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World first: Magic mushrooms shown to ease symptoms of anorexia

Anorexia nervosa is notoriously difficult to treat. A definitive treatment remains elusive.

Anorexia nervosa is notoriously difficult to treat. A definitive treatment remains elusive. Photo: Getty

Of all psychiatric disorders, anorexia nervosa is the most deadly and confounding.

While anorexia nervosa is commonly talked about as an eating disorder, it’s less about food than a tragically flawed strategy to deal with emotional problems.

Sufferers tend to equate thinness with self-worth, and will adopt strict, often ritualised behaviours around food.

These behaviours are underpinned by rigid thinking that becomes more entrenched and damaging as times goes by, as the brain is affected my malnutrition.

Read more here, here and here.

The consequences are catastrophic

Up to 10 per cent of people with anorexia die within about 10 years of getting the disease.

About one in five die after 20 years due to consequences of malnutrition and system failure, or from suicide.

In fact, anorexia has more suicides than any other psychiatric disorder.

Why is the mortality rate so high?

As a new paper in Nature Medicine notes, anorexia nervosa is “notoriously difficult to treat”.

In fact, there “are no proven treatments for adult anorexia that reverse core symptoms and no approved pharmacological interventions”.

Bottom line: Only about one-third of patients achieve a stable, long-term recovery.

But, despite its bleak overview, the research is a potential good news story.

A small phase 1 clinical trial found that a single dose of the psychedelic psilocybin decrease eating-disorder behaviours in some anorexic patients. Remarkably, four patients in the study went into remission.

Psilocybin is the psycho-active ingredient in magic mushrooms.

Magic mushrooms? Really?

Yes, really.

From July 1, medicines containing psilocybin, which are found in magic mushrooms, were approved as a therapy for treatment-resistant depression. This was a world first. (Read our report here.)

Psilocybin, from magic mushrooms, is approved for psychiatric use in Australia. Photo: Getty

Psilocybin has been found to serve as a breakthrough drug in patients held hostage by severe depression. Psilocybin therapy is also associated “with improvements in anxiety, cognitive flexibility and self-acceptance”.

For some time, researchers wondered if it might also serve as a breakthrough drug for anorexia. The small clinical trial, the first of its kind, suggests so.

The new study

This was, in essence, a feasibility study. It came from the Eating Disorder Treatment and Research Centre at the University of California.

It involved 10 women, aged 18–40, who were diagnosed with anorexia.

They were each given a single 25mg dose of a synthetic form of psilocybin. This was delivered alongside psychological support. They were then assessed for three months.

Results

There were no serious adverse events reported by the participants. And the acute effects of the treatment were well tolerated.

Nine out of the 10 patients “regarded the psilocybin treatment as meaningful and positive, endorsing additional treatments if available”.

The authors found that four participants “demonstrated substantial decreases in eating-disorder scores at a three-month follow-up”.

These patients qualified “for remission from eating-disorder psychopathology”.

However, the authors note that “the results were based on a small sample size”. And because there was no placebo group, the findings “should be interpreted with caution”.

They conclude that although they found psilocybin therapy to be a safe and acceptable treatment, further randomised controlled trials are needed to validate the findings.

Response from Australian experts

Dr Claire Foldi, Senior Research Fellow at the Monash University Biomedicine Discovery Institute, said:

Dr Claire Foldi

“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 10 participants included, four individuals (40 per cent) 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.”

Eating disorders patients express interest

Associate Professor Gemma Sharp, leader of the Body Image and Eating Disorders Research Group at Monash University and a senior clinical psychologist at Alfred Health, said:

Associate Professor Gemma Sharp.

“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 …

“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.”

Important first step

Dr Trevor Steward, Senior Research Fellow in the School of Psychological Sciences at the University of Melbourne, said:

Dr Trevor Steward.

“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 …

“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.”

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