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Introduction
It’s an appropriate day to start writing this blog (18th Oct 2021.) In the US, Johns Hopkins Medicine was awarded a grant from the National Institutes of Health (NIH) to research the impacts of psilocybin* on tobacco addiction. This is the first NIH grant in half a century to investigate the therapeutic effects of psychedelics. Momentum around the use of psychedelics as an option within therapeutic treatments has been building for decades. However, the relatively recent declassification of cannabis to treat pain in some US states, a high profile Netflix show on Fungi, and the publication of Merlin Sheldrake’s Entangled Life, means more people have mushrooms on the brain.
It’s also Autumn, the season when friends and acquaintances flood my social media with pictures of mushrooms they’ve found, asking for quick identification. They do this because I’m outdoorsy and have been well documented rambling around the countryside hunting for mushrooms. I’m also a mental health clinician, which means it’s never long before the question of psychedelics and mental health treatment arises.
Brief history
Psychedelic mushrooms have been used as medicine and in religion for thousands of years. The Aztecs in Mexico believed in their sacred power so much that they named them ‘teonanácatl,’ ‘Flesh of the gods.’ In 1957, pharmaceutical companies isolated psilocybin (the psychedelic element) from mushrooms. Throughout the 1960’s it was used in medical trials. The climate changed under the presidency of Richard Nixon, declaring in 1971, drug abuse was ‘public enemy number one.’ The war on drugs not only clamped down on the drug-taking counterculture of the 1960s but also signalled the end of psychotropic research. Flash forward several decades, and in the 2000’s the science, psychological and pharmaceutical communities started to revisit the potential of mushroom power once again.
What does science say?
There is a vast number of studies examining the effects of psilocybin. Two that I find particularly interesting are a UK study on psilocybin’s effect on people resistant to conventional treatment of depression and a US study examining the use of psilocybin alongside talking therapy.
In 2016, researchers at London’s Imperial College published a paper in The Lancet with the aim to: “investigate the feasibility, safety, and efficacy of psilocybin in patients with unipolar treatment-resistant depression**.” The study found that relative to the patient’s psychological baseline, the depressive symptoms were reduced after one week, and after three months, patients also felt sustained improvements in anxiety and anhedonia.***
In November 2020, an American study titled the Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder, A Randomized Clinical Trial was published, asking, “Is psilocybin-assisted therapy efficacious among patients with major depressive disorder?” In other words, could taking psychedelics and having therapy improve the moods of people with severe depression? By the end of the study, three quarters of the participants felt better, and over half said their depression had been cured.
Why does psilocybin do this? It turns out that psilocybin is many things. Among them, it is an ‘Agonist,’ a chemical that binds to receptors in our brain cells. The receptor psilocybin binds to is the same one that produces serotonin, the hormone that stables our mood and wellbeing. Psilocybin also increases activity in your visual cortex. It decreases areas of your brain responsible for everyday functions, softening inhibitions and enabling space for your brain to light up parts of it that usually work in the background. In addition, a study published in the journal of Biological Psychiatry placed participants in an MRI machine while taking psilocybin and tried to trigger their amygdala (the part of the brain stimulated when afraid or in danger.) The MRI showed that the participants did not have a fear response to the simulated triggers.
(Cantharellus cibarius or the chanterelle mushroom.)
What about the risks?
One risk is that people find it ineffective. The symptoms of depression do not get better, or they come back shortly after treatment. Some participants in these studies found that they returned to their baseline of depression within a few months. The disappointment of this can compound a sense of depression and deepen a person’s low sense of self. Most trials have excluded participants with bipolar disorder (or a family history of it.) While there is limited evidence, the concern is that psilocybin could trigger or worsen a manic episode. Those who may be at risk of impulsive behaviours may also be at risk of psilocybin exasperating risk-taking behaviour.
The body can vomit and become ill, but it cannot overdose on psilocybin, and it is not clinically addictive. This does not mean that a person cannot depend on the drug, but this is a psychological dependency rather than a chemical one. Nevertheless, this can impact a person’s life in detrimental ways. Arguably the most significant risk is people cultivating mushrooms themselves in the wild. Misidentification is a common cause of mushroom poisoning leading to illness, liver failure, or death. It also bypasses the intervention of clinical professionals and proper care plans.
It’s important to acknowledge that while it’s easy to get excited about this cool new approach of treatment, it is still in its early stages. Clinical trials have been small, and long term studies have yet to identify long term effectiveness or adverse side effects.
Important sidebar: Mushrooms, and by extension psilocybin, is a Class A drug in the UK and a Schedule I substance in the USA. Being caught with them carries the same legal weight as all other Class A drugs, like cocaine and heroin. Health risks aside, do not break the law!
What would mushroom therapy look like?
Psilocybin-Assisted Therapy (or Mushroom Powered Therapy, as I’m calling it) is a long way off. A model hasn’t been developed, and one isn’t coming any time soon. My best guess, it will be for people who have a long history of presenting with unipolar treatment-resistant depression. They will need a referral from their mental health team to a physiatrist to assess the patient for feasibility and dosage. Then, if the assessment is successful, a mental health nurse will administer the drug and be present in an inpatient facility for the duration of the psilocybin effects (approximately five hours.) After that, the patient will be back in talking therapy and need further assessments and monitoring.
This is wild speculation on my part. However, treatment is unlikely to be the magic bullet to cure anxiety and depression instantly. Patients are likely to need ongoing therapy. Like current SSRIs, they can help manage and alleviate mental anguish and pain, while therapy can help understand, contextualise, and hopefully bring valuable insight.
It feels like we are only just beginning to understand the brain and potential ways of treating mental health disorders. New breakthroughs in drugs and technology keep emerging at increasing speed. As an amateur mycologist, clinician, and someone who strives for better mental wellness in society, I am excited to see robust, scientific evidence pointing toward our mushroom friends for answers.
Can I send you pictures of mushrooms I find?
Absolutely, as long as you promise not to eat them! @JeremySachs_
* Psilocybin is the chemical in some mushrooms that makes them hallucinogenic.
** Unipolar treatment-resistant depression means people with a major depressive disorder do not recover after their initial treatment (talking therapy and SSRIs.) Also known as major depression (MDD.)
***Anhedonia is the inability to feel pleasure and is a common symptom of depression.
(A Helvella lacunosa, or the Elfin Saddle.)
(Mushroom pictures in this blog are photos from my walks. They are not an identification guide. If you are not sure about a mushroom, don't touch it.)