In recent years, there has been a resurgence of interest in psychedelics and their potential therapeutic benefits in treating psychiatric disorders, particularly obsessive-compulsive disorder (OCD). Researchers at the Paris Brain Institute, including Anne Buot and Luc Mallet from AP-HP, along with their colleagues, are actively gathering evidence that could open the doors to large-scale clinical trials. Their latest study, published in Scientific Reports, suggests that both LSD and psilocybin show strong potential in providing long-lasting relief for patients suffering from OCD.
OCD is a debilitating condition affecting approximately 2% of the population, regardless of age. It’s characterized by intrusive thoughts, repetitive undesirable gestures, and behaviors, often accompanied by high levels of anxiety. This condition can lead to isolation as individuals tend to focus excessively on their obsessions, which can detrimentally impact relationships, work, and leisure activities.
The primary treatments for OCD currently involve cognitive-behavioral therapy (CBT) aimed at helping patients reconfigure their thought patterns, often combined with antidepressant medications. Unfortunately, the effects of these treatments can be slow to manifest, and a significant portion of patients, around 30–40%, do not respond to them at all. This challenging landscape has reignited interest in a clinical research option from the 1970s—psychedelics, a category of psychotropic substances.
However, conducting clinical studies with psychedelics is hampered by the fact that these substances are prohibited in many countries, making it challenging to gather robust data on their effectiveness. To establish randomized, double-blind studies, the gold standard in clinical research, researchers require promising preliminary data urgently. Delayed clarity on the efficacy of psychedelics, coupled with the possibility of media sensationalism, could potentially lead to recreational misuse or the uncontrolled use of these substances by vulnerable patients without proper medical supervision. Additionally, there’s a concern that patients might be diverted from psychotherapeutic interventions that could be effective for them.
Spotlight on individual experience
Psychedelics have the remarkable ability to induce altered states of consciousness, offering users a profound, often overwhelming, shift in their perception of the world that lasts for several hours. This experience can create a sense of disconnection from previous emotional states and foster the emergence of entirely new thought patterns.
While previous studies have hinted at the stark contrast between the immediate effects of psychedelics and the delayed effects of continuous treatments like antidepressants, there remains a critical question: Is there a connection between the user’s subjective experience during the psychedelic journey and the actual therapeutic benefits they might gain? Anne Buot raises this important question.
Two compounds, synthetic LSD and psilocybin from hallucinogenic mushrooms, have shown particular promise in addressing conditions like OCD, partially due to their influence on specific serotonin receptors, as noted by psychiatrist Luc Mallet. Yet, even in animal studies, the data is insufficient to confidently predict their effectiveness.
To expand their understanding, researchers have taken a retrospective approach, analyzing the experiences of individuals who have previously used these substances. Their goal is to determine whether these individuals perceived any improvement in their symptoms after taking LSD or psilocybin, whether this improvement was enduring, and if it could be linked to different factors. The insights gained from patients’ lived experiences are invaluable, especially in the absence of concrete clinical data, as they play a pivotal role in evaluating the therapeutic potential of psychedelics and shaping ongoing research efforts.
The shape of possible efficiency
We gathered a group of 174 individuals displaying OCD symptoms who had prior experiences with psychedelics, whether occasionally or regularly, through an online questionnaire. Our inquiry extended beyond their mental health and included details about the treatments they had previously undergone, as well as their socio-demographic background,” Anne Buot explains. “Subsequently, we tasked them with reporting the circumstances surrounding their psychedelic use, including the dosage, the nature of their psychedelic journey, and how it impacted their symptoms.”
The participants’ feedback revealed several positive outcomes, including the reduction of obsessive thoughts, decreased compulsion to engage in rituals, lowered levels of anxiety and avoidance behaviors, and an increased sense of acceptance regarding their OCD. Luc Mallet adds, “Encouragingly, 30% of participants reported that these positive effects endured for more than three months. Additionally, we observed a positive correlation between the dosage of LSD or psilocybin and the intensity and pleasantness of the psychedelic experience.”
However, it’s essential to approach these results with caution. The assessment of psychedelic therapy’s therapeutic effects is subjective and vulnerable to various biases, including the personal beliefs of the participants. “The individuals we studied generally hold very positive and enthusiastic views about these substances, sometimes irrespective of their therapeutic effects. Moreover, many of them find themselves in a therapeutic impasse and have high expectations that LSD or psilocybin will enhance their lives. These expectations can significantly influence their testimonies,” notes the psychiatrist.
Towards robust knowledge and the definition of best practices
The transformative power of the psychedelic experience itself plays a pivotal role in reinforcing this bias. For some, it brings forth feelings of euphoria, ecstasy, or a profound connection with the universe, which starkly contrasts with their usual perception of reality and encourages them to view the world with fresh eyes. Anne Buot underscores the importance of comprehending how the inherent nature of the psychedelic encounter, heavily influenced by individuals’ personal history, cultural background, and imagination, influences therapeutic outcomes. To achieve this understanding, complementary approaches, such as ethnography and psychology, will be crucial in further research.
To fully harness the potential of these emerging treatments and establish responsible usage guidelines, it’s imperative not only to expand the number of rigorous clinical studies but also to delve into the biological mechanisms that underlie the enduring effects of psychedelics. Researchers speculate that these substances may enhance neuroplasticity by facilitating the rewiring of synaptic connections. Yet, in this realm, many mysteries still await discovery.
Source: Paris Brain Institute