Could a single tablet help improve the outcome for patients with anorexia? That is the tantalising prospect offered by a study published yesterday looking at the use of psilocybin, the hallucinogenic component of magic mushrooms.
Researchers at the University of California tested the treatment on ten patients who had been ill for a number of years with the eating disorder but had no success with standard treatments such as talking therapies — each was given one pill and, after three months, 40 per cent went into ‘what we are saying is remission’, Dr Stephanie Knatz Peck, a clinical psychologist and one of the study’s authors, told Good Health.
That means their responses to a standardised questionnaire ‘went from scores in the elevated range — indicating anorexia — back into the normal range’, says Dr Knatz Peck. ‘That’s significant.’
The results, published in Nature Medicine, show the treatment was ‘safe and acceptable’ and are being followed up by larger studies. If successful, they could herald a new era for treating anorexia, which has the highest mortality rate of any psychiatric condition (more than 5 per cent, reported JAMA Psychiatry in 2011).
Could a single tablet help improve the outcome for patients with anorexia? File image
There are significant caveats —the trial was small and designed to explore the drug’s safety rather than efficacy; and there was no placebo group for comparison. Also, the nature of the treatment meant the participants endure a potentially anxiety-inducing ‘trip’ for several hours. Some patients and experts may have misgivings about the use of a psychedelic drug.
Anorexia, characterised by a preoccupation with food and body shape that can often lead to dangerously low bodyweight, affects around 100,000 people in the UK. While the cause is not fully understood, it can run in families and certain personality types seem to be at increased risk, such as perfectionists and those with low self-esteem.
‘One of the things that makes anorexia so hard to treat is that, while most people with a psychiatric illness want to get rid of it, that’s not the case with this,’ says Dr Knatz Peck. ‘People become identified with their illness — they say they like themselves better or feel better with anorexia. So they might refuse to come back for more treatment.’
Talking therapies can be effective, especially if given early, ‘to help distance the patient from their preoccupation with weight and shape’, adds Dr Knatz Peck. But it can be harder than it sounds to overcome such feelings.
‘It can be like asking someone without anorexia to jump off a building — that’s how difficult it is in their minds,’ she adds.
That’s why, for a proportion of patients, anorexia can persist. One study in the Journal of Clinical Psychiatry found that, after nine years, 31 per cent had made a full recovery — at 22 years that figure was 62 per cent.
Could psilocybin improve such outcomes? In the trial, the ten participants (aged 18-40) were given a 25 mg tablet of synthetically made psilocybin and three months later their symptoms were reassessed.
Four of the ten women experienced an improvement in symptoms, while nine ‘found it helped with a shift in their identity, they described it like having a complete change in the value of their anorexia’, says Dr Knatz Peck. However, on average there was little change in weight among the group, although some saw slight gains, she adds.
A larger study with 80 patients is underway at centres in the U.S., Ireland and at King’s College London: this time patients are being given 25 mg or 1 mg of psilocybin. One theory is psilocybin ‘re-sets’ the brain, breaking the rigid thought processes that drive anorexic behaviour.
A study published yesterday is looking at the use of psilocybin, the hallucinogenic component of magic mushrooms. File image
In the body psilocybin breaks down into another drug, psilocin, which attaches to receptors for serotonin (a ‘feelgood’ chemical). ‘It seems to have an immediate effect to change the brain pathways and synaptic plasticity: in other words, the connections between cells,’ explains Guy Goodwin, a former professor of psychiatry at Oxford University and now chief medical officer of Compass Pathways, the company that made the synthetic psilocybin used.
‘Based on laboratory studies it appears the synapses start growing — and that persists,’ he adds. ‘So the drug produces an experience which lasts [just] hours but alongside this are persistent effects which we think are mainly behind the anorexia effect.’
Dr Goodwin emphasises the trials involve a specified dose tablet — not recreational drugs — and says: ‘It is vital the patient knows what to expect — about 20 per cent of patients who take it feel anxious and some people have very anxiety-provoking experiences.’
In June, Australia became the first country worldwide to allow psilocybin to be prescribed for conditions such as depression — a move criticised by some as being premature, based on the small number and size of trials for it.
Another concern is side-effects. A study published in the New England Journal of Medicine last year, involving 75 patients with drug-resistant depression, found that while a single dose of psilocybin improved symptoms, it was also associated with nausea and suicidal thoughts. Other potential side-effects include a temporary rise in blood pressure and a ‘hangover’ effect, says Dr Goodwin.
Stephen Alexander, an associate professor of molecular pharmacology at Nottingham University, says measuring the true effectiveness of any new drug for mental health disorders is complex. ‘I don’t think this one will work any better or worse just because it’s a psychedelic,’ he adds. ‘But I do think patient care around the treatment day [as they are essentially having a ‘trip’] would be an important consideration.’