PHOTO: Annie Spratt
PHOTO: Annie Spratt

EXPERT REACTION: First look into psilocybin’s potential to treat anorexia

Embargoed until: Publicly released:
Peer-reviewed: This work was reviewed and scrutinised by relevant independent experts.

Experimental study: At least one thing in the experiment was changed to see if it had an impact on the subjects (often people or animals) – eg: changing the amount of time mice spend on an exercise wheel to find out what impact it has on weight loss.

People: This is a study based on research using people.

A single dose of psilocybin, administered alongside psychological support, was not only safe and well-tolerated in a group of 10 adult women with anorexia, but most participants self-reported positive changes three months after their experience. Four participants’ symptoms dropped so much by the three-month check-in that they qualified for being in remission of an eating disorder. The US study is a first-ever data report of using psilocybin, the key psychoactive ingredient in magic mushrooms, in anorexia nervosa in a clinical research trial. The researchers highlight that their study is preliminary and they call for more extensive research, but say it’s a promising finding for a deadly and difficult-to-treat illness.

Journal/conference: Nature Medicine

Research: Paper

Organisation/s: University of California - San Diego, USA; University of Michigan Medical School, USA

Funder: A special thank you to Compass Pathways and their team for funding this study (W.H.K.) and to Phastar for performing statistical analyses.

Media release

From: Springer Nature

Health: A potential treatment for Anorexia nervosa (N&V)

A single dose of the psychedelic psilocybin administered alongside psychological support is a safe and acceptable treatment for patients with anorexia nervosa and may decrease eating-disorder behaviours in a subset of patients. The results come from a small phase 1 clinical trial published in Nature Medicine. These findings provide a foundation for future studies to continue to evaluate psilocybin therapy as a new avenue for treatment.

Anorexia nervosa is a mental health disorder characterized by excessive and undue preoccupation, fear and distress surrounding food, body weight and shape, and eating. The condition is difficult to treat; there are currently no proven treatments for adult anorexia to reverse the core symptoms, nor are there any approved pharmacological interventions. Psilocybin therapy has been shown to be a promising treatment for other mental illnesses and is associated with improvements in anxiety, cognitive flexibility and self-acceptance.

Stephanie Knatz Peck and colleagues investigated the safety, tolerability and exploratory efficacy of a single 25-mg dose of investigational COMP360 psilocybin (a synthetic form of psilocybin developed by COMPASS Pathways) delivered alongside psychological support in 10 female adults 18–40 years of age with anorexia, assessed for 3 months following the single dose. The authors detail that no serious adverse events were reported by the participants and that the acute effects of the psilocybin treatment were well tolerated. Qualitative, self-reported responses from the patients revealed that 90% regarded the psilocybin treatment as meaningful and positive, endorsing additional treatments if available. Additionally, the authors indicate that four participants demonstrated substantial decreases in eating-disorder scores at a three-month follow-up, qualifying for remission from eating-disorder psychopathology. However, they highlight that these results are preliminary and further research is needed.

The authors note that the results were based on a small sample size and did not include a placebo group, so they should be interpreted with caution. They conclude that although they found psilocybin therapy to be a safe and acceptable treatment, further randomized controlled trials are needed to validate the findings.

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Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Dr Claire Foldi is a Senior Research Fellow at the Monash University Biomedicine Discovery Institute

This study in Nature Medicine reports that a single dose of psilocybin, administered in a tightly controlled setting and with specialised psychological support, was safe, well tolerated and acceptable for individuals with anorexia nervosa, in line with previous reports of psilocybin-assisted psychotherapy in other clinical populations.

Novel treatment strategies are urgently needed for anorexia nervosa, which is associated with one of the highest mortality rates of any psychiatric condition, but until now there was concern of specific risks of adverse effects in these individuals based on the medical abnormalities of low body weight and cardiovascular complications.

It’s important to recognise that while the effects of psilocybin therapy on eating disorder symptoms in this study were exploratory in nature and highly variable among the ten participants included, four individuals (40%) demonstrated clinically significant reductions in symptom presentation three months after the experience.

A major limitation of this study, duly noted by the authors, was that it included a small, self-referred and therefore perhaps non-representative clinical sample. In addition, the lack of a control comparison precludes the possibility that an expectation of positive outcomes may have influenced these findings. These caveats aside, the results offer promise in the pursuit of larger, adequately controlled trials that will determine whether psilocybin-assisted psychotherapy could aid in the unmet need for effective treatment options for individuals suffering from anorexia nervosa.

Last updated: 24 Jul 2023 10:05am
Declared conflicts of interest:
None declared.
Associate Professor Gemma Sharp is the leader of the Body Image & Eating Disorders Research Group at Monash University and a Senior Clinical Psychologist at Alfred Health

It is exciting to see this research being undertaken. There are currently no approved pharmacological interventions for anorexia nervosa and these are very much needed to save lives!

My own eating disorder patients have expressed interest in psilocybin therapy for a number of years and I am glad that there are gradually more opportunities for them to participate in research. Having said that, this published research is very preliminary. It involved only 10 women with anorexia nervosa, five in partial remission, and an average BMI in the normal weight range rather than underweight.

Nevertheless, the research suggested that a single dose of psilocybin together with psychological support was safe, tolerable and acceptable. The number of people involved in the research was too small to thoroughly examine the impacts on eating disorders and broader mental health symptoms. However, the women generally reported improvements in their quality of life which is so important in eating disorder recovery.

This research provides an important platform for larger-scale research. A crucial goal for future research is understanding exactly how psilocybin might assist people with anorexia nervosa (the biological mechanisms) as this will allow us as clinicians and researchers to optimise any treatment strategies.

Last updated: 24 Jul 2023 10:04am
Declared conflicts of interest:
None declared.
Dr Trevor Steward is Senior Research Fellow in the School of Psychological Sciences at the University of Melbourne

This study represents an important first step towards determining how safe and well-tolerated psilocybin therapy is for adult patients with anorexia nervosa. It opens the door for the next phase of clinical trials to assess the effectiveness of psilocybin therapy in improving anorexia nervosa symptoms.

Psilocybin therapy has provided glimmers of hope in other mental health disorders, notably by providing evidence that it can improve anxiety, cognitive flexibility, and self-acceptance for some people. These are all features of anorexia nervosa and the rationale for exploring psilocybin therapy as an option in the case of anorexia is strong. However, this study does not demonstrate that psilocybin therapy can be used to treat anorexia nervosa. Larger-scale clinical trials are a fundamental requirement to confirm whether psilocybin therapy can indeed be considered a viable treatment for anorexia nervosa. While these results show this psilocybin therapy is safe under controlled conditions, it's essential not to let the hype around psychedelics outpace the scientific evidence. Continued research and caution are of the utmost importance to ensure we make informed decisions about the potential of psilocybin therapy in tackling this deadly illness.

The field is only beginning to scratch the surface in terms of understanding how psilocybin impacts the brain and dedicated funding to exploring how it specifically acts to target anorexia nervosa symptoms is crucial to advancing this important avenue of research. As there are no approved medications available specifically for anorexia nervosa treatment, psilocybin therapy may prove to be a promising option, though additional research is needed to test this.

Last updated: 21 Jul 2023 9:25am
Declared conflicts of interest:
None declared.
Dr Marion Roberts, Director & Principal Clinical Psychologist, Nurture Psychology, and Senior Lecturer, Faculty of Medical & Health Sciences, University of Auckland, comments:

Anorexia nervosa is a debilitating mental illness resulting in significant physical, psychological, developmental and social impacts. When not caught and treated early by specialist clinicians, it can result in a long illness that is difficult to treat.

With current treatments only successful for a minority of adult patients, it is highly appropriate that the field is thinking creatively - in this case, the use of psychedelics. These early yet promising findings certainly merit further investigation.

Last updated: 20 Jul 2023 9:13am
Declared conflicts of interest:
No conflicts of interest declared.

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