Psychedelic Treatments Show Promise for OCD, Unlike Cannabis, Study Finds Obsessive compulsive disorder

A recent review of alternative treatments for obsessive compulsive disorder (OCD) indicates that psychedelic treatments show promise for the disorder, while cannabis does not.

Dr. Michael Van Ameringen, a professor of psychiatry at McMaster University in Ontario, Canada and lead author of the study published in the Journal of Psychiatric Research, said 40 to 60 percent of OCD patients get partial or no relief with available treatments, including SSRIs and exposure and response prevention therapies.

While psychedelics and cannabinoids have become part of the debate around OCD – a disorder characterized by intrusive, obsessive thoughts and/or compulsive behaviors – there is a much larger body of published evidence on the effectiveness of these substances for more common conditions, such as depression and anxiety.

“We wanted to refine and really understand: Is there evidence that these things that we’ve been talking about could be used as a next-step treatment? » Van Ameringen explained.

Given the lack of existing literature, Van Ameringen said he didn’t know what to expect. To compensate for the lack of published information, he included unpublished conference presentations and preliminary findings in the summary paper.

Compiling the available evidence, Van Ameringen and his team found “stronger signals” for the effectiveness of psychedelics, particularly psilocybin (the psychoactive component of “magic mushrooms”), than for cannabinoids like THC and CBD.

Van Ameringen theorizes that the difference has to do with how these substances interact with areas of the brain linked to OCD. Although cannabinoids activate the brain’s CB1 receptors, which regulate symptoms such as compulsions and anxiety, available evidence shows that they do not provide lasting relief from OCD symptoms.

Psilocybin, on the other hand, may reduce connectivity in the brain’s default mode network, which “is basically involved in self-referential thinking and rumination. The default mode network is actually activated in OCD,” he says.

A difference in the methodology of the cannabis and psilocybin studies may also have contributed to the different results, says Dr. Mohamed Sherif, a psychiatrist and computational neuroscientist at Brown University who will lead a future clinical trial of psilocybin for OCD. Psychedelic clinical trials, like the one Sherif envisions, tend to offer patients not only medication, but also encouragement to frame their experience as a therapeutic “journey.”

“This has not been done with cannabinoids [studies,]» explained Chérif.

Dr. Terrence Ching, a clinical psychologist at the Yale School of Medicine, also wondered whether the way people consume cannabis versus psilocybin could explain the different results. While people tend to use cannabis for temporary relief, psilocybin can help facilitate actual changes in the brain and in patients’ perception of their OCD.

“One might use cannabis for the same therapeutic reason, to confront something deeper about their OCD or obsessive fears. But conventionally, people tend to use cannabis for an avoidance function,” Ching explained.

Preliminary results from Ching’s clinical trial of a single dose of psilocybin for OCD were included in Van Ameringen’s review article and showed that psilocybin was effective for OCD symptoms compared to placebo. Ching is currently preparing to publish the trial results and is planning a second clinical trial in which OCD patients will receive two doses of psilocybin at different times.

During the single-dose trial, 11 patients each received psilocybin or niacin, a placebo intended to mimic some of the effects of psilocybin so patients were unsure which drug they received. During dosing sessions, patients sat with two facilitators who offered minimal guidance in the form of open-ended questions.

Ching said his protocol included strict rules about what kind of contact was allowed if patients requested it — only a hand on the shoulder or forearm — to create unambiguous ethical boundaries. Previous psychedelic clinical trials have generated controversy when facilitators initiated unwanted contact with participants under the influence.

Ching said the trial was useful not only for showing that psychedelics can improve OCD symptoms, but also for revealing more about the nature of OCD, both for clinicians and for the participants themselves.

Psilocybin is known to induce “mystical experiences,” characterized by a specific type and intensity of psychedelic effects, according to Ching.

“What we see in OCD is more often partial mystical experiences, people kind of put the brakes on when they have the feeling that the psilocybin wants to take them into a deeper experiential state,” Ching said, adding that this highlights one of the fundamental characteristics of the disorder: the need to be in control.

While clinicians in psychedelic trials typically encourage patients to go further, Ching said that with OCD patients, it’s important to remain “non-directive and non-judgmental.”

During the trial, Ching saw patients recognize their own resistance to the drug and better understand their need for control, saying things like: “I really realize that this is how I have approached the unknowable things in my life, but that’s what life is. Life is full of unknowable things.”

Ching is optimistic about the future of psychedelic drugs, but several obstacles make researching them difficult. Psilocybin is still an illegal Schedule I substance in the United States, which means researchers must take additional steps to study it, including working with a DEA liaison and using a DEA-approved safe that “must be bolted to the floor,” in a private, windowless room.

Researchers must also confront the issue of “functional unblinding,” or the fact that psychedelic effects may allow trial participants to guess whether they received psilocybin or a placebo, which could alter their perception of their own symptoms. This is particularly problematic given the hype around psychedelics, Ching said.

Many participants will go into a trial expecting a “miracle cure” – a narrative that Ching says is actually harmful to psychedelics research: “What we need to do now is seriously, treat psychedelics seriously, like any other valid medicine, investigate in a controlled, rigorous way, in a way that is ethical, that honors traditional indigenous users of psychedelics, because there are, there is great wisdom there as well.