Anorexia nervosa is a serious mental health issue characterized by a fear of gaining weight. Individuals with this disorder often have a distorted perception of their body and firmly believe they are larger than they actually are. They generally cope with this by limiting their food intake, which can lead to significant health problems due to malnutrition. Anorexia has one of the highest mortality rates among mental illnesses. Currently, there are no effective medications for it, and psychotherapy results are disappointing, indicating an urgent need for new and better treatments. One innovative treatment under consideration is psilocybin, commonly known as magic mushrooms. However, despite its initial promise, it cannot yet be used in clinical settings because more research is needed to verify its safety and effectiveness. The treatment process includes the patient consuming a dose of psilocybin in a controlled setting, often a specially prepared clinic.
Patients undergo preparatory therapy before taking the psilocybin and integration therapy afterward. Psilocybin, a psychedelic compound from mushrooms, can alter thought processes, sense of time, and emotions, often leading to hallucinations. It may help break patients out of their inflexible thinking. It is not used in isolation but along with structured psychotherapy sessions, which aid patients in understanding their experiences and changing their thinking. This combination is crucial to the treatment. Studies have shown improved results from psilocybin-assisted psychotherapy following one or two dosing sessions spaced a few weeks apart. While most research has focused on depression, psilocybin has been shown to enhance cognitive flexibility, which is the ability to adapt thinking patterns to different environments or requirements. This adaptability may help improve symptoms in conditions like depression and alcohol use disorder, characterized by rigid thinking. People with anorexia also struggle with rigid thought patterns, prompting recent interest from researchers and clinicians in this disorder.
In 2023, a small pilot study of ten women with anorexia was published in the journal Nature Medicine. It indicated that psilocybin-assisted psychotherapy (with 25mg of psilocybin) was both safe and well-received, with no significant adverse effects, and participants reported valuable experiences. Although this study was not a formal efficacy trial, 40% of the patients showed notable reductions in their eating disorder behaviors. However, as the trial involved only one dosing session and lacked long-term follow-up, further research is necessary. A recent study with rats explored whether psilocybin could improve rigid thinking in this animal model. After receiving psilocybin, the rats showed weight gain and more flexible thinking when assessed with a reversal learning task.
These positive outcomes were linked to the serotonin neurotransmitter system, which affects mood, behavior, and feelings of fullness. In human studies using brain imaging, serotonin imbalances have been noted in those with anorexia. Psilocybin-assisted psychotherapy seems promising in addressing these serotonin disturbances and the cognitive inflexibility that are issues in anorexia. Although animal studies offer valuable insights into brain functions that may be difficult to explore in living humans, they cannot completely replicate human behaviors or the complexities of chronic mental health conditions. More clinical trials involving humans are crucial and are currently being conducted by a team from the University of Sydney and our group at Swinburne University. Our study will start with an initial 5mg dose of psilocybin, followed by two additional 25mg doses, spaced several weeks apart.
Starting with a low dose helps participants get accustomed to what could be a novel and somewhat unforeseeable experience. Our study will also evaluate the effectiveness of psychotherapy that specifically targets body image disturbances. In addition, we are examining whether including a family member or close friend in the treatment process can enhance support for the participant. Evidence from studies on other mental health conditions suggests that not everyone will experience benefits; some may have negative experiences or see their mental health worsen. Therefore, it’s crucial to determine who is most likely to benefit from the treatment and under what circumstances.