In early September, the burgeoning field of psychedelic research got a long-sought-after dose of legitimacy: Johns Hopkins Medicine received $17 million in funding to launch the Center for Psychedelic and Consciousness Research. A first-of-its-kind facility for the United States, the center will study the efficacy of psychedelics — namely psilocybin (otherwise known as psychedelic mushrooms) — as a treatment for a range of mental health disorders. While much of the existing research around psychedelics and mental health focuses on the drugs’ ability to treat PTSD, depression, and addiction, the launch of the center brings a new and less-expected line of research: psychedelics as a treatment for anorexia nervosa.
Anorexia, as it’s more commonly known, is a mental illness affecting some 30 million Americans that manifests as an eating disorder, characterized by abnormally low body weight, body image distortion, and a fear of gaining weight. People with the condition often go to extreme measures to control their weight and eating habits, which can be dangerous: Complications from the disease can include heart problems, bone loss, anemia, and even death.
In fact, anorexia nervosa is responsible for more deaths than any other mental illness. This is due, in part, to the physically degrading nature of the illness, but it’s also attributable to the fact that medical professionals have yet to find an effective treatment for the disorder. As of now, the accepted treatment consists of supervised weight gain coupled with cognitive behavioral therapy (CBT), which aims to challenge and change the thinking and behaviors behind the issue. The relapse rate for the treatment is up to 52%, according to a 2017 review.
Given psilocybin’s track record of treating people with other treatment-resistant mental health disorders, researchers at Johns Hopkins are cautiously hopeful that it could be the answer, and the team is in the recruiting phase of a landmark clinical trial to explore the possibility. The study will likely take two to three years to complete, from recruitment to analysis, but the trial itself will take about eight months.
In structure, the trial will look similar to the psilocybin trials Johns Hopkins has completed in the past for other disorders. After a month-long prep period, people in the study will have two psilocybin sessions two weeks apart, lasting six to eight hours each. The dose for the first session will be 20 milligrams (considered a typical dose for inducing a psychedelic experience) and the second dose will be either 20 or 25 milligrams, depending on the experience of the first session.Though counselors are present, these sessions aren’t therapy-like. Instead, people are encouraged to “go inside” their minds and “be with their internal experience,” says Natalie Gukasyan, a post-doctoral research fellow at Johns Hopkins’ psychedelic research unit.
“It’s really a complicated illness, and we really don’t know what’s going to happen in the laboratory when we give folks like this psilocybin. But we’re hoping it can be helpful.”
The sessions are followed by a next-day follow-up, then another follow-up a week later to discuss the experience. After the second session, people in the study will have a month-long “integration period,” where counselors help them integrate their psilocybin experiences into their understanding of their disease. The therapy will be based on motivational interviewing, a counseling method that aims to help people find the internal motivation to change behaviors by resolving insecurities. Finally, the people in the study will have a follow-up six months later to determine the effectiveness of the intervention on the eating disorder.
Though this is the first study that will examine psilocybin as a treatment for anorexia, early research with other psychedelics has suggested promise. A 2017 study interviewed 16 people with eating disorders who had participated in an ayahuasca ceremony, which involves drinking a psychedelic brew from the Amazon. Eleven of the people reported that the experience led to reductions in their symptoms, and 14 said the drug made them better able to regulate their emotional state. There are also several first-person accounts of people using psychedelics to help heal eating disorders.
In a 2013 review examining the failure of treatment options for eating disorders, researchers concluded that the resistance to treatment stemmed from the “ego-syntonic” nature of the illness, meaning many of the behaviors, values, and feelings behind the symptoms of the disease stem from the needs and goals of the ego. Dissolving the ego happens to be a hallmark of the psychedelic experience: In this altered state, people are often able to gain a new perspective on themselves in the world. If psilocybin works for eating disorders, researchers believe this may be the reason.
More often than not, people diagnosed with anorexia have other mental health conditions, according to Gukasyan, which means even if the psilocybin treatments don’t treat the disease directly, the experience could still be effective for the person’s overall mental health. “It tends to be more the rule than the exception that someone with anorexia is also struggling with anxiety, depression, OCD, or have some sort of trauma-related problems,” she says.
Though anorexia nervosa is classified as a mental illness, research is increasingly showing that there are physiological components to the disease as well, which, according to Gukasyan, means that “there are things that happen in the body chemically” that keep people stuck in the patterns of starvation and excessive exercise. This includes hormone changes and potentially even genetics, as anorexia is often hereditary. Gukasyan is unsure of whether the psilocybin intervention can help address these physical aspects, but believes the trial is still worth a shot.
“It’s really a complicated illness,” she says. “And we really don’t know what’s going to happen in the laboratory when we give folks like this psilocybin. But we’re hoping it can be helpful.”
You can find more information on the Johns Hopkins trial, including an online screening form to participate, here.