Medical Editor: Dr. Lynn Marie Morski, MD, Esq
What is Psilocybin Therapy?
Psilocybin therapy is a form of psychedelic-assisted therapy. Psilocybin is a classic tryptamine, a psychoactive compound found in over 200 species of psilocybe mushrooms.
Where Did Psilocybin Therapy Start?
While the indigenous use of psilocybin mushrooms for healing goes far back to pre-colonial times, the idea of psilocybin therapy only recently emerged in Western science.
In 1957 a curandera (Latin American healer) called Maria Sabina was persuaded to share the healing knowledge of psilocybin mushrooms with R. Gordon Wasson (a banker and mycology enthusiast). Sabina held a velada, a form of traditional Mazatec healing that incorporates various species of psilocybin mushrooms and other sacred plants.
Wasson returned to Europe with mushroom spores and began to research their therapeutic potential from a non-indigenous perspective. After publishing an article on his experience with the divine, Western tourism descended on Oaxaca and inspired some early psychedelic researchers to investigate the impacts of a psilocybin trip.
Outside of its traditional cultural container, psilocybin therapy was reconfigured to conform to a Western view of medicine and mental illness. Rather than healing physical ailments and sickness in the Mazatec ways, ritual participants became therapy clients or intrepid explorers looking to encounter the divine.
From a Controlled Substance to Breakthrough Status
In the decades before psilocybin was prohibited under the Controlled Substance Act, several scholars studied and utilized psilocybin therapy with their clients and students. And despite the onset of the War on Drugs, clinicians and folk healers continued to administer psilocybin therapy, sharing best practices and protocols among community members.
Since being driven into the underground, psilocybin therapy in the United States has evolved beyond the traditional psychotherapy model. Integrating the lessons from decades of practice, practitioners began to incorporate expressive arts, mindfulness, ecotherapy, and somatic therapy to cultivate their clients’ ideal treatment environment.
Curiously, it seems that psilocybin therapy is especially effective for mental health because of its low risk of toxicity and more remarkable ability to elicit the kind of mystical-type experience that supports long-term, sustainable behavior change.
What Can Psilocybin Therapy Treat?
There is limited clinical research available to determine what conditions psilocybin therapy treats best. This healing modality has seen the most press coverage for its efficacy in treating end-of-life anxiety in terminal cancer patients.
Psilocybin therapy also demonstrates the unique potential for eliciting mystical experiences that increase openness, emotional empathy, and creative thinking following a single session. As laws continue to evolve and psychedelic-assisted therapy becomes widely available, researchers will have a better opportunity to investigate the therapeutic potential of psilocybin therapy. Here are some promising potentials:
Psilocybin Therapy for Treatment-resistant Depression
Major Depressive Disorder (MDD) is often challenging to treat, even with pharmaceutical intervention and on-going therapy. However, due to its promise as a therapy for MDD, psilocybin was granted breakthrough status by the FDA for the treatment of depression in 2019.
For those with depression with proven resistance to treatment, psilocybin therapy might offer a safer alternative to conventional antidepressant treatment. In one study, two oral doses of psilocybin used in combination with psychological support had an antidepressant effect that was present six months post-treatment.
Because psilocybin supports nerve growth, taking it in combination with therapy allows new neural pathways to form, essentially rewiring thought patterns that contribute to treatment-resistant depression.
Psilocybin Therapy for Addiction
While clinical research is lacking, we do have a proof-of-concept study that suggests psilocybin therapy enhances the benefits of certain types of therapy for alcohol addiction. Additional studies indicate that psilocybin used in conjunction with psychotherapy can treat alcohol addiction and nicotine addiction.
Psilocybin Therapy for Bipolar Disorder
Bipolar disorder is consistently listed as an exclusion criterion in psilocybin therapy trials, at psilocybin therapy retreats, and among practitioners. However, beginning in 2021, the first clinical trial to investigate the risks, intentions, and outcomes for adults with bipolar disorder will begin.
It is important to note that people with bipolar disorder do have a higher likelihood of experiencing hypomania when taking SSRIs, medications that operate on the same receptors as psilocybin, the 5-HT2A receptor.
Psilocybin Therapy for OCD
Obsessive-Compulsive Disorder (OCD) is the 4th most common psychiatric diagnosis and is typically treated with long-term use of antidepressants and cognitive behavioral therapy. OCD exhibits increased brainwave patterns related to self-referential thinking that might be uniquely interrupted by psilocybin.
While no clinical trials have incorporated psychotherapy combined with psilocybin therapy for OCD, the symptom reduction experienced in one small study suggests an acute benefit and proof of concept.
Psilocybin Therapy for Migraine
Migraine headaches are quite common, affecting roughly a quarter of U.S. households and approximately 1 in 5 women and 10% of children. Previously shown to have efficacy in treating cluster headaches, a small-scale study shows potential for psilocybin therapy to treat migraine headaches.
Where is Psilocybin Legal?
Psilocybin is legal in very few nations—and the United States is not one of them. Oregon recently passed a measure to regulate psilocybin-assisted therapy — and another to decriminalize all illicit drugs. By 2023, mechanisms should be in place to permit licensed practitioners from offering psilocybin to patients.
But until then, legal psilocybin trials are underway, and people may apply if they meet the criteria.
Outside of the United States, psilocybin is also a Schedule 1 drug as defined by the United Nations. However, some nations have elected to decriminalize psilocybin, either directly or indirectly, through permitted loopholes rarely challenged in Mexico, Portugal, and Brazil.
You may find psilocybin mushroom therapy allowed at retreats in Jamaica, Costa Rica, the British Virgin Islands, Portugal, and psilocybin truffle therapy in the Netherlands.
Is Psilocybin Addictive?
Psilocybin has not been shown to cause compulsive use, nor is it addictive in the classical sense because the body builds up a tolerance to it quickly. Due to the intensity of the experience, people who use psilocybin tend to self-regulate their use behaviors.
As with any drug, psilocybin can be harmful if there is no proper care and attention placed on pre and post-integration work. Because profound transformations and feelings of well-being can arise from psilocybin therapy, there is a risk of falling into spiritual narcissism patterns that can make overcoming addictive behaviors more difficult.
A final thought: While psilocybin therapy shows many promising treatment avenues, clinical research is still restricted by prohibitive drug laws. It will be challenging to develop psilocybin therapy protocols to address a wide range of diseases until these change. The sooner clinical research is permitted, the sooner psilocybin therapy will be coming to a center near you.