Psilocybin therapy (or psilocybin-assisted therapy) is the use of psilocybin (the psychoactive ingredient in psilocybin mushrooms) in treating a range of mental health conditions, such as depression, anxiety, addictions, obsessive compulsive disorder (OCD), and psychosis. It is one of several forms of psychedelic therapy under study. Psilocybin was popularized as a psychedelic recreational drug in the 1970s and was classified as a Schedule I drug by the DEA. Research on psilocybin as a medical treatment was restricted until the 1990s because of the sociocultural fear of dependence on this drug. As of 2022, psilocybin is the most commonly researched psychedelic due to its safety and low potential for abuse and dependence. Clinical trials are being conducted at universities and there is evidence confirming the use of psilocybin in the treatment of depression, post-traumatic stress disorder (PTSD) and end-of-life anxiety.
History The first historical record of psilocybin use dates back to Mesoamerica. A Codex known as the "Yuta Tnoho" or "Vindobonensis Mexicanus I" that belonged to the Mixtec culture in the 1500s BCE depicted religious and medicinal ritual ingestion of psilocybin-containing mushrooms. Fungi were a prominent feature in Mixtec cultures, with over 5,000 different names of common edible mushrooms known across Mexican languages. Despite colonists' efforts to eradicate these ceremonies, ritualistic consumption of Psilocybe mushrooms continues in modern spiritual and medicinal practice. The hallucinations produced by the psilocybin induce a trance-like state that is believed to allow the soul to disconnect from the body, resulting in healing and spiritual enlightenment. Traditional psilocybin use was typically achieved through the consumption of dried or fresh psilocybin-containing mushrooms. However, in 1959, Albert Hofmann, a Swiss chemist, became the first person to extract pure psilocybin from the mushroom Psilocybe mexicana. Sandoz, the company that employed Hofmann, then began to sell the active compound to clinicians as an aid in psychedelic psychotherapy. Albert Hofmann's discovery of psilocybin played a pivotal role in catalyzing the Psychedelic Era, a cultural phenomenon that unfolded during the 1960s and 1970s. This era witnessed significant societal, musical, and artistic transformations, many of which were heavily influenced by the use of psychedelic substances, including psilocybin. At this time, though, there was very little known about psychedelics and their long-term effects. In August 1960, Timothy Leary conducted a self-experiment using psilocybin mushrooms. After trying pure, extracted psilocybin, he and Dr. Richard Alpert conducted research on whether it could help reduce recidivism rates and constitute an effective psychotherapy aid. In 1963, Leary and Alpert were suspended from their jobs at Harvard University, for engaging in irresponsible and dangerous experimentation with psilocybin mushrooms. Psilocybin research in the United States ended in 1970 when the use and possession of psilocybin mushrooms became illegal. In 2018–19, the United States Food and Drug Administration (FDA) granted breakthrough therapy designation to facilitate further research for psilocybin in the possible treatment of depressive disorders.
Neuroscience and pharmacology Psilocybin is the main psychoactive compound in the mushroom genus Psilocybe. Psilocybin (O-phosphoryl-4-hydroxy-N,N-dimethyltryptamine) and its active metabolite psilocin (4-hydroxy-N,N-dimethyltryptamine) are part of a group of tryptamine/indolamine hallucinogens that are related to serotonin. Psilocybin is a prodrug for psilocin, meaning that psilocybin is de-phosphorylated in the GI tract of the body into psilocin so it can cross the blood-brain barrier. Psilocin is a selective agonist of the 5-HT receptors, specifically 5-HT1A, 5-HT1B, 5-HT2A, 5-HT2B, and 5-HT2C. Although to a lesser extent, psilocin also bonds to dopamine D3 receptors, which may aid in treating substance use disorders. Further, psilocin has some effect on the amygdala and hypothalamus that aids in circadian rhythm regulation. Nausea, vomiting, muscle weakness, and lack of coordination are some of the physical side effects. Hallucinations and an inability to distinguish fiction from reality are among the psychological effects of psilocybin use. Panic attacks and psychotic-like episodes are also possible, especially if a large amount is consumed.
Research Use of psilocybin for treating depression is under preliminary research. Evidence to date indicates that psilocybin therapy produces substantial reductions in depressive symptoms, for major depressive disorder and treatment-resistant depression, and also for depression associated with life-threatening cancer. Similarly, psilocybin therapy has been found to increase rates of remission from depression.
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