A recent review of alternative treatments for obsessive compulsive disorder (OCD) indicates that psychedelic treatments show promise for the disorder while cannabis does not.
Dr Michael Van Ameringen, a psychiatry professor at McMaster University in Ontario, Canada and lead author of the review published in the Journal of Psychiatric Research, said that 40-60 % of OCD patients get either partial or no relief with available treatments, including SSRIs and exposure and response prevention therapy.
While psychedelics and cannabinoids have become part of the conversation surrounding OCD – a disorder characterized by intrusive, obsessive thoughts and/or compulsive behaviors – there is a much larger body of published evidence on the efficacy of these substances for more common conditions, like depression and anxiety.
“We wanted to hone down and really understand, is there evidence for these things that have been talked about to be used as the next step treatments?” Van Ameringen explained.
Given the paucity of existing literature, Van Ameringen said he didn’t know what to expect. To make up for the lack of published information, he included conference presentations and preliminary, unpublished findings in the review paper.
Upon compiling available evidence, Van Ameringen and his team found “stronger signals” for the efficacy of psychedelics, specifically psilocybin (the psychoactive component of “magic mushrooms,”) than for cannabinoids like THC and CBD.
Van Ameringen theorizes that the difference is related to how these substances interact with areas of the brain related to OCD. While cannabinoids activate the brain’s CB1 receptors, which regulate symptoms like compulsions and anxiety, available evidence shows they don’t offer lasting relief from OCD symptoms.
Psilocybin, on the other hand, can reduce connectivity in the brain’s default mode network, which “essentially is involved in self referential thinking and rumination. The default mode network is really activated in OCD”, he says.
A difference in the methodology of cannabis and psilocybin studies might also have contributed to the different results, says Dr Mohamed Sherif, a psychiatrist and computational neuroscientist at Brown University who will lead a future clinical trial on psilocybin for OCD. Psychedelic clinical trials, like the one Sherif is planning, tend to offer patients not only medication but also encouragement to frame their experience as a therapeutic “journey”.
“This was not done in cannabinoids [studies,]” Sherif explained.
Dr Terrence Ching, a clinical psychologist at the Yale School of Medicine, similarly wondered if the way people use cannabis versus psilocybin might explain the different outcomes. While people tend to use cannabis for temporary relief, psilocybin can help facilitate actual changes in the brain and in patients’ perception of their OCD.
“One could use cannabis for the same therapeutic reason, of confronting something deeper about their OCD or their obsessive fears. But conventionally, people tend to use cannabis for an avoidance function,” Ching explained.
Preliminary results from Ching’s clinical trial on a single dose of psilocybin for OCD were included in Van Ameringen’s review paper, and showed that psilocybin was effective for OCD symptoms compared to placebo. Ching is now preparing the results of the trial for publication, and planning a second clinical trial where OCD patients will receive two doses of psilocybin at different times.
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