Psilocybin

What is psilocybin?

Psilocybin is a naturally found compound produced by a large variety of fungi (more than 200 species!). While psilocybin itself is relatively inert, the body converts this compound to psilocin, which results in its well-known psychedelic effects. As a naturally occurring compound, humans have been consuming psilocybin for centuries, with early use facilitating spiritual ceremonies. It wasn't until the 1950s, however, that researchers began to better understand how to isolate the compound from known mushroom species and subsequently study its effects in humans, particularly in mental health. Similar to MDMA, however, increasing use by the general public and negative press led to laws prohibiting its production and use for any purpose. With advances in our understanding of human biology and a renewed interest in alternative treatments for mental health disorders, however, psilocybin began seeing a resurgence in research in the 1990s. Some states more recently have even decriminalized its use among the general public and enhanced access for providers utilizing psilocybin for medical purposes. During this same time, a growing body of research has indicated that psilocybin has the potential to dramatically improve depressive symptoms and other mental health-related disorders. With this, it is anticipated that the use of psilocybin for the treatment of mental health disorders will increase.

How does it work?

After psilocybin is consumed, it is rapidly metabolized to the active compound psilocin. Because of differences in each individual's metabolism of the parent compound, the resultant subjective effects may vary from one user to another. At a low dose, sympathomimetic effects predominate, whereas at higher doses, the psychedelic effects (e.g., hallucinations) become more prominent. As it pertains to neurochemistry, psilocybin predominantly impacts serotonergic receptor pathways in the brain, which is why it is thought to have such positive impacts on mood, anxiety, and depressive symptoms. From a mental health perspective, psilocybin actively works on areas of the brain that are thought to be dysregulated in mood disorders, serving as a functional reset button. Part of this process, however, likely also involves the subjective experience brought on by moderate to high dose psilocybin, offering psychological insight and deep personal meaning. As with any psychedelic, "set and setting" are nearly as important as the drug itself, and psychotherapy is important to help navigate the human experience of the process.

What is it indicated for?

While specific indications are continuing to be researched, the anticipated predominant indication for psilocybin is for patients suffering from depression. Other potential indications include obsessive-compulsive disorder, substance use disorder(s), and reactive anxiety or mood disorders, particularly in patients suffering from advanced stage cancer. As it pertains to what we currently know, we anticipate that indications will broaden but the near-term focus will be for patients suffering from depression.

What does the data say?

At a moderate dose and in conjunction with psychological support and/or psychotherapy, psilocybin has continued to show great improvements in depressive symptoms. While it is unlikely to replace standard therapies (e.g., SSRIs), we believe that there is enough emerging evidence that it will enter into mainstream treatment for patients suffering from major depression shortly with tremendous benefit.

When will it be available?

At present, FDA approval for psychedelic drugs, including psilocybin, remains for investigational purposes only. This is out of an abundance of precaution to ensure safety and efficacy for general, widespread use before implementation. We anticipate that any widespread FDA approval will require close, supervised use and patient monitoring in a controlled setting with well-established protocols, particularly as it pertains to concurrent psychotherapy sessions. While we are hopeful that the therapy will become more readily available soon, it could be years until formal approval.

What are some alternative treatments in the meantime? As with MDMA, general use of psilocybin for the treatment of mental health disorders is likely some time off outside of the few states with less strict regulations. However, both Spravato and intravenous ketamine therapies have shown similar treatment response rates with less time commitment. We believe that psychotherapy is integral to any mental health treatment plan. As it pertains to MDMA and psilocybin, the duration of effect of the drug(s) will require longer monitoring and longer active psychotherapy sessions based on treatment protocols known in the literature to date. With ketamine-based therapies, including Spravato, therapy remains important but can occur surrounding treatments on a patient's own timeline, adding some flexibility. If you are looking for more information or would like to discuss treatment options, call our office at 380-214-1636.