Psilocybin, the active chemical ingredient in psychedelic mushrooms, may be beneficial in the treatment of episodic migraines, suggests a review published earlier this month.
The review of a study by Dr. Emmanuelle Schindler, medical director of the Headache Center of Excellence at Yale School of Medicine, “found a roughly 50% reduction in weekly migraine days, as well as significantly reduced attack intensity, for two weeks following administration of a single, low (non-psychedelic) dose of psilocybin,” with no “serious or adverse events” reported.
Along with migraine relief, a small but growing body of research suggests that psilocybin might have several mental health benefits, including improving depression and anxiety.
What is psilocybin?
Psilocybin is a hallucinogen found in more than 200 species of fungi. Although it’s been illegal in the U.S. since 1970, in recent years, researchers have been granted more opportunities to study its effects in clinical trials and look for potential health benefits.
“Psilocybin is not fundamentally an addictive drug,” Dr. Boris Heifets, an assistant professor at Stanford School of Medicine whose research focuses on psychiatric therapies like psilocybin, tells Yahoo Life. “It is nothing like nicotine, alcohol, morphine or even ketamine, for that matter, which has more abuse liability. So people generally don't abuse it.”
While psilocybin itself isn’t addictive, researchers are probing a number of ways that it might be useful in treating some addiction disorders, among other conditions. In clinical trials involving a psychedelic "trip," Heifets said psilocybin therapeutic sessions often have three phases:
Preparation: You meet with a therapist and get familiar with the room where the trip will take place — which Heifets says usually feels more like a living room than a doctor’s office. “You talk about what to expect and what you hope to get out of it. Usually, there's up to three sessions like that in a lot of trials, and those last an hour or two.”
Dosing: You unknowingly take a placebo, high dose or low dose of psilocybin. A therapist and support person are there to help create a safe space and to listen or reassure during the trip, which lasts about five hours. “Patients are basically staying in one place for the duration of the session,” Heifets says. “They often have eyeshades, they have headphones for music, and the idea is to drive the trip inwards, [to] sort of let things come out.”
Integration: The final phase takes place the day after dosing and typically lasts for a few weeks. “With the same therapist, over days and weeks, you reflect on the trip you took and what it means for you and how you might integrate that experience into your life and improve things going forward.”
Your body on psilocybin
Psilocybin enters the brain through the same receptors as serotonin, the “feel good” hormone that plays a key role in well-being and happiness. People with depression, anxiety, posttraumatic stress disorder, anorexia and smoking or substance abuse disorders tend to have low levels of serotonin, but some researchers are hoping psilocybin may offer a solution. Here are some disorders for which it is believed psilocybin might be beneficial:
Depression: Most studies looking at psilocybin-assisted therapy since 2016 have focused on major depressive disorder, known colloquially as “depression.” A small study by Johns Hopkins Medicine found that treatment with psilocybin relieved symptoms for up to a month, and a follow-up study with the same patients found the effects could last up to a year for some.
End-of-life anxiety: The first big studies of psilocybin were for examining its benefits for existential distress caused by a life-altering diagnosis or terminal illness. One study at NYU Langone involving terminally ill cancer patients found that one-time treatment with psilocybin quickly brought relief from distress that had lasted more than six months in 80% of patients.
Obsessive-compulsive disorder (OCD): “Treatment with psilocybin, when done in an interpersonally supportive setting with a well-prepared individual, is not only safe but may result in rapid and significant reductions in overall OCD symptoms and a general improvement in overall quality of life,” according to Dr. Francisco Moreno and Dr. Brian Bayze of the University of Arizona College of Medicine Tucson, who research the impacts of psilocybin on OCD. “If psilocybin shows to be safe and effective in current trials, it may advance our ability to develop new therapies to best serve people suffering from OCD.”
Alcohol use disorder: In an in-depth review of studies on psilocybin’s impact on multiple mental health conditions, researchers identified a small study in which all patients “had a significant decrease in alcohol use post psilocybin administration.”
Tobacco addiction: In that same review, researchers found that in one study, 80% of participants still abstained from tobacco six months after a 15-week course treatment that included psilocybin administration every few weeks. The researchers concluded that psilocybin may have wide-ranging benefits, with all of the studies they looked at showing “potentially positive benefits with minimal safety concerns for psilocybin use in suicidality, anxiety disorders, OCD, alcohol use disorder and tobacco use disorder with improvement in target symptoms.”
Psilocybin research is promising, but is still in its very early stages. Most studies have been small, and larger, longer trials are needed to compare it to existing treatments and assess its safety and efficacy. But Heifets says that if psilocybin does get medical approval, it likely won’t be a take-home drug; it will probably need to be taken in a standardized setting with a therapist or other professional present.
There are also risks involved with using psilocybin as a therapeutic.
“The main risks are psychotic disorders and unknown risks around destabilizing previous psychiatric illness,” Heifets says. “Patients with mania — like bipolar disorder, schizophrenia, psychosis — there's a risk that is hard to quantify, that you may trigger the onset of a psychotic illness in patients who are high-risk.”
In her review of the migraine study, Schindler noted there are still unknown risks of chronic use and that more research is needed. And there are still unanswered questions as to how long the benefits of psilocybin might last.
“There have been some small studies that suggest [the benefits] can last months or even years,” Heifets says. “But in the largest clinical study [of patients with major depressive disorder], up to six weeks, there was a benefit compared to placebo.”