Psilocybin in the Treatment of Mood and Substance Use Disorders
Research on classic hallucinogens as an aid in the treatment of mood and substance use disorders has generated renewed interest over the past decade. Recent pilot studies have shown safety and feasibility of psilocybin, a naturally occurring serotonin 2A receptor agonist, as a therapeutic tool in the treatment of depression, end-of-life anxiety, alcohol, and tobacco use disorders. Moreover, data suggest a notable effect of psychedelics in occasioning profound and lasting changes in mood, behaviors, and attitudes consistent with enhanced health and well-being in diverse populations.
Despite these compelling findings, the psychological mechanisms of action of psychedelic-facilitated treatments remain poorly understood. Preliminary evidence indicates that acute mystical-type drug effects, and sometimes intensity, are significantly associated with therapeutic outcomes in psilocybin-facilitated treatments, consistent with earlier researchers’ assertions that the subjective effects of psychedelics play a pivotal role in mediating persisting beneficial effects. Psychological insight, personality change, increased motivation, and enhanced self-efficacy are among the factors hypothesized to contribute to observed benefits of psychedelic-facilitated treatments.
Furthermore, psychedelics’ effects on functional connectivity within the default mode network, and actions on serotonergic and glutamatergic systems have been implicated as potential neurobiological mechanisms of therapeutic outcomes via neuroplastic brain changes, improved mood, and decreased anxiety and craving. However, the manner in which time-limited drug effects may provoke enduring changes in personal attitudes and behaviors, and appropriate methods for minimizing risks while maximizing therapeutic benefits require further elucidation.
This discussion focused on contemporary clinical research with psilocybin, and key methodological issues in working with psychedelics, as well as highlighted important clinical paradigms and considerations in studying psychedelics as a therapeutic tool.
Albert Garcia-Romeu, Ph.D.
Albert Garcia-Romeu, Ph.D. is a member of the Psychiatry and Behavioral Sciences faculty at the Johns Hopkins University School of Medicine, where he studies the effects of psychedelics in humans, with a focus on psilocybin as an aid in the treatment of addiction. He received his doctorate in Psychology in 2012 from the Institute of Transpersonal Psychology, where he researched self-transcendence and meditation, and their role in mental health. His current research interests include clinical applications of psychedelics, mindfulness, and altered states of consciousness, and their underlying neurobiological mechanisms.