Psilocybin for OCD

Overview: Obsessive–compulsive disorder (OCD) is challenging to treat, with many patients not responding well to standard therapies like SSRIs and CBT. Psilocybin, found in magic mushrooms, shows promise in reducing OCD symptoms based on case reports and a small clinical trial. Individuals have reported significant relief from obsessions and compulsions after using psilocybin, with effects lasting days to weeks. The therapeutic mechanisms may involve profound experiences, psychological insights, cognitive improvements, and serotonin receptor changes. Further research is needed to explore the safety and efficacy of psilocybin for OCD treatment.

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Understanding OCD and the Search for New Treatments

Obsessive–compulsive disorder (OCD) is a mental health condition marked by obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that cause significant anxiety or distress. Compulsions are repetitive behaviors or mental acts performed to alleviate this anxiety. Over time, OCD can become severely disabling, partly because of delays in receiving effective treatment. The disorder affects about 2.3% of people over their lifetimes, with a similar percentage at risk of developing it.

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Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat OCD. While SSRIs can be effective, they often take weeks to produce noticeable benefits, and up to 60% of patients do not respond adequately.

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Cognitive-behavior therapy (CBT), particularly with exposure and response prevention (ERP), is the leading psychological treatment. However, access to this therapy is often limited, and relapse is common after stopping SSRIs or completing CBT.

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Given these limitations, there is a pressing need for new, faster-acting, and less invasive treatment options.

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Early research suggests that psilocybin, the active compound in magic mushrooms, may help reduce OCD symptoms. Studies conducted both in clinical settings and through anecdotal reports indicate that psilocybin-assisted therapy holds promise. These preliminary findings support further investigation into the feasibility, safety, and therapeutic potential of psilocybin for treating OCD.

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Case Reports: Psilocybin and OCD Symptom Relief

Case reports are detailed accounts of individual patients' experiences with a particular treatment. They offer valuable insights into how a treatment might work in real-world settings. Several case reports have been published, suggesting the potential of psilocybin to alleviate OCD symptoms and offering a promising direction for further research.

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LSD, Psilocybin, and Mescaline: A Teen’s Experience with OCD Symptom Relief

A 1987 case report documented the experiences of a 17-year-old high school senior with severe OCD. His OCD had started at age 8 and by 13, his life was dominated by obsessive thoughts

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Every action had to be performed in a specific way and a certain number of times. For instance, he would lather soap exactly 22 times while showering and could not walk down a corridor without tapping the wall a specific number of times. Completing school assignments was impossible because he had to finish writing letters in a precise manner.

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From the age of 14, he began using drugs extensively and noticed three distinct effects on his OCD symptoms: specific selective improvement, nonspecific improvement, and specific worsening. The classic psychedelic LSD, which he used over 100 times, initially worsened his obsessive thoughts slightly for about an hour, but then provided total symptom remission for 4-5 hours.

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Similarly, psilocybin mushrooms and mescaline, which he used around 20 times each, also led to the complete disappearance of his obsessive thoughts (see How to Identify Magic Mushrooms: A Field Guide for advice on how to safely forage for psilocybin mushrooms).

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Mr. A’s Story: Overcoming OCD with Psilocybin Mushrooms

Another case report, this one from 1997, tells the story of “Mr. A,” a 34-year-old man who experienced significant relief from his OCD symptoms by using psilocybin mushrooms.

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Mr. A’s OCD started at age 6, with a strong focus on cleanliness, fear of contamination, and a need for order. These obsessions led to compulsive behaviors like counting, frequent washing, and ritualistic cleaning. For example, he had to lather exactly 17 times in a specific sequence while showering, or he couldn't continue with his day. Although cannabis helped with his anxiety, it didn't ease his OCD symptoms.

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When he was 20, Mr. A tried freeze-dried psilocybin mushrooms. By 21, he was using 2 grams of psilocybin twice a week. This brought significant improvements to his obsessions and compulsions while he was under the influence of psilocybin. His fears of contamination disappeared, and he stopped his washing and counting rituals.

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These effects lasted 4-5 days before his symptoms gradually returned, but taking psilocybin again brought immediate relief. Mr. A also tried mescaline-containing peyote cactus five times, which produced similar improvements in his OCD symptoms.

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For the next four years, Mr. A took psilocybin daily. Even though he developed a tolerance to its psychedelic effects, his OCD symptoms remained improved. After stopping psilocybin, he had minimal OCD symptoms for two years, although they slowly returned to their previous levels over time.

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Breaking the Cycle: Psilocybin Mushrooms Alleviate Chronic OCD

A 2014 case report tells the story of a 38-year-old man who sought help at a clinic for chronic anxiety that had plagued him since childhood. As an adult, he developed a consistent pattern of OCD symptoms including intrusive, disturbing thoughts, checking behaviors, and persistent worry.

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These intrusive thoughts occurred up to 100 times a day, severely disrupting his daily life. To manage these thoughts, he developed counting rituals and repetitious routines, performing them dozens of times each day. Unfortunately, these rituals only increased his anxiety and became even more disruptive.

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His condition worsened to the point where he could no longer work and lost most of his social connections. Despite trying various forms of psychotherapy and medications, including diazepam, fluoxetine, buspirone, and clomipramine, he found no relief. 

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His breakthrough came when a friend gave him home-grown psilocybin mushrooms labeled as Psilocybe cubensis. He consumed three of these mushrooms with a friend supervising him. Although he found the experience unpleasant and slightly dissociating, with no strong psychedelic effects, the following day brought significant relief, with his intrusive thoughts being greatly reduced. 

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Mr. J.C.’s Journey: Finding Relief from OCD with Psilocybin Mushrooms

In 2020, researchers shared the story of “Mr. J.C.,” a 30-year-old man who had grappled with OCD for more than a decade, with the condition severely impairing his daily life. Over the years, he tried various medications, including: 

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• Sertraline

• Escitalopram

• Mirtazapine

• Fluoxetine

• Venlafaxine

• Paroxetine

• Duloxetine

• Milnacipran

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None of these treatments provided significant relief. Additionally, intranasal ketamine was ineffective, and while celecoxib offered some improvement when combined with escitalopram, it had to be discontinued due to gastritis. At the clinic, Mr. J.C. was taking fluoxetine (up to 60 mg/day), fluvoxamine (up to 300 mg/day), and risperidone (up to 1 mg/day), which provided only partial relief.

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Nine months into this treatment, he decided to try psilocybin mushrooms from Oaxaca, Mexico, specifically Psilocybe caerulescens. He consumed about 2 grams of dried mushrooms at home with a friend present. Although he felt mild dissociation for an hour, he did not experience strong psychedelic effects. During this hour, his OCD symptoms vanished, and they remained significantly reduced for two weeks.

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Mr. J.C. continued taking 2 grams of dried psilocybin mushrooms every two weeks, experiencing consistent symptom relief without further dissociation or side effects. He visited the clinic every two months and reported no adverse effects from the mushrooms. Six months after starting psilocybin, he still experienced a significant reduction in OCD symptoms.

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His progress was tracked using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). His scores were:

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• Before psilocybin: 35 (extreme OCD)

• One month after: 18 (moderate OCD)

• Six months after: 13 (mild OCD), showing a 63% reduction

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Mr. J.C.’s obsessive thoughts, compulsions, worry, anxiety, and checking behaviors significantly decreased. He could perform daily tasks and work without interruptions, greatly improving his quality of life. He continues his conventional treatment along with psilocybin mushrooms as an additional therapy.

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Daniel’s Journey: Psilocybin's Impact on Treatment-Resistant OCD

In 2022, researchers began conducting a double-blinded, randomized placebo-controlled trial to explore the effects of a single dose of psilocybin on treatment-resistant OCD. One participant, a 33-year-old man “Daniel,” (a pseudonym) experienced rapid and lasting improvement. Daniel had a primary diagnosis of OCD, along with a history of major depressive episodes, Tourette syndrome (TS), and panic disorder.

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First diagnosed with OCD and TS around age 10, he never found relief from multiple trials of SSRIs and cognitive-behavioral therapy. At the time of initial evaluation for the trial, his severity score on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was 24, indicating severe OCD. This scale measures the severity of OCD symptoms, with higher scores indicating greater severity. His condition severely affected his social functioning, hobbies, and work.

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Daniel was randomized to receive psilocybin at a dosage of 0.25 mg/kg (19.4 mg psilocybin). Before the session, facilitators spent time getting to know him and provided non-directive support during the session. No structured psychotherapy was provided before, during, or after dosing.

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The dosing session took place in a research-dedicated psychiatric inpatient unit, where the room was arranged to be relaxing, minimizing external distractions. During the session, Daniel lay down on a pull-out couch with facilitators nearby. He wore eyeshades and headphones with music for most of the experience.

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Starting with the first integration session two days post-dose, Daniel reported a new sense of “space” between himself and his OCD symptoms, leading to a changed relationship with them. At 12 weeks post-dose, Daniel stated that OCD was no longer a significant part of his life, though he acknowledged a lingering "imprint" of obsessions and compulsions. He felt equipped with the tools to manage his symptoms if they re-emerged.

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Daniel’s scores on the acute YBOCS (A-YBOCS), which measures OCD symptoms over the previous 24 hours, showed a dramatic decrease from 23 on the morning of the dosing session to 2 at 48 hours post-dose. His YBOCS scores continued to improve: 4 at one week, 1 at four weeks, 1 at eight weeks, and 0 at 12 weeks.

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These improvements persisted up to 12 weeks after the single dose of psilocybin. Daniel reported significant improvements in his social life, relationships, and obtained a new job, describing the psilocybin experience as “a very powerful inflection point in my life.” A year later, he reported still being free of OCD symptoms.

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Psilocybin’s Impact on OCD Symptoms - Insights from a Clinical Trial

The first and only clinical trial investigating psilocybin's effects on OCD to date was a small, modified double-blind study focused on safety, tolerability, and clinical outcomes.

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Nine participants, each diagnosed with OCD, received four single doses of psilocybin paired with unstructured psychological support once per week for four weeks. The doses were administered in a sequence: Low (100 μg/kg), Medium (200 μg/kg), and High (300 μg/kg) levels, with a very low dose (25 μg/kg) randomly inserted at any point after the first dose. This setup ensured a balanced and unbiased evaluation.

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In this study, participants received structured doses of psilocybin in a controlled environment. During the sessions, participants were asked to wear eye shades and listen to a standard music playlist to help minimize external distractions and enhance the introspective experience. Interaction was kept to a minimum, with a trained sitter present throughout the session to provide support if needed. Towards the end of the 8-hour session, participants were allowed to choose their music, remove the eye shades, and engage more freely in discussions about their experiences with the sitter

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Assessments were conducted at 0, 4, 8, and 24 hours post-psilocybin session using the YBOCS and a visual analog scale to gauge overall OCD symptom severity. Significant reductions in OCD symptoms were observed in all participants during one or more testing sessions, with improvements ranging from a 23% to a 100% decrease in YBOCS scores 24 hours after the psilocybin session. These positive effects generally persisted beyond the 24-hour mark, and one participant maintained full symptom remission at a six-month follow-up.

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While one participant experienced transient hypertension, a temporary increase in blood pressure, no other significant adverse effects were noted.

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These findings highlight psilocybin’s potential therapeutic promise in treating OCD. 

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How Does Psilocybin Treat OCD? 

The researchers in the clinical trial from 2006 speculated on several therapeutic mechanisms by which psilocybin could improve OCD symptoms.

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One notable aspect was the transcendental experiences reported by participants. Four individuals described profound experiences, such as exploring other planets, visiting past-life reincarnations, and interacting with deities. These extraordinary experiences might catalyze significant acute feelings of wellness, contributing to the therapeutic effects.

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Interestingly, the period of symptom relief extended well beyond the direct effects of psilocybin. The authors discussed the possibility that this prolonged relief might stem from a residual sense of well-being resulting from the experiences themselves, psychological insights gained during the sessions, or changes in cognitive processes like working memory (the brain’s ability to hold and manipulate information over short periods)  and attention. Improvements in these areas could help individuals better manage their OCD symptoms.

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Additionally, the researchers suggested that rapid serotonin receptor down-regulation might play a role. This process involves the brain quickly reducing the number of serotonin receptors, which could alter mood and behavior.

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These combined effects—transcendental experiences, lasting psychological insights, cognitive improvements, and serotonin receptor changes—provide a comprehensive framework for understanding how psilocybin might offer significant relief to those suffering from OCD.

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Summary: Exploring the Potential of Psilocybin for OCD

In conclusion, while conventional treatments for obsessive–compulsive disorder (OCD) often fall short in providing sufficient relief, emerging research suggests that psilocybin, the active compound in magic mushrooms, holds promise as a potential therapy.

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Case reports and a small clinical trial indicate that psilocybin may offer rapid and lasting relief from OCD symptoms, with mechanisms possibly involving profound experiences, psychological insights, cognitive enhancements, and serotonin receptor changes. However, further research is necessary to fully understand its safety, efficacy, and long-term effects before it can be considered a mainstream treatment option for OCD. Nonetheless, these findings open exciting avenues for exploration in the quest to alleviate the burden of OCD for individuals worldwide.