A single pill made using magic mushroom hallucinogen could help treat anorexia that affects 100,000 Britons, study suggests

Can a single tablet help improve the outcome for patients with anorexia? That’s the tantalizing prospect presented by a study published yesterday on the use of psilocybin, the hallucinogenic component of magic mushrooms.

Researchers at the University of California tested the treatment in 10 patients who had been sick with the eating disorder for several years but had no success with standard treatments such as talk therapies — each was given one pill, and after three months, 40 percent went into “what we say is remission,” Dr. Stephanie Knatz Peck, a clinical psychologist and one of the study’s authors, told Good Health.

That means their answers to a standardized questionnaire “went from scores in the elevated range — indicating anorexia — back to the normal range,” says Dr. Knatz Peck. “That’s significant.”

The results, published in Nature Medicine, show that the treatment was ‘safe and acceptable’ and are being followed up by larger studies. If they succeed, they could usher in a new era for the treatment of anorexia, which has the highest mortality rate of any psychiatric illness (more than 5 percent, JAMA Psychiatry reported in 2011).

There are important caveats – the trial was small and designed to investigate the drug’s safety rather than efficacy; and there was no placebo group for comparison. Also, the nature of the treatment required participants to endure a potentially terrifying ‘trip’ for several hours. Some patients and experts may have doubts about using a psychedelic drug.

Anorexia, characterized by a preoccupation with food and body shape that can often lead to dangerously low body weight, 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 difficult to treat is that most people with a psychiatric condition want to get rid of it, but this one doesn’t,” says Dr. Knatz Peck. “People become identified with their illness — they say they like themselves better or feel better with anorexia. So maybe they refuse to come back for more treatment.’

Talking therapies can be effective, especially if given early, “to help the patient move away 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 — it’s that hard in their head,” she adds.

Therefore, anorexia may persist in a proportion of patients. A study in the Journal of Clinical Psychiatry found that 31 percent had fully recovered after nine years, compared to 62 percent after 22 years.

Could psilocybin improve such results? In the trial, the ten participants (ages 18-40) were given a 25 mg tablet of synthetically made psilocybin and their symptoms were reassessed three months later.

Four out of 10 women experienced an improvement in symptoms, while nine “felt it helped with a shift in their identity, they described it as a complete change in the value of their anorexia,” says Dr. Knatz Peck. On average, however, there was little change in weight among the group, although some saw slight gains, she adds.

A larger study is underway with 80 patients at centers in the US, Ireland and at King’s College London: this time, patients will receive either 25 mg or 1 mg of psilocybin. One theory is that psilocybin “resets” the brain, breaking the rigid thought processes that drive anorexic behavior.

A study published yesterday looks at the use of psilocybin, the hallucinogenic component of magic mushrooms. File image

In the body, psilocybin is broken down into another drug, psilocin, which attaches to receptors for serotonin (a “feel good” chemical). “It seems to have an immediate effect of changing 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 lab studies, it looks like the synapses are starting to grow – and they’re continuing to do so,” he adds. So the drug produces an experience that lasts [just] hours, but in addition there are persistent effects that we think are mainly behind the anorexia effect.’

Dr. Stressing that the trials involve a specific dose tablet – not recreational drugs – Goodwin says: ‘It’s vital that the patient knows what to expect – about 20 percent of patients who take it feel anxious and some people have very frightening experiences.’

In June, Australia became the first country in the world to allow psilocybin to be prescribed for conditions such as depression – a move some have criticized as premature, based on the small number and size of studies 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 possible side effects include a temporary increase in blood pressure and a “hangover” effect, Dr. Goodwin says.

Stephen Alexander, an associate professor of molecular pharmacology at the University of Nottingham, says measuring the true effectiveness of a new drug for mental disorders is complex. “I don’t think this one will work better or worse just because it’s a psychedelic,” he adds. ‘But I do think about patient care around the treatment day [as they are essentially having a ‘trip’] would be an important consideration.’