In a small-scale preliminary study, a UA psychiatrist has found that psilocybin, the active agent in psychedelic mushrooms, is effective in relieving the symptoms of people who suffer from severe obsessive compulsive disorder.
Dr. Francisco A. Moreno and his colleagues conducted the first FDA-approved clinical study of psilocybin since it was outlawed in 1970. The results are published in the latest edition of the Journal of Clinical Psychiatry.
Moreno cautions that the study was simply to test the safety of administering psilocybin to OCD patients. The effectiveness of the drug is still in question until a larger controlled study can be conducted.
Still, in each of the nine patients in the study, psilocybin completely removed OCD symptoms for a period of generally four to 24 hours, with some patients remaining symptom-free for days.
"What we saw acutely was a drastic decrease in symptoms," he said. "The obsessions would really dissolve or reduce drastically for a period of time." People would report that it had been years since they had felt so good, he said.
Provisions and policies for scientific research of controlled substances like psilocybin were included in the 1970 Comprehensive Drug Abuse Prevention and Control Act, which outlawed psilocybin.
New research into psilocybin does not reflect any change in government policy, said Rogene Waite, a spokeswoman for the Drug Enforcement Administration. The same review process has governed such research the entire time although researchers may have been hesitant to consider using psilocybin in the past, she said.
Currently, there is no treatment in the medical literature that eases OCD symptoms remotely as fast, Moreno said. Other drugs take several weeks to show an effect, but the psilocybin was almost immediate.
Still, it's not a drug patients could take daily and in any case, doctors don't know what would happen with repeated use: Would the effects be additive and longer-lasting over time? Or would the effects dissipate as the patient developed a tolerance?
Moreno, who is in "grant-seeking mode," said the next step is to conduct an expanded study. The findings would be far more convincing on the effectiveness of psilocybin in OCD patients, he said.
"We're very cautious about making too much of the early results," Moreno said. "I don't want to characterize it as psychedelics are the way to go. Although it seemed to be safe, this was done in the context of supervision by trained professionals in a medical setting. This is not ready to be used by the public just because nine people tolerated it."
A spokeswoman for the Food and Drug Administration declined to comment on the research, citing "confidentiality."
Moreno, whose specialty is in treatment resistance, started thinking about the psilocybin study in the mid-1990s after a patient said the only time he was ever free of OCD symptoms was a decade earlier in college when he experimented with psychedelic mushrooms. Psilocybin and other drugs in that family work by activating certain serotonin receptors, in some ways similar to the mechanisms of anti-depressants used to treat OCD.
Moreno examined the medical literature on psilocybin and LSD and found some other cases in which OCD patients reported improvement under similar conditions. He started the study in 2001, gradually recruiting patients through 2004.
Under strict rules to guard against complications, Moreno gathered nine OCD patients who had treatment with the typical medications and had prior positive experience with psychedelic drugs. The patients were tested between one and four times, with 29 sessions in all.
They were administered one of four dose levels of psilocybin in the morning and were monitored in a modified office for eight hours. The patients were given eye shades and listened to music, with instructions to turn their attention inward.
They were each interviewed at the end of the day about their experiences and kept in the hospital overnight to make sure they had no drug complications.
The patients had a range of obsessions and compulsions, including fear of being contaminated, elaborate cleaning rituals, tapping or touching rituals and mental rituals. One patient wouldn't touch the floor with anything but the soles of his shoes. Others would shower for hours or put on pants over and over again until they felt right.
"They know it's senseless. They know it doesn't do anything for them, but if they don't do it they become very distraught and very uncomfortable and have a very difficult time functioning," Moreno said.
OCD symptoms develop as early as childhood but typically in the teen years. Over time the mental barriers make it hard for patients to lead normal, day-to-day lives.
Leslie Tolbert, UA vice president for research, graduate studies and economic development, said the university's Human Subjects Protection Program sets the rules for all research involving people to ensure the safety of participants and maximize the usefulness of the study. Psilocybin, like any other controlled substance, is heavily monitored.
Any further study of psilocybin at the UA would be federally funded and subject to review and oversight at that level as well, she said.
"We don't have great treatments out there for OCD and any indication that there is a path to explore for something that would be effective seems an important thing to respond to," Tolbert said. "It's important that if psilocybin, perhaps in lower doses than are hallucinogenic, really has an impact, it's known. It's not a trivial question. There is a huge number of people who could benefit."
A few other researchers across the country have been involved in psilocybin research in the last several years, with some looking at the mystical experiences or sense of well-being associated with the drug, others examining its effect on patients with post-traumatic stress disorder and others examining it as a possible treatment for cluster headaches.
"Our study goes a little bit more in line with the use of pharmaceuticals to treat a bona fide clinical condition," Moreno said.
Read more about OCD causes, symptoms and treatments at go.azstarnet.com/ocd
"I don't want to characterize it as psychedelics are the way to go. Although it seemed to be safe, this was done in the context of supervision by trained professionals in a medical setting."
Dr. Francisco A. Moreno