Psilocybin therapy

Psilocybin therapy describes the controversial use of psilocybin to treat anxiety and depression. Psilocybin is the active substance found in "magic" mushrooms. Due to the absence of medical evidence for efficacy and safety, and legal concerns, psilocybin therapy is not used in conventional medical practice.

Research

Anxiety

Potential anxiolytic and antidepressant mechanisms of psilocybin include serotonergic and psychedelic effects in the brain.[1][2]

Depression

In vitro research indicates that mechanisms of psilocybin pharmacological action are mediated by binding to 5-HT2 receptors.[3]

Ethical concerns

A debate has been going on about whether psilocybin is an ethical, or even safe, treatment for depression and other mental illnesses such as anxiety. In comparison to other drugs, psychedelics in general are relatively harmless physiologically. Many of the currently known psychedelics, including psilocybin, are classified as having no accepted medical use in the US.[4]

In the past, research with psychedelics has been conducted in the absence of rigorous guidelines. Especially during the 1950s and 1960s, lack of informed consent led to substantial and long-lasting harm to some subjects, averting the public away from use of psychedelics in medical practice. Further, unsupported claims led to drug abuse in the absence of a formal and supervised setting. This undoubtedly raised ethical concerns. Since then, research regarding the effectiveness of psilocybin therapy has been conducted under strict ethical guidelines, with fully informed consent and a prescreening to avoid people with psychosis taking part.[5] Additionally, the experimenters conducting it are trained to properly administer the drug, and suggestions for experiments have to comply with the APA's ethical guidelines as well as pass expert reviews before they can be carried out.[6]

Furthermore, potential harms of psilocybin, such as psychosis and hallucinations, have only been linked to recreational and unsupervised nonmedical use of the drug.[4] Experts agree that the drug treatment is still under development and they do not recommend to the public to try and self-medicate their mental states. Acute effects, such as anxiety, fear states, and increases in heart rate and blood pressure, can occur during the time of drug action, and without supervision dangerous behaviors can emerge. However, trained specialists can readily manage this and usually no negative long-term effects are reported.[5]

History

The first use of "magic mushrooms" is believed to have taken place in around 9,000 B.C in North Africa, where they were consumed by indigenous cultures. Different rock paintings depicting what seemed to be mushrooms have been found originating in this time. Additionally, statues and other forms of representations of mushrooms or mushroom-like figures have been discovered in Mayan and Aztec ruins in Central America. The mushrooms were most likely used by indigenous cultures to produce visions, induce a state of trance and to 'talk to the gods'.[7]

First experiments

In October 1799, the first experiment investigating mushrooms and their psychedelic effects took place in London. It was conducted by Dr. Everdad Brande, who visited and observed families whose members were seized with visions and laughter following consumption of wild mushrooms. Later, these mushrooms were examined and classified as Agaricus Glutinosus and reclassified as Psilocybe Semilanceata at a later point in time.[8]

As European travelers, traders and missionaries arrived in these areas where mushroom consumption was common, they attempted to ban mushroom consumption and possession, arguing they were unhallowed, indulgent and dangerous.

In 1959, Albert Hofmann, as Swiss chemist, was the first person to ever extract pure psilocybin from the mushrooms that commonly contain it (Psilocybe mexicana). Sandoz, the company that Hofmann worked for at that time, then began to sell the active compound to clinicians and physicians all across the world, which then used the drug as an aiding substance in psychedelic psychotherapy.

In August 1960, Timothy Leary, a psychology professor from Harvard University, traveled to Mexico to conduct a self-experiment using psilocybin mushrooms. After trying pure, extracted psilocybin he decided to experiment even more with the substance, even administering it to his students. In conducting his experiment, he was assisted by his colleague, prof. Dr. Richard Alpert. One of their experiments consisted of administering psilocybin to prisoners, attempting to find out whether it could help reduce recidivism rate and constitute an effective psychotherapy aid. In fact, the results showed a recidivism rate that was 40% lower than expected. In another experiment, Leary and Alpert gave psilocybin to divinity graduate students with the aims of observing the effects of the drug on spiritually predisposed subjects. Students confirmed afterwards that their experience had made positive, lasting changes in their lives.

In 1963, however Dr. Leary and Dr. Alpert were faced with disapproval from other colleagues at Harvard University, eventually leading to their suspension from their jobs at the University. Academics criticized their experiments and their project, describing it as irresponsible and dangerous.[9]

First medical use

Around the years 1960-1977, psilocybin was first studied as a psychotherapeutic drug. Research on humans in this field was approved by the Food and Drug Administration (FDA), but after a while it was ended and did not continue until the late 1990s, when research on the medical use of psilocybin was finally picked up again.

In 2011, a study conducted at Johns Hopkins School of Medicine showed that about 60% of the subjects that were given psilocybin under controlled conditions underwent significantly positive personality changes concerning traits like openness, imagination or feelings. On the basis of these findings, researchers have since been working on studies of psilocybin treatments in patients with cancer, who frequently experience depression, anxiety or ache.[10]

Society and culture

Legal status

Further information: Legal status of psilocybin mushrooms

Psilocybin is listed as a Schedule I drug under the United Nations 1971 Convention on Psychotropic Substances.Therefore, the legal status of psilocybin varies internationally. In Jamaica, any kind of psilocybin is legal and openly sold.[11] Psilocybin is partially legal in the Netherlands. Possessions of 0.5g dried or 5g fresh psychoactive mushrooms is allowed, but everything whereas major amount will lead to a penalty.[12] In Australia, Bulgaria, Belgium, Canada, Denmark, Finland, France, Germany, Hong Kong, Indonesia, Ireland, Japan, New Zealand, Poland, Russia, South Africa, Sweden, Taiwan, Turkey, the UK and the US psilocybin is illegal and therefore possession, use or cultivation will usually lead to significant punishment. Psilocybin is not legal worldwide, but psilocybists argue that it is very important to have research on the positive consequences on mental illnesses. Thus, there is a bureaucracy to follow for the permission of psilocybin as used by researchers.[13][14]

Therapy

In Germany, psilocybin therapy is not illegal per se but the usage of psychedelic drugs like LSD or psilocybin while therapy generally is unlawful. Furthermore, the German Medical Association stated in 2010 an explicit warning about the application of drugs as part of therapy after two patients died during a poly-drug therapy session that year. The drugs used, although including psilocybin and LSD which are known to be reasonably safe, also included more dangerous drugs such as MDMA, heroin and amphetamine.[15]

In the United States it is only possible to receive a psilocybin therapy in context of a study to the effects of this therapy form on different psychological illnesses. The same is true for the United Kingdom and the Netherlands. All three countries are pioneers in studying psilocybin therapy. In 2006 for example people with Obsessive-compulsive Disorder were able to apply for a study at the University of Arizona which observed the effects of psilocybin therapy on OCD.[16]

Since 2014 the Swiss authorities give permission for the usage of psilocybin in some individual cases.[17]

The usage of psilocybin holds a low but unpredictable chance of eliciting panic attacks, lasting flashbacks of the drug experience or even a psychosis, which serves as one of the reasons why psilocybin is illegal in many countries and not used in therapy.[18] Another reason was formulated by the president of the German Medical Association in 2010 appealing to official psychotherapies as aiming to support a patient's self-organization instead of a drug-based therapy.[15] On the other hand, there is increasing evidence for the medical practicality of psilocybin. Also, different studies showed that it is not likely that psilocybin induces dependence and the therapeutic index for psilocybin is about 1000, contrasting, for example 10 in alcohol.[19]

References

1. Kyzar, Evan J.; Nichols, Charles D.; Gainetdinov, Raul R.; Nichols, David E.; Kalueff, Allan V. (2017-11-01). "Psychedelic Drugs in Biomedicine". Trends in Pharmacological Sciences. 38 (11): 992–1005. doi:10.1016/j.tips.2017.08.003. ISSN 0165-6147. PMID 28947075.
2. Vollenweider, Franz X. (18 August 2010). "The neurobiology of psychedelic drugs: implications for the treatment of mood disorders". Nature Reviews Neuroscience. 11 (9): 642–651. doi:10.1038/nrn2884. PMID 20717121.
3. Mahapatra, Ananya (January 2017). "Role of psilocybin in the treatment of depression". Therapeutic Advances in Psychopharmacology. 7 (1): 54–56. doi:10.1177/2045125316676092. PMC 5228719. PMID 28101325.
4. Anderson, Brian. "Psychedelic Psychotherapy The Ethics of Medicine for the Soul" (PDF). Penn Bioethics Journal. 2: 9–12.
5. Tupper, Kenneth W.; Wood, Evan; Yensen, Richard; Johnson, Matthew W. (2015-10-06). "Psychedelic medicine: a re-emerging therapeutic paradigm". CMAJ : Canadian Medical Association Journal. 187 (14): 1054–1059. doi:10.1503/cmaj.141124. ISSN 0820-3946. PMC 4592297. PMID 26350908.
6. S., Bordens, Kenneth (2017-03-20). Research design and methods: a process approach. Abbott, Bruce B. (Tenth ed.). Dubuque, IA. ISBN 9781259844744. OCLC 953984959.
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15. http://www.berliner-aerzte.net/pdf/bae0911_012.pdf
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