Psilocybin as a Novel Pharmacotherapy for Treatment-Refractory Anorexia Nervosa

Abstract

Anorexia Nervosa (AN) is a major health problem with one of the highest mortalities and treatment costs of any psychiatric condition. Cognitive behavioural therapy (CBT) is currently the most widely used treatment for AN in adults but provides remission rates ≤ 50%. Treatment drop-out is exceedingly high and those that persevere with treatment often relapse, causing increased risk of morbidity and mortality. There is an urgent need to find new interventions, especially as there are no approved pharmacological treatments for AN. Ideally, new treatments would target treatment-resistance and to decrease the chronicity associated with the disorder. Over the past two decades, emerging research into classic psychedelic substances (lysergic diethylamide acid (LSD), 5-Methoxy-N,N-Dimethyltryptamine (5-MeO-DMT), N,N-Dimethyltryptamine (DMT) and psilocybin), indicates that marked reductions in anxiety and depression-like symptoms, and lasting improvement in mental health, can follow from one or two exposures to these psychedelic substances. Anxiety and depression are the most prevalent co-morbid psychiatric symptoms in AN. Here we suggest that classic psychedelics, particularly psilocybin, have the potential to normalise dysfunctional neurobiological systems in AN and provide a novel treatment intervention that is worthy of consideration, particularly for treatment-resistant patients.

Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study

“…To date, no modern publications have reported data regarding the safety, tolerability and efficacy of psilocybin therapy for AN within the context of a clinical intervention; however, at the time of this publication, two additional registered clinical trials are currently underway ( NCT04505189 and NCT04052568 ), and other ED expert groups have provided rationales for further evaluation of psychedelic treatments for AN 31 , 32 .…”

Current approaches in the recognition and management of eating disorders

“…There is preliminary evidence for the efficacy of psychedelics in the treatment of anorexia nervosa, 75 and further research is needed to assess the feasibility, brain mechanisms, and outcomes of treating anorexia nervosa with psilocybin and other psychedelics such as ketamine 76 . Research regarding the clinical utility of neuromodulation (eg, with transcranial direct current stimulation) for binge eating disorder and bulimia nervosa, or electroencephalography neurofeedback for binge eating disorder, is sparse but shows promise in increasing self‐regulatory control and reducing participant self‐reported binge eating urges 71 .…”

Perspectives and preliminary experiences of psychedelics for the treatment of eating disorders: A systematic scoping review

“…Recent preliminary evidence suggests that psychedelics may be effective in the treatment of EDs; however, high quality clinical studies regarding efficacy and safety are needed (Gukasyan et al., 2022; Ledwos et al., 2022). Theoretical reviews suggest that psilocybin and ketamine may potentially ameliorate dysfunctional neurobiological systems, particularly for patients with treatment‐resistant AN (Keeler et al., 2021; Rodan et al., 2021). Further, two recent reviews have investigated the potential of psychedelics in ED treatment.…”