Can Psychedelics Treat Obsessive Compulsive Disorder?

Obsessive-Compulsive Disorder (OCD) is a challenging condition, with some patients experiencing persisting symptoms despite intensive treatments. Recent interest has emerged in the potential therapeutic use of classic psychedelic substances like psilocybin for various psychiatric disorders. While there have been controlled studies demonstrating the benefits of psilocybin in conditions like major depressive disorder and anxiety in late-stage cancer patients, research on its use for OCD is limited.

Early case reports suggested improvements in OCD symptoms after using psilocybin and LSD, and recent case reports have continued to explore this potential. However, there is a need for more comprehensive studies to follow up on these observations.

Theoretical rationales for using psilocybin in OCD treatment include its effects on the serotonin system, potential glutamatergic effects, modulation of brain networks like the default mode network, and the facilitation of mystical experiences that could enhance cognitive flexibility and creativity. Additionally, the potent thoughts and emotions that emerge during a psychedelic experience may provide opportunities for new insights and better emotional processing, which is crucial for individuals with OCD.

Most recent studies

A study published in Scientific Reports on August 17, 2023, explored the potential therapeutic effects of classic psychedelics, such as LSD and psilocybin, in reducing symptoms of Obsessive-Compulsive Disorder (OCD). OCD is a challenging psychiatric condition characterized by intrusive thoughts, repetitive behaviors, and avoidance behaviors. Current treatments, including cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), often have limitations, and some patients do not respond well.

The study investigated the subjective efficiency of various psychoactive substances in reducing OCD symptoms through an online survey. Classic psychedelics were found to be associated with significant improvements in OCD symptoms compared to other substances. The intensity and pleasantness of the acute effects of psychedelics, as well as the dose, were correlated with the magnitude of the therapeutic effect. Furthermore, over 30% of participants reported that these improvements lasted for more than three months.

The study also found that substance usage appeared to be tuned to the therapeutic effect, with participants experiencing stronger therapeutic effects more likely to use the substance again. However, there was no significant impact observed regarding the mindset and context during substance intake.

The results suggest that classic psychedelics may have potential in reducing OCD symptoms, but caution is advised due to the subjective nature of the study and the need for further clinical trials to confirm these observations. Additionally, the persistence of the therapeutic effect and its mechanisms remain to be explored.

Classic psychedelics appeared as the only substance category inducing a significant improvement in OCD symptoms, both in terms of the proportion of users declaring a change and the direction of the change

Buot, A., Pallares, C., Oganesyan, A. et al. Improvement in OCD symptoms associated with serotoninergic psychedelics: a retrospective online survey. Sci Rep 13, 13378 (2023). https://doi.org/10.1038/s41598-023-39812-0

What we knew about the OCD and psychedelics?

In a case report published in Heliyon in December 2022, the study explored the use of a single dose of psilocybin for treating treatment-resistant obsessive-compulsive disorder (OCD). The findings suggested the potential benefits of psilocybin-based treatment for some individuals struggling with treatment-resistant OCD. However, the study emphasized the need for caution and highlighted several critical considerations. Firstly, psilocybin and other psychedelics remain classified as Schedule 1 substances in the United States and are similarly restricted in many other jurisdictions, making their clinical use complex and illegal outside of research settings. Secondly, the study emphasized that while there is optimism surrounding psychedelic treatments, many questions regarding dosing, therapeutic approaches, and the ideal patient population remain unanswered. Controlled studies like this one have specific inclusion criteria, and the suitability of psilocybin treatment for a broader population needs careful consideration in the future, particularly if regulatory environments change and these substances become more widely available.

What’s next?

In recent years, there has been growing interest in using classic psychedelic substances like psilocybin to potentially treat Obsessive-Compulsive Disorder (OCD). While there is significant evidence suggesting that psychedelics may improve OCD symptoms, caution is needed before generalizing these findings to the broader OCD population. Initial case reports and recent studies have explored the benefits of psychedelics for OCD, highlighting the potential therapeutic mechanisms at the neurotransmitter, brain network, and psychological levels.

However, several factors complicate the broader application of this treatment approach. Psilocybin and similar substances are currently classified as Schedule 1 substances in many jurisdictions, posing regulatory and legal challenges.

Questions about optimal dosing, therapeutic approaches, and identifying the most suitable patient population remain unanswered. While promising, further research and clinical trials are necessary to establish the safety and efficacy of psychedelics in treating OCD.