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Q. One of my patients, a 30-year-old with long-term AN, recently asked me about adding a psychedelic agent to her current treatment regimen. I have many doubts about this, including possible harm. Are there any benefits to adding such an agent to her treatment? (S.Y., Camden, ME)
A. A quick answer at this time would be No, because not enough study has been done about adding psychedelics, for example, to a normal treatment regimen.
Some information about the growing work on adding psychedelic agents to eating disorders treatment regimens has come from a group of Swiss researchers at the University of Fribourg and the University Hospital Zurich, both in Zurich, Switzerland (Euro Neuropsychopharm. 2023. 75:1). Dr. Abigail Caldera and colleagues found preliminary evidence that psychedelic-assisted therapy (PAT) showed potential in treating some common comorbidities of eating disorders, including mood disorders, post-traumatic stress disorder, and substance abuse disorders among patients with AN and BN (CNS Drugs. 2020. 34:925). They found little data on binge eating disorder, or BED.
Specifically, according to the authors, preliminary evidence suggests that PAT could be beneficial in the treatment of AN and BN, as well as several common comorbidities. Patients with AN have disturbances in their view of body weight or shape and feel an undue influence of body weight and shape on their self-evaluation, intense fear of weight gain, and/or behavior interfering with weight gain.
Previous accounts of psychedelic use in people with EDs suggest that psychedelics may improve distorted body image, normalize maladaptive reward processing, reduce behavioral and cognitive rigidity, and aid in trauma processing. The ability of psychedelics to relax higher-order beliefs may account for some of this, as may their ability to promote acceptance of difficult thoughts and emotions. Changes arising during or shortly after a psychedelic experience may additionally have a lasting impact on the brain via psychedelics’ effects on cortical neuroplasticity.
Specifically, according to the authors, preliminary studies support more research into therapy with psilocybin, ketamine, and ayahuasca. Ayahuasca is a psychotropic beverage from South America, derived from Banisteriopsis caapi and Psychotria viridis. The beverage contains alkaloids such as β-carbolines and dimethyltryptamine (DMT), which alter the psychoactive functions associated with perception and thought processes. People in Brazil, Colombia, and Peru widely consume it.
Safety is always a concern. The potential impact on comorbid psychopathology should be considered, as should interactions with other medications. The risk of serotonin toxicity, in particular, may be substantial. Persisting perceptual problems can occur in the weeks after a psychedelic experience,
Some side effects of psychedelics are particularly relevant for those with eating disorders. For example, vomiting is a common effect of ayahuasca.
One caveat is that the majority of the evidence so far appears to be from case reports and case series. While valuable, these can provide an unduly positive impression (as negative results are less likely to end up as case reports). Still, given preliminary results and plausible therapeutic mechanisms, there is a clear rationale for future studies into PAT for eating disorders, according to the authors. Larger, controlled trials investigating the safety and efficacy of PAT with different substances for different ED diagnoses are needed.
—SC