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  • Writer's pictureDr. Harold Pierre

Psilocybin Therapy: Is this the future of Psychotherapy?

Updated: Nov 30, 2023

Psilocybin Therapy: Can this Psychedelic Treatment be the Future of Psychotherapy?


Psilocybin therapy uses mushrooms (magic mushrooms) along with counseling. Early results demonstrate helping different mental struggles. In recent times, more research explores psilocybin and other psychedelics' possible aids. As a physician who treats addiction, one day I hope to offer patients alternate paths, should these prove safe. The idea of mushrooms assisting substance abuse intrigues me. More discovery could open doors to relief for those seeking care. Though not something I currently provide, understanding this area better interests me for anyone confronting tough illnesses.


This article takes a close look at exactly what this "mushroom therapy" entails, how it may work on the brain, and what conditions show response. The future of psychiatry could be transformed if large studies continue validating early successes. As a board certified anesthesiologist and board certified addiction medicine specialist, I aim to explore evolving frontiers and keep my patients updated on innovative developments in medicine.


What is Psilocybin Therapy?


Certain mushrooms hold a "magical" compound helping people for ages. Called "psilocybin", this compound occurs naturally and brings hallucinogen effects. Indigenous societies used psilocybin rituals since ancient times for soul and healing journeys holistically in community. Modern psilocybin therapy blends its impacts with mind guidance from trained experts. Patients access inner realms with professionals providing outside support. Together, this treatment is called psilocybin therapy.


During "psilocybin therapy" meetings, people receive a measured amount of "psilocybin" within a relaxing, pleasing space. Patients rest, cover eyes and hear specially designed music. The wish is for focusing inside and testing thoughts and feelings differently. Doctors give help before, during and after to help people feel encouraged to discuss their thoughts. Patients feel supported and at ease. They form a trusting relationship. This allows new insights and ideas, and potentially updating how one sees and acts in good ways.


Not like unsupervised recreational use of psychedelics, "psilocybin therapy" happens in a regulated, medical zone with educated guides. The helpers make a trusting bond and lead people through effects. Patients talk about their learnings and thoughts after, and consider how changing unhelpful feelings and actions. Doctors goal is helping apply what patients discover inside themselves to live improving lives. Under these conditions, psilocybin is safe and well tolerated.


Psychedelic mushrooms on purple background and pink light

A Brief History of Psilocybin Research


Use of "psilocybin" for wellness has roots over thousands of years. In the 1950s-1970s, investigation thrived on materials like LSD and "psilocybin". Yet abruptly, this ended when psychedelics faced unlawful status in the 1970s.


In 2000, the premier modern probe of "psilocybin" occurred by Dr. Franz Vollenweider at Zurich's college. This reopened study of psychedelics. Since, heavy research centers such as Johns Hopkins and Imperial College issued many works on "psilocybin'"s aids for issues including sadness, anxiety, and addiction matters.


In 2018, the FDA accepted COMPASS Pathways' "psilocybin therapy" as a revolutionary treatment for depression not easing. This validated potential. In 2022, a huge COMPASS experiment became the largest randomized, controlled assessment so far of "psilocybin therapy". Presently, over 100 trials globally now explore advantages.


As further evidence accumulates and approval grows, this pioneering intervention appears ready to enter mainstream psychiatry within a decade. The upcoming looks bright for psychedelics and psychotherapy combined. Meanwhile, investigators worldwide persist difficult jobs. Careful documentation of impacts and safety remain essential to determine conditions aiding, and ascertain progress results from treatment, not just circumstance.


Physicians also search whether natural products like "psilocybin" could enhance nicely being, not simply illness. Slow, meticulous scrutiny stays key to translate preliminary accomplishments into responsible options for those struggling with mental anguish. Yet continuously, diligent exploration gives hope that mystical materials safely and prudently utilized might rework brain wellness care.


Psilocybin Abuse and Addiction


In the 1960s, use became recreational. Young people started taking psilocybin in uncontrolled settings seeking euphoria, mind expansion and mystical experiences. While some had profound awakenings, others experienced paranoia and loss of control. Though psilocybin is not considered addictive, irresponsible use caused accidents and even deaths in rare cases. Psilocybin's checkered past offers crucial lessons as we shape its promising future. Let's not make those mistakes again. Thankfully, modern clinical protocols emphasize careful screening, preparation and monitoring under medical supervision. This balances psilocybin's risks against its emerging therapeutic potential.


How Does Psilocybin Therapy Work?


Psilocybin is a psychoactive compound that produces altered states of consciousness by activating certain serotonin receptors in the brain. Specifically, psilocybin is a partial agonist of the serotonin 2A receptor (5-HT2A). It also interacts with other serotonin receptor subtypes.


Through these receptors, psilocybin produces psychological effects that are believed to "reset" brain circuits that maintain unhealthy thought and behavior patterns. This results in long-term changes in outlook, behavior, and mood.


Psilocybin has also been shown to occasion profound "mystical-type experiences" of unity, transcendence, joy, and insight. Studies show that these mystical experiences increase openness and lead to positive changes that persist for months or years after the psilocybin session.


Exactly how psilocybin therapy leads to therapeutic outcomes is still being elucidated. However, research suggests it works through several mechanisms:

  • Increasing neuroplasticity and “fluidity” in brain networks

  • Producing a brain state akin to the dream state with increased access to emotions and memories

  • Reducing activity in brain circuits linked to depression

  • Increasing emotional responsiveness and positive mood

  • Enabling patients to objectively examine habitual patterns of thinking

The psychological support provided before, during, and after the psilocybin session is also thought to play a crucial role in yielding long-term benefits.


Conditions Psilocybin Therapy May Help Treat


Psilocybin therapy is being investigated as a treatment option for a wide range of mental health disorders and behavioral conditions including:

  • Major depressive disorder

  • Treatment-resistant depression

  • Anxiety disorders

  • Post-traumatic stress disorder (PTSD)

  • Eating disorders like anorexia nervosa

  • Addiction to tobacco, alcohol, and other substances

  • Obsessive-compulsive disorder (OCD)

  • Cluster headaches

  • Demoralization in terminal illness

  • Cancer -related anxiety and depression

  • Negative behavior patterns like domestic violence

The most robust evidence exists for psilocybin therapy in treating major depression and cancer-related psychiatric distress. Other areas like addiction and PTSD show promise but require further study.


Efficacy of Psilocybin Therapy


A growing body of research points to psilocybin’s significant and sustained benefits for various mental health conditions:


In 2016, Hopkins explored impacts of solitary "psilocybin" doses on 51 cancer patients' sadness and worries. Instantly, sizeable declines showed. At half a year, roughly 80% maintained serious lessening of depressed mood and concern. Around 60-80% retained such progress half a year after.

In 2021, COMPASS Pathways led a randomized, regulated experiment on difficult-to-treat depression, comparing effect of higher and lesser amounts of COMP360 "psilocybin therapy" to a popular medication (escitalopram). Following three weeks, 50% of the group receiving potent "psilocybin therapy" no longer exhibited depression, versus 32% of the escitalopram recipients.

  • An open-label study in 2020 found that COMP360 psilocybin therapy rapidly reduced symptoms of anorexia nervosa, with 60% of patients achieving full remission after 6 months.

  • A pilot study in 15 patients with tobacco addiction found that 80% had successfully quit smoking at 6 months after treatment with psilocybin therapy.

  • Multiple small pilot studies show promising results for psilocybin therapy decreasing problematic alcohol use and cravings.

  • A small research study found that psilocybin therapy significantly reduced OCD symptoms although the benefits were short-lived.

Larger, prolonged clinical trials are still needed to thoroughly evaluate the efficacy of psilocybin therapy for various disorders. However, early results are extremely encouraging and underscore this treatment’s immense promise as an anti-depressant, anxiolytic, and anti-addiction intervention.


The Exciting Potential of Psilocybin Therapy for Substance Use Disorders


Substance abuse takes an immense toll on individuals, families, and society. Current treatment options like behavioral therapy and 12-step programs have limited success. Up to 90% of drug users relapse within one year of conventional treatment. This highlights the urgent need for novel, more effective therapies. Emerging research suggests psilocybin therapy could be a game-changing intervention for substance use disorders.


Multiple small pilot studies show that psilocybin combined with therapy may help treat alcohol, nicotine, and drug addiction. In one smoking cessation trial, 67% of participants quit smoking for over one year after psilocybin therapy. This is compared to just 31% success after 12 weeks on varenicline, a leading smoking cessation medication.


In an alcohol study, heavy drinkers experienced a lasting reduction in cravings and alcohol misuse after two psilocybin sessions. They drank less for over one month of follow-up, with some still sober at 36 weeks.


There are a few small studies that have explored using psilocybin as a treatment for cocaine and opioid addiction:

  • A 2014 review paper discussed the potential of psilocybin as a treatment for cocaine addiction. However, the authors noted there have been no published clinical trials directly testing psilocybin for cocaine addiction yet.

  • A pilot study in 2010 gave psilocybin-assisted therapy to 7 opioid-dependent adults. Participants experienced reduced cravings and anxiety after treatment. Out of 5 participants who completed the 8-month follow-up, 4 remained opioid abstinent. This very small preliminary study suggests psilocybin treatment may have promise for opioid addiction, but larger randomized trials are needed.

  • A survey study in 2021 interviewed 30 people who used psychedelics like psilocybin to help quit an addictive substance. 38% reported using psychedelics to help overcome opioid addiction specifically. Many shared experiencing reduced cravings, increased motivation for recovery, and ability to break out of destructive thought patterns during psychedelic experiences.

  • In animal studies, psilocybin has been shown to decrease morphine addiction behaviors in rodents. Rats treated with low doses of psilocybin had less morphine withdrawal symptoms.

Psychological Effects: During the psychedelic experience, people may come to profound new insights about their addiction. By observing their addictive patterns in a new light, they develop awareness needed to break strongly entrenched habits.


The mystical-type experiences psilocybin can produce are also linked to increases in life meaning, openness to change, and motivation for self-improvement. This new mental outlook promotes the willpower and healthy habits needed to overcome addiction.


Psilocybin Therapy Protocol

Professional growing of psilocybin mushrooms in America. Scientific studies of the effects of psilocybin on the human brain copy

Psilocybin therapy entails extensive preparation and follow-up in addition to the acute psychedelic session. A typical protocol looks like this:

  • Initial screening visit to determine eligibility

  • Preparatory therapy sessions to build rapport, set intentions, and prepare mindset

  • Psilocybin session lasting 4-6 hours with 2 therapists present

  • 1-2 integration sessions to process experience and plan behavioral changes

  • Follow-up monitoring and support

During the acute session, patients generally receive a moderate-high dose of psilocybin (10-25 mg psilocybin) along with eye shades, headphones, and relaxing music. They are encouraged to direct their attention inward. Therapists provide guidance and emotional support as needed.


Patients are required to remain at the clinic for observation for at least 6 hours after receiving psilocybin. Medical support is available in case of adverse reactions.


Psilocybin Microdosing Protocol


Psilocybin microdosing involves taking very small doses of psilocybin mushrooms or psilocybin extracts on a regular schedule, usually every 3-4 days. It aims to elicit subtle cognitive/mood effects without causing any overt psychedelic experiences.

A typical microdosing protocol looks like:

  • Psilocybin dose: A microdose is generally considered to be 0.1-0.5 grams of dried mushrooms or around 5-10mg of psilocybin. This is roughly 1/10th of a full psychedelic dose.

  • Frequency: Microdosing every 3-4 days appears most common. Taking small doses more frequently may lead to tolerance.

  • Schedule: Some people follow specific microdosing schedules such as taking a microdose every Monday, Thursday, and Saturday. Others microdose as needed when they feel they could benefit from cognitive boosting effects.

  • Periods: Microdosing periods tend to last several weeks or months before taking a break to reset tolerance.

  • Activities: Some microdosers prefer to take microdoses on days they need extra focus like work days. Others microdose before creative activities.

  • Effects: Reported effects of microdosing include improved mood, focus, creativity, energy, productivity, and sense of well-being. However, some people may not notice any obvious effects.

  • Drawbacks: Potential risks of microdosing include development of tolerance, lack of regulation around psilocybin products, and possible legal issues depending on the jurisdiction. Some also report feeling irritable or anxious while microdosing.

Safety and Side Effects


Modern clinical research indicates that psilocybin therapy is generally safe and well-tolerated when administered under controlled conditions.

The most common side effects include:

  • Anxiety or paranoid thinking

  • Headaches

  • Nausea

  • Elevated blood pressure and heart rate

  • Dizziness

Such effects are usually mild, transient, and manageable. Severe or dangerous reactions are very rare in a clinical setting.


However, psilocybin therapy may not be suitable for people predisposed to psychosis or unable to give informed consent. Extensive medical screening is done to exclude high-risk patients.


With proper precautions and procedure, psilocybin therapy appears to have a low risk profile compared to existing pharmaceutical anti-depressants and anxiolytics.


Outlook for the Future


The past two decades saw rebirth in psychedelic research. Clinical trials results display psychedelic treatments such as "psilocybin therapy" show enormous potential as groundbreaking remedies for psychological disorders including addiction, depression, and anxiety disorder.


Larger-scale clinical trials are just beginning. Despite the early phases, various experts forecast psychedelics gaining FDA approval as recommended remedies within five to ten years. Foundations similar to COMPASS Pathways currently have phase 3 trials of their proprietary "psilocybin therapy" COMP360 for depression.


As stigma fades and awareness of psychedelic therapy grows, a paradigm shift may occur in psychiatry from daily medication to limited psychedelic-assisted sessions that lead to long-term changes in mental outlook and behavior.


Key factors that will determine the future adoption of psilocybin therapy include building an infrastructure of psychedelic clinics, training specialized therapists, navigating regulatory hurdles, and demonstrating consistent effectiveness through wide-scale clinical trials.


The future of medicine points to a new era of healing and wellbeing enabled by psychedelic therapies like psilocybin-assisted therapy. While important challenges remain, psychedelic compounds could fundamentally transform how we treat some of society’s most intractable mental health conditions.


Conclusion

  • Psilocybin therapy combines the therapeutic potential of psilocybin with psychological support to safely occasion transformative states of consciousness.

  • A growing body of research indicates psilocybin therapy has significant efficacy in treating conditions like major depressive disorder, anxiety, addiction, and existential distress in cancer.

  • Exact mechanisms are still being understood but may involve “re-wiring” brain circuits, emotional catharsis, spiritual experiences, and gaining insight into unhealthy patterns.

  • When conducted clinically, psilocybin therapy appears relatively safe and well-tolerated. However, medical oversight is critical.

  • As clinical trials progress, therapeutic psilocybin is expected to become an approved treatment option within the next decade and radically transform psychiatry.

  • More human research on psilocybin could reveal great promise for society's mental health needs. Yet we must proceed prudently, as psilocybin's full risks and benefits are still unfolding.

This article is for informational purposes only. It is not meant to provide medical advice or replace consultations with a qualified medical professional. Always discuss your health with a doctor before pursuing any treatment.


Frequently Asked Questions


Q: What occurs during psilocybin therapy?

A: Psilocybin therapy combines the positive effects of psilocybin with counseling help for mental health struggles.


Q: How does psilocybin therapy Work?

A: Therapy works using psilocybin, a compound in "magic mushrooms." This compound produces psychedelic experience that is believed to "reset" brain circuits.


Q: Is psilocybin therapy legal?

A: It is legal for medical use in some Oregon counties.


Q: What problems may psilocybin therapy treat?

A: Studies show promise helping treatment resistant depression. One dose seemed to lessen sadness long-term for some. May also ease anxiety, addiction, and other mental illnesses.


Q: How long do the effects last?

A: Effects vary per person. In some people, the effects of a single dose of psilocybin are substantial and sustained. Others may need more sessions and psychological support to maintain the beneficial effects of psilocybin.


Q: What risks come with psilocybin therapy?

A: Generally safe with experts' care. But the risks include hallucinations, fast heart, anxiety during a psilocybin therapy session.


Q: Are there on-going studies?

A: Yes. Trials exploring the effectiveness for many mental illnesses. Double-blind randomized clinical trials aim to learn more about healing mechanisms and as a treatment option.


Q: Can it help alcohol use disorder?

A: Early research shows potential assisting battling alcohol cravings and consumption long-term.


Q: Can it help cancer patients?

A: Interest in aiding existential distress, anxiety, depression in cancer patients. Early results show improved well-being and less distress.


Q: When might more widespread accessibility emerge?

A: Hard to say. Multiple years possible as research and attitudes adjust. Approvals for special cases maybe by 2023.


About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.


This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.




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