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Psychedelics for the Treatment of Obsessive–Compulsive Disorder: Efficacy and Proposed Mechanisms

Summary

Psilocybin mushrooms show promise as a treatment for obsessive-compulsive disorder (OCD), a condition where people experience unwanted intrusive thoughts and compulsive behaviors. Current standard treatments with antidepressants don’t work for many patients and take weeks to show effects. Early research suggests psilocybin may reduce OCD symptoms quickly and works in treatment-resistant cases, though more rigorous studies are needed to confirm its effectiveness and understand how it works in the brain.

Background

Obsessive-compulsive disorder (OCD) is a chronic psychological disorder affecting 1.5-3% of adults, characterized by intrusive thoughts and repetitive behaviors. Current first-line treatments (SSRIs) have limited efficacy with 30-60% of patients being treatment-resistant. Psychedelics, particularly psilocybin, are emerging as potential novel treatments for various mental health conditions.

Objective

This review evaluates the clinical evidence supporting the use of classical psychedelics for OCD treatment and examines proposed mechanisms of action. The review synthesizes data from case reports, clinical trials, and surveys to assess efficacy and discusses ongoing research addressing current knowledge gaps.

Results

Case studies since the 1960s report reduced obsessive and compulsive behaviors following psychedelic use. The 2006 clinical trial of 9 patients showed 23-100% reduction in Yale-Brown Obsessive Compulsive Scale scores. Proposed mechanisms include modulation of serotonin signaling, normalization of cortico-striatal-thalamo-cortical circuits, enhanced neuroplasticity, and psychological effects including mystical experiences and psychological insight.

Conclusion

Psilocybin shows promise as a safe and well-tolerated treatment for OCD with faster responses than current therapies. However, current evidence is limited by small trial sizes, methodological issues including poor blinding, and lack of long-term follow-up. Further rigorous, well-controlled clinical trials are needed to establish optimal dosing, determine target populations, and clarify mechanisms of action in OCD patients specifically.
  • Published in:International Journal of Neuropsychopharmacology,
  • Study Type:Review,
  • Source: PMID: 39611453, DOI: 10.1093/ijnp/pyae057
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