“The cruel irony of OCD, like every addiction, is that over time, it actually becomes the primary cause of the very pain that it seeks to relieve,” says Strauss. “It’s the classic vicious circle.”
Acceptance of the “underlying pain” that compulsive behavior tries to neutralize was the way he found to step out of that circle. Magic mushrooms helped Strauss let go of the “refusal to allow the unwanted obsessive thoughts and urges,” and “relax into the anxiety.” His OCD didn’t immediately go away, he says, “but it was no longer an enemy to be rooted out.”
Strauss also found that magic mushrooms connected him to something greater than himself, “beyond words,” that held and supported him, fostering a deeper sense of faith. “It’s easier to surrender and accept when there’s some sense that there’s intelligence and order pervading reality,” he says. Magic mushrooms have deepened his meditation practice as well, allowing him to access “realms of stillness and presence” that he found inaccessible prior to taking them.
In the published review, Jacobs cites studies in which the “disintegration” of resting-state networks such as the DMN were associated with “subjective reports of ‘ego dissolution’ and the ‘peak’ or ‘mystical experience’,” leading to a “sense of sacredness” and a “deeply felt positive mood.” These kinds of transcendent experiences are “predictive of therapeutic effect,” writes Jacobs.
The report cites the one completed clinical investigation of psilocybin as an OCD treatment, which dates back to 2006. It was conducted by Francisco Moreno and a team of researchers at the University of Arizona. In the open-label study, nine patients were given three doses of psilocybin, spaced a week apart. As reported in the New Atlas article, the patients displayed “symptomatic relief” in the day following treatment, but fell into remission shortly after (with the exception of one patient, who showed “sustained remission” from OCD symptoms after 6 months).
A crucial shortcoming of the study, Jacobs writes in his review, is the lack of “adjunct therapy” before and after treatment. “Psilocybin therapy is enhanced by placing it within a wider psychotherapeutic program,” Jacobs tells New Atlas. According to Jacobs, the afterglow period that follows a psychedelic session is a “period of malleability,” and a “powerful opportunity to make positive changes, which therapy can help.”
Today, Moreno and his team are recruiting patients for a more rigorous, placebo-controlled trial at the University of Arizona that will administer eight doses of psilocybin over the course of eight weeks to 15 patients. Researchers at Yale, in collaboration with Heffter Institute, are also actively seeking 30 participants for a double-blind, placebo-controlled study, examining the effects of psilocybin on OCD.
Despite the increased rigor in today’s trials, Jacobs tells Lucid News he’s “doubtful” that psychedelic medicine for OCD will receive FDA approval in the next few years.
Both the Arizona and Yale studies are “Phase 1 with small samples,” making them “about five years behind psilocybin for treatment-resistant depression,” says Jacobs. His hope is that once the first licensing for psychedelic medicines has been completed, “various policy and regulatory changes will pave the way for research on other indications to be streamlined.”
So far, only one company has publicly expressed interest in developing psilocybin as a medication to treat OCD. Tassili Life Sciences Corp., a Toronto-based “producer of psilocybin-based therapeutics” recently acquired by the medicinal mushroom company Champignon Brands, announced in a March press release that they intend to demonstrate that a combination of psilocybin and cannabidiol (CBD) would be effective in treating both post-traumatic stress disorder (PTSD) and OCD.
Since then, however, there has been no further update. Jacobs speculates that Tassili Life Sciences may be “waiting to learn more about the prospects for success courtesy of Arizona and Yale before making any significant commitments.”