Psychedelic treatments show promise for OCD while cannabis doesn’t, review finds | Obsessive-compulsive disorder
A recent review of alternative treatments for obsessive-compulsive disorder (OCD) shows that psychedelic treatments show promise for this disorder, but marijuana does not.
D., professor of psychiatry at McMaster University in Ontario, Canada, and lead author of the review. Michael Van Ameringen Published in the Journal of Psychiatric ResearchHe said 40-60% of OCD patients achieve partial or no relief with existing treatments, including SSRIs and exposure and response prevention therapy.
While psychedelics and cannabinoids have become part of the conversation surrounding OCD, a disorder characterized by intrusive, obsessive thoughts and/or compulsive behavior, there is much more published evidence of the effectiveness of these substances for more common conditions such as depression and anxiety.
“We wanted to drill down further and really understand, is there evidence that these things that are being talked about are being used as next-step treatments?” Van Ameringen explained.
Given the paucity of available literature, Van Ameringen said he didn’t know what to expect. To compensate for the lack of published information, he included conference presentations and preliminary unpublished findings in the review article.
After compiling the available evidence, Van Ameringen and his team found “stronger signals” for the effectiveness of psychedelics, particularly psilocybin (“the psychoactive component of magic mushrooms”), than cannabinoids such as THC and CBD.
Van Ameringen theorizes that the difference has to do with how these substances interact with areas of the brain involved in OCD. While cannabinoids activate CB1 receptors in the brain, which regulate symptoms such as compulsion and anxiety, current evidence suggests that they do not provide lasting relief from OCD symptoms.
On the other hand, psilocybin may reduce connectivity It’s in the brain’s default mode network, which is “mainly involved in self-referential thinking and rumination. The default mode network is really activated in OCD,” he says.
D., a psychiatrist and computational neuroscientist at Brown University who will lead a future clinical trial on psilocybin for OCD. Mohamed Sherif says a difference in the methodology of the cannabis and psilocybin studies may also have contributed to the different results. Psychedelic clinical trials, such as the one Sherif plans, not only offer patients drug therapy but also incentive to frame their experience as a therapeutic “journey.”
“This is not done in cannabinoids [studies,]” The Sheriff explained.
Clinical psychologist Dr. from Yale School of Medicine. Terrence Ching similarly wondered whether the way people use marijuana rather than psilocybin could explain the different results. While people tend to use marijuana for temporary relief, psilocybin may help facilitate actual changes in the brain and patients’ perception of OCD.
“A person might use marijuana for the same therapeutic reason, which is to confront something deeper about their OCD or obsessive fears. But traditionally people tend to use marijuana for an avoidance function,” Ching explained.
Preliminary results from Ching’s clinical trial of single-dose psilocybin for OCD were included in Van Ameringen’s review article and showed that psilocybin was effective compared to placebo for OCD symptoms. Ching is currently preparing the results of the trial for publication and is planning a second clinical trial in which OCD patients would receive two doses of psilocybin at different times.
During the single-dose trial, each of the 11 patients received either psilocybin or niacin, a placebo intended to mimic some of the effects of psilocybin, so patients could not be sure which drug they were receiving. During dosing sessions, patients sat with two facilitators who offered minimal guidance in the form of open-ended questions.
Ching said his protocol includes strict rules about the type of touching allowed if patients request it (only placing the hand on the shoulder or forearm) to establish clear ethical boundaries. Past psychedelic clinical trials Controversy arose when facilitators initiated unwanted contact with participants under the influence.
Ching said the experiment not only showed that psychedelics can improve OCD symptoms, but was also useful for both clinicians and participants to learn more about the nature of OCD.
According to Ching, psilocybin is known for triggering “mystical experiences,” characterized by a specific type and intensity of psychedelic effects.
“What we see in OCD is often partial mystical experiences; when people feel like psilocybin wants to take them into a deeper state of experiencing, they kind of put on the brakes,” Ching said, adding that this highlights one of the core features of the disorder: the need to be in control.
While clinicians in psychedelic studies often encourage patients to dig deeper, Ching said it’s important to “be non-directive and non-judgmental” with OCD patients.
During the trial, Ching found that patients recognized their own resistance to medication and gained deeper insight into their need for control, saying things like: “I’m really aware that this is how I approach unknown things in my life, but that’s how life is. Life is full of unknowable things.”
Ching is hopeful about the future of psychedelic drugs, but there are several obstacles that make researching them difficult. Psilocybin is still an illegal program in the U.S., which means researchers must take additional steps to study it, including working with a DEA liaison and using a DEA-approved safe that “must be bolted to the floor” in a private windowless room.
Researchers also have to grapple with the issue of “functional unblinding,” or the fact that psychedelic effects can mean that trial participants can predict whether they are taking psilocybin or a placebo; this may change their perception of their own symptoms. This is especially problematic given the hype around psychedelics, Ching said.
Many participants will enter a trial expecting a “miracle cure” – a narrative Ching believes is actually harmful to psychedelic research: “What we need to do now is to take psychedelics seriously, like any other valuable medicine, to study them seriously, in a controlled, rigorous way, in an ethical way, in a way that pays homage to the traditional Indigenous users of psychedelics, because there is great wisdom there too.”
