The Healing Potential of Psychedelic-Assisted Therapy for Eating Disorders

Eating disorders affect millions of people worldwide, presenting complex challenges that often require comprehensive and innovative approaches to treatment. In recent years, there has been growing interest in the potential of psychedelic-assisted therapy as a transformative tool in the realm of mental health. This blog post explores the emerging field of psychedelic-assisted therapy for eating disorders, shedding light on its promising benefits and the implications it may have for the future of treatment.

Introduction

Eating disorders affect at least 9% of the population, or 70 million people, worldwide[8], and this number is increasing. A review of worldwide data found that eating disorder diagnoses more than doubled from 2000-2018, with the trend was consistent across regions, age groups, and genders.[10]

These conditions are also serious, falling among the deadliest mental illnesses, second only to opioid overdose.[8] Every year, 10,200 deaths occur as the direct result of an eating disorder—that’s one death every 52 minutes.[9]

 

Understanding Eating Disorders

“Eating disorders are a window into the struggle of the soul.”

People don’t choose eating disorders. Nobody wakes up one day and says “I’d like to have anorexia”—If they do, they’re seriously misinformed. Eating disorders aren’t choices, but rather serious multi-faceted and biologically influenced illnesses. An individual may consciously decide to purge or over-exercise at first, but before long, this disordered relationship with food and one’s body can become a deeply-ingrained subconscious pattern that takes on a life of its own. When left untreated, eating disorders can lead to serious, and sometimes life-threatening, physical and psychological consequences, underscoring the urgent need for effective therapeutic interventions.

Thankfully, eating disorder behaviors are learned behaviors and can be unlearned—but it takes time. Everyone has the capacity for full recovery. Part of the work in recovery is to uncover the meaning or purpose behind the symptoms.

 

The Limitations of Traditional Treatments

Conventional treatment approaches, including cognitive-behavioral therapy and medication, have demonstrated some effectiveness in managing eating disorders. However, there are currently no FDA-approved treatment options for anorexia nervosa and only one for bulimia nervosa and binge-eating disorder respectively. While depression commonly occurs with most eating disorders, traditional antidepressants (i.e. SSRIs) often lack efficacy in patients with anorexia. Even when patients are able to take advantage of available treatments, many continue to struggle with symptoms, and relapse rates remain high.

Studies have found that over a third of all patients treated for anorexia or bulimia end up relapsing within the first few years of completing treatment. The highest risk for relapse from anorexia occurs in the first 18 months (about 1 and a half years) after treatment, with 35% falling back into eating disordered behaviors.[1]

While the onset of bulimia usually occurs during adolescence or early adulthood, it tends to persist for several years, either chronically or intermittently. Treatment does help most people with bulimia achieve long-lasting recovery, but relapse still is a significant concern, with rates of up to 41% of former patients resuming bulimic behaviors within 2 years.[2]

Recognizing these challenges, researchers and clinicians have continued to search for new and improved ways to help individuals with eating disorders find more long-lasting and complete healing, including the use of psychedelic-assisted therapy as a potential alternative or complementary treatment modality.

 

The Role of Psychedelics in Healing

Psychedelic substances like psilocybin, MDMA, and LSD have shown promise in facilitating profound psychological healing in individuals dealing with depression, PTSD, substance abuse, eating disorders, and other mental health conditions. Though theoretical mechanisms of action of psychedelic medicines are still being investigated, a growing body of research points suggest that psychedelics create desirable brain states that can accelerate therapeutic processes and make eating disorder interventions easier to receive. The desirable brain states in

 

Research Studies

Group Ketamine-Assisted Therapy for Eating Disorders [3]

This pilot study, led by Dr. Reid Robison, Chief Clinical Officer of Numinus, explored the use of group ketamine-assisted psychotherapy (KAP) in a residential eating disorder treatment facility. 5 individuals with eating disorder diagnoses and comorbid mood and anxiety disorders received weekly intramuscular ketamine injections in a group setting followed by non-drug psychotherapy over 4 weeks.

Regarding the outcomes, the study found promising results. Group KAP was feasible and well-tolerated, with high patient satisfaction and treatment adherence rates. Participants experienced reduced symptoms of depression, anxiety and showed significant improvements in eating eating symptoms and quality of life, with effects persisting at a 6-month follow-up.

Participant quote:

“Trying ketamine allowed me to see the possibility of a life I could have. While the effects did not last, my very first experience snapped me out of a state of life-long, deep disconnection that I didn't even know I had been experiencing. Suddenly, I was able to live in the world in the way people had always described it. Though I am still trying to figure out how to attain that level of connection after catching a glimpse, that one experience was so essential. I could finally feel hunger and fullness cues. I felt what it's like to live in a body, instead of living a short distance from it. I felt connected to others and genuinely cared about their well-being. I felt human for the first time in a long time.”

 

Psilocybin-Assisted Therapy for Anorexia [4]

This study being conducted by Compass Pathways in collaboration with University of California San Diego,  is exploring the safety, tolerability, and efficacy of psilocybin-assisted therapy for patients with anorexia. Preliminary results from 10 participants who received a single 25 mg dose of synthetic psilocybin (~3.5 grams of dried psilocybin) shows:

 

Psilocybin-Assisted Therapy for Binge-Eating Disorder [5]

This Phase II study is currently underway at the University of Florida in collaboration with Tryp Therapeutics and happens to be the first ever psilocybin-assisted therapy study addressing binge-eating disorder. Interim analysis of five early participants has found:

MDMA-Assisted Therapy for Eating Disorder Symptoms [6]

This study investigated the effects of MDMA-assisted therapy on adults with severe PTSD, specifically exploring its impact on eating disorder symptoms. A total of 90 participants with severe PTSD received treatment in a double-blind, placebo-controlled trial. At baseline, 13 participants had EAT-26 scores in the clinical range, and 28 had scores in the high-risk range, despite the absence of active purging or low weight. After finishing the study, there was a significant reduction in total EAT-26 scores in the entire PTSD group following MDMA-assisted therapy compared to placebo. Moreover, significant reductions in total EAT-26 scores were observed in women with high EAT-26 scores (≥11 and ≥20) following the study protocol.

 

Other studies:

 

GROUP PHASE INDICATION STATUS
MAPS Phase II MDMA for anorexia and BED Anticipated start date in 2023
Johns Hopkins Phase I Psilocybin for anorexia Enrollment complete
Imperial College Phase I/II Psilocybin for anorexia Enrollment complete
TRYP Phase II Psilocybin for BED Enrolling
XPIRA Phase II Psilocybin for Anorexia Anticipated start date in 2023
COMPASS Phase II Psilocybin for Anorexia Enrolling

 

 

Integrating Psychedelics with Conventional Models

Integration of psychedelic-assisted therapy with conventional eating disorder treatment requires careful consideration of medical and safety factors, as well as the crucial involvement of specialized eating disorder clinicians. These clinicians have the expertise to navigate the unique challenges and triggers associated with eating disorders, helping patients access and integrate psychedelics in a safe and therapeutic manner. Their involvement ensures a comprehensive treatment approach that combines the benefits of psychedelic therapy with the tailored support required for individuals with eating disorders, leading to more effective and sustainable outcomes. We view the role of psychedelics as an adjunctive to traditional treatments, not a “replacement.”

 

Conclusion

Psychedelic-assisted therapy represents a promising frontier in the treatment of eating disorders, offering new possibilities for deep healing and transformation. While further research is needed to fully understand its effectiveness and establish appropriate guidelines, preliminary studies and anecdotal evidence suggest that this approach holds tremendous potential. As the field progresses, it is essential to strike a balance between innovation and responsible practice, ultimately providing individuals with hope and a path toward recovery from their eating disorders.

 

References

  1. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
  2. BMC Psychiatry. 2019; 19: 134. Published online 2019 May 6. doi: 10.1186/s12888-019-2112-9
  3. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00588-9
  4. https://compasspathways.com/comp360-psilocybin-therapy-shows-potential-in-exploratory-open-label-studies-for-anorexia-nervosa-and-severe-treatment-resistant-depression/
  5. https://tryptherapeutics.com/updates/tryp-therapeutics-announces-interim-results-for-its-phase-ii-clinical-trial-for-the-treatment-of-binge-eating-disorder-with-psilocybin-assisted-psychotherapy
  6. https://www.sciencedirect.com/science/article/pii/S0022395622001303
  7. https://pubmed.ncbi.nlm.nih.gov/9797933/
  8. (Ghaderi et al., 2018, Ward et al., 2019)
  9. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
  10. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342

Bicycle Trip: Commemorating Albert Hofmann’s Ride

Artwork by Haruka Sato. Instagram: @here_is_haruka

BY REID ROBISON, MD, MBA, CHIEF MEDICAL OFFICER, NOVAMIND & KIRSTEN HIRST, NOVAMIND

On April 19th, 1943, the chemist Albert Hofmann first experienced the full effects of LSD during a psychedelic bicycle ride home from work. For those working to harness psychedelics for the betterment of humankind, Bicycle Day marks an important moment in medical and spiritual history.

Basel, Switzerland 1943

It was a wet Monday in mid-April when Albert Hofmann hopped on his bicycle and began his daily ride to work at Sandoz laboratories.

The streets were quieter in those days. Wartime restrictions on automobiles had made sure of that. Cycling through the picturesque city speckled with medieval artifacts and colorful baroque homes, Hofmann was preparing himself for an interesting experiment.

Three days previously, the 37-year-old chemist had stopped in the middle of his work, feeling a bit funny. Resigning early, Hofmann had stumbled home. For two hours, his curious condition intensified until he entered a strange dream-like state. The daylight outside Hofmann’s window had become almost unbearably bright as prisms of colors bounced through his visual field.

Emerging from the experience, Hofmann was perplexed.

Because of the sudden severity of the event, Hofmann guessed that the peculiar episode might have resulted from his chemical work that day. Hofmann had been working with lysergic acid diethylamide tartrate, aka LSD-25. In 1938, the chemist had first synthesized the substance for potential medical use, but it hadn’t raised any particular interest. Five years later, Hofmann had decided to produce LSD-25 again, following a gut instinct that there was some greater potential latent in the substance’s properties.

Still, the LSD answer was not an entirely satisfactory one to explain Hofmann’s experience that Friday. A consummate chemist, and knowing full well the toxic nature of the compounds he worked with, Hofmann was always cautious.

He reasoned that if it was the LSD solution that had caused such strange effects, then the exposure must have been minuscule—perhaps only a trace amount had been picked up by his fingertip and absorbed through his skin. Still more baffling to Hofmann was the strength of the effect on him. Friday’s two-hour long episode seemed too fantastic to have arisen from such a small quantity of any known substance.

That day, April 19th, 1943—Hofmann intended to test his hypothesis. He walked into the lab, resolved to take a small quantity of the LSD-25 solution, and determine if the bizarre phenomenon could be replicated.  The mystical nature of the previous Friday’s experience was, after all, just the sort of thing that had persuaded Hoffman to study chemistry. Insight to explain magic—that’s what he would be gaining by his experiment.

Drawing reference from his study of similar compounds, Hofmann decided on 0.25 milligrams (or 250 micrograms) of the liquid LSD-25. It was a miniscule quantity—just .00005 teaspoons. After making a quick note in his lab book, Hofmann drank.

4/19/43 16:20: 0.5 cc of 1/2 promil aqueous solution of diethylamide tartrate orally = 0.25 mg tartrate. Taken diluted with about 10 cc water. Tasteless.  

Forty minutes later, the unusual sensations of the previous Friday returned. Mystery solved. 

Feeling the distortions began to cloud his vision, Hofmann quickly began to jot down the initial effects in his journal: Visual distortions. Symptoms of paralysisDesire to laugh.

Hofmann hardly managed to scribble the last word before the kaleidoscopic perceptions of a few days previous flooded in. Hofmann grabbed his assistant and asked him to escort him home. Off on their bicycles they went.

Ottawa, Ontario 1953

A decade after Hofmann’s self-experiment, two psychiatrists spent a sleepless night conversing in an Ottawa, Ontario hotel.

Humphry Osmond and Abram Hoffer were set to speak at a conference the next day, but instead of resting, they were up late discussing the difficulties of their profession. Their common problem was the challenge of treating patients with alcoholism.

At around four in the morning Osmond and Hoffer had an idea: what if LSD could be used to treat alcoholism?

At first, the two friends laughed at themselves. That’s absurd. LSD makes you delirious, and so does severe alcohol withdrawal. Why would we do that? But when the pair of psychiatrists stopped laughing the idea was still there, and there was something to it.

From their previous work, Osmond and Hoffer noticed that when alcoholism patients hit rock bottom, they would go through ‘delirium tremens’—a catalyzing experience that, while physically painful, often brought them to a place of being willing to to give up their drinking habits. Could LSD replicate the experience of delirium tremens? Osmond and Hoffer wondered.

As they continued to converse, the psychiatrists’ idea seemed less and less absurd. What if they purposely occasioned a difficult but transformative experience in their clients simply by giving them a medicine like LSD? Thus, a hypothesis began to emerge.

Basel, Switzerland 1943

Forms of gingerbread houses and vibrant landscape teetered in and out of Albert Hofmann’s vision. The world around had become a perilous enclosure of distorted mirrors. He was racing through Basel. Or was he? He felt stuck, pedaling slowly through the thick spring air.

When he was finally home and laying on his sofa, Hofmann felt the intensity of his bicycle ride escalate. The room spung around him with alien malformity. The pleasant colors of Friday were now saturated with a new level of strange intensity. Occasionally, Hofmann was visited by the frightful form of his neighbor, slithering in and out of the room as a terrifying witch, face veiled in a colorful mask.

Unsure of how to respond to the delusions, Hofmann lay there—nearly overcome by the sensory experience that entangled him. As is common in many initial encounters with psychedelics, Hofmann concluded that he was either losing his sanity or approaching his death.

Or maybe I’ve already passed beyond the end, Hoffman thought. After all, at times he almost seemed to hover outside of himself. Perhaps his spirit was pulling away from his body. No. It is too soon, Hofmann thought trembling. It is far too soon to leave my family, and it would be so unfortunate to leave my work unfinished.

But then gradually, the monstrous turned magical. Gratitude for the retreating unknown warmed Hofmann’s mind and rationalized his thoughts. Whimsical synesthesia overtook the alarming sensations of a few moments previous. His thoughts emerged into the air, each dancing playfully as its own image—beautiful shapes circling in and out of his vision. A doctor, arriving for a house call shortly after the peak of the delirium, confirmed that Hofmann’s health appeared to be in no real danger.

Hollywood, California 1953

On a clear Sunday morning, Humphry Osmond nervously made his way to Aldous Huxley’s home in West Hollywood. Per Huxley’s request, Osmond had brought with him 400mg of mescaline.

It was 1953, and the 58-year-old writer was living in Los Angeles with his wife Maria. Over two decades earlier, the publication of Huxley’s Brave New World had skyrocketed the author into a highly prolific and successful writing career. Now settled in Hollywood, Huxley had added screenplays and editorials to his growing library of work.

Huxley’s latest fascination with eastern mysticism coupled with his long-time interest in the hallucinogenic properties of certain plants had eventually led the writer to Osmond’s work with mescaline. In 1953, Huxley began writing to the psychiatrist about his interest in mind-expanding substances.

When Osmond arrived at the Huxleys’s home, he was greeted by the gangly writer dressed in a modest pair of blue jeans. Huxley led Osmond back to his study, a library of books complete with a small table and a wicker chair for writing.

Osmond prepared the mescaline on the table, stirring the shining white crystals into the glass until they dissolved. Suppose he pours half of the full glass into an adjacent flower vase? Osmond thought to himself. As the psychiatrist would recall years later, “I did not relish the possibility, however remote, of finding a small, but discreditable niche in literary history as the man who drove Aldous Huxley mad.”

Huxley did not go mad. Much to Osmond’s relief, the writer considered the experiment “an experience of inestimable value.”

While under the effects of the mescaline, Huxley had lived a day visiting a drug store and enjoying a casual evening with friends as one of the most transformative of his life.

 In his book The Doors of Perception, Huxley wrote what would become the most famous trip report of the modern day. For Huxley, the journey had reaffirmed his personal philosophy that hidden inside each of us is a special kind of awareness, one that does not require patience for the arrival of a divine gift—but can instead be accessed on demand through tools like mescaline and LSD.

“The man who comes back through the door will never be quite the same as the man who went out,” Huxley would later write.

New York, New York 1957

Humphry Osmond had just flown in from Saskatchewan to present at a conference for the New York Academy of Sciences. It was a cool day in mid-November and the sun was setting over the Rockefeller Institute in Manhattan. Just to the north, the summer perennials of the New York Botanical Garden had given way to a blanket of autumn-dusted leaves.

Four years had passed since Osmond and Hoffer’s late-night laugh over their strange LSD hypothesis. In the interim, and surprising both friends, the theory had yielded remarkable results. Over the past few years, the two psychiatrists had successfully given their experimental LSD therapy to over 700 patients. Of those treated, nearly 45 percent had not returned to drinking after a year. According to Hoffer, “Many of them didn’t have a terrible experience. In fact, they had a rather interesting experience.”

At the New York conference, Osmond stood in front of his colleagues and spoke about his work thus far with LSD and mescaline: “For myself, my experiences with these substances have been most strange, most awesome, and among the most beautiful things in a varied and fortunate life,” Osmond continued, “These are not escapes from but enlargements, burgeoning of reality.”

During the conference, Osmond suggested that the so-called “psychotomimetic agents” be given a more inclusive name that spoke to the complete capacity of these drugs.

He chose the term “Psychedelic”, meaning “mind-manifesting.” For the psychiatrist, the word was “clear, euphonious and uncontaminated by other associations.”

Later, Aldous Huxley wrote to the psychiatrist with an alternative name to consider (true to his literary niche, Huxley wrote it as a rhyme): ”To make this trivial world sublime, take half a gram of phanerothyme.” (“Phaneros” means “visible” and “Thymos” means “soul” in Greek.)

In a quippy rejection to Huxley’s suggestion, Osmond replied, ”To fathom Hell or soar angelic, just take a pinch of psychedelic.”

Basel, Switzerland 1943

Basel, Switzerland has long been regarded as one of the world’s best cycling cities. In 1943, an encroaching war and the monotony of required daily use had likely watered-down any novelty gained from pedaling through the city’s aged cobblestone roads or past the shining Rhine river. But on that rainy afternoon in mid-April, Albert Hoffman experienced a bicycle trip like no other.

The next morning, Hofmann woke up to a warm spring sun shining like drops of glitter in the wet garden.  For the whole day, Hofmann could feel the rich depth of the world around him. Food tasted better. The earth looked better.

Hofmann’s LSD trip had been difficult, if not frightening, at times. But emerging into a reality with each of his senses refreshed, the chemist recognized that it was the frightening aspects of his trip that were, in fact, key to the entire experience. Hofmann’s ride had left him with the self-tested conviction that difficult does not equal bad.

Years later, in a speech delivered to the 1996 Worlds of Consciousness Conference in Germany, Hofmann reflected on his experiences with LSD: “Only when we are conversant with both, heaven and hell, is our life full and rich; and it is fuller and richer the more deeply we experience both. The psychedelic experience can lead us to the deepest depths and the highest heights, to the boundaries of that which humankind is capable of experiencing.”

Originally Published on truffle report