Use of psylocybin in the treatment of psychiatric disorders: Literature review

Authors

DOI:

https://doi.org/10.33448/rsd-v13i2.44971

Keywords:

Mental disorders; Psilocybin; Hallucinogens; Psychiatry.

Abstract

Objective: To describe the information available in the literature regarding the use of psilocybin in the treatment of psychiatric disorders, its mechanisms of action and toxicity, as well as other relevant data on the subject. Methodology: This paper presents a narrative review of the literature, which allows for the synthesis of multiple studies, thus enabling general conclusions about a particular subject. The searches took place between the months of September and December of 2023, in the following databases: PubMed, Virtual Health Library, SciELO and Google Scholar. The critical analysis of the studies and the synthesis of bibliographic data were performed descriptively, grouped in topics relevant to the studied subject. Results: Given its mechanism of action – psilocybin acts mainly as an agonist of the 5-receptorHT2A, acting in the serotonergic system, amplifying the action of serotonin in the synaptic cleft and promoting qualitative and quantitative changes in brain function –, several studies relate psilocybin to the improvement of symptoms of depression and anxiety. As for the evaluation of the toxicity of this substance, psilocybin is generally considered of low-toxicity, not generating physical dependence. Conclusion: Considering the above, there is potential for this hallucinogen in the treatment of psychiatric disorders, such as depression and anxiety. However, more studies are still needed to better understand the efficacy of psilocybin, its risks and benefits, as well as to verify regulatory aspects and protocols for its safe and rational use.

References

Agin-Liebes, G. I., Malone, T., Yalch, M. M., Mennenga, S. E., Ponté, K. L., Guss, J., & Ross, S. (2020). Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer. Journal of Psychopharmacology, 34 (2), 155-166. https://pubmed.ncbi.nlm.nih.gov/31916890/. 10.1177/0269881119897615.

Anderson, B. T., Danforth, A., Daroff, R., Stauffer, C., Ekman, E., Agin-Liebes, G., & Woolley, J. (2020). Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: An open-label safety and feasibility pilot study. EClinicalMedicine, 27. https://pubmed.ncbi.nlm.nih.gov/33150319/. 10.1016/j.eclinm.2020.100538.

Anvisa. (2022). Agência Nacional de Vigilância Sanitária. Resolução da Diretoria Colegiada (RDC) Nº 676 de 28 de abril de 2022. Dispõe sobre a atualização do Anexo I (Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial) da Portaria SVS/MS nº 344, de 12 de maio de 1998. Recuperado de https://www.gov.br/anvisa/pt-br/assuntos/medicamentos/controlados/copy_of_RDC6762022.pdf.

Belouin, S. J., & Henningfield, J. E. (2018). Psychedelics: where we are now, why we got here, what we must do. Neuropharmacology, 142, 7-19. https://pubmed.ncbi.nlm.nih.gov/29476779/. 10.1016/j.neuropharm.2018.02.018.

Brasil. (1998). Portaria da Secretaria de Vigilância Sanitária nº 344 de 12 de maio de 1998. Aprova o Regulamento Técnico sobre substâncias e medicamentos sujeitos a controle especial. Diário Oficial da União. 15 maio 1998. Ministério da Saúde.

Breeksema, J. J., Niemeijer, A. R., Krediet, E., Vermetten, E., & Schoevers, R. A. (2020). Psychedelic treatments for psychiatric disorders: A systematic review and thematic synthesis of patient experiences in qualitative studies. CNS drugs, 34, 925-946. https://link.springer.com/article/10.1007/s40263-020-00748-y. https://doi.org/10.1007/s40263-020-00748-y.

Carhart-Harris, R. L., Erritzoe, D., Williams, T., Stone, J. M., Reed, L. J., Colasanti, A., & Nutt, D. J. (2012). Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proceedings of the National Academy of Sciences, 109(6), 2138-2143. https://www.pnas.org/doi/abs/10.1073/pnas.1119598109. https://doi.org/10.1073/pnas.1119598109.

Carhart-Harris, R. L., Bolstridge, M., Day, C. M., Rucker, J., Watts, R., Erritzoe, D. E., & Nutt, D. J. (2018). Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology, 235, 399-408. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813086/. 10.1007/s00213-017-4771-x.

Carhart-Harris, R. L., Bolstridge, M., Rucker, J., Day, C. M., Erritzoe, D., Kaelen, M., & Nutt, D. J. (2016). Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. The Lancet Psychiatry, 3(7), 619-627. https://pubmed.ncbi.nlm.nih.gov/27210031/. 10.1016/S2215-0366(16)30065-7.

Carhart-Harris, R., Giribaldi, B., Watts, R., Baker-Jones, M., Murphy-Beiner, A., Murphy, R., & Nutt, D. J. (2021). Trial of psilocybin versus escitalopram for depression. New England Journal of Medicine, 384(15), 1402-1411. https://www.nejm.org/doi/full/10.1056/NEJMoa2032994. 10.1056/NEJMoa2032994.

Chhabra, R., Kremzner, M. E., & Kiliany, B. J. (2005). FDA policy on unapproved drug products: past, present, and future. Annals of Pharmacotherapy, 39 (7-8), 1260-1264. https://pubmed.ncbi.nlm.nih.gov/15956239/. 10.1345/aph.1E569.

Davis, A. K., Barrett, F. S., May, D. G., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., & Griffiths, R. R. (2021). Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. JAMA psychiatry, 78(5), 481-489. https://pubmed.ncbi.nlm.nih.gov/33146667/. 10.1001/jamapsychiatry.2020.3285.

Galvão, T. F., & Pereira, M. G. (2022). Revisões sistemáticas e outros tipos de síntese: comentários à série metodológica publicada na Epidemiologia e Serviços de Saúde. Epidemiologia e Serviços de Saúde, 31. https://www.scielo.br/j/ress/a/Y9kdncBVqh4bHx9CBN8xHCd/?lang=pt. https://doi.org/10.1590/S2237-96222022000300023.

Goel, D. B., & Zilate, S. (2022). Potential therapeutic effects of psilocybin: a systematic review. Cureus, 14(10). https://pubmed.ncbi.nlm.nih.gov/36381758/. 10.7759/cureus.30214.

Goldberg, S. B., Pace, B. T., Nicholas, C. R., Raison, C. L., & Hutson, P. R. (2020). The experimental effects of psilocybin on symptoms of anxiety and depression: A meta-analysis. Psychiatry research, 284, 112749. https://pubmed.ncbi.nlm.nih.gov/31931272/. 10.1016/j.psychres.2020.112749.

Goodwin, G. M., Aaronson, S. T., Alvarez, O., Atli, M., Bennett, J. C., Croal, M., & Malievskaia, E. (2023). Single-dose psilocybin for a treatment-resistant episode of major depression: Impact on patient-reported depression severity, anxiety, function, and quality of life. Journal of Affective Disorders, 327, 120-127. https://pubmed.ncbi.nlm.nih.gov/36740140/. 10.1016/j.jad.2023.01.108.

Griffiths, R. R., Johnson, M. W., Richards, W. A., Richards, B. D., McCann, U., & Jesse, R. (2011). Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects. Psychopharmacology, 218, 649-665. https://pubmed.ncbi.nlm.nih.gov/21674151/. 10.1007/s00213-011-2358-5.

Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., & Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of psychopharmacology, 30 (12), 1181-1197. https://pubmed.ncbi.nlm.nih.gov/27909165/. 10.1177/0269881116675513.

Gukasyan, N., Davis, A. K., Barrett, F. S., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., & Griffiths, R. R. (2022). Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up. Journal of Psychopharmacology, 36(2), 151-158. https://pubmed.ncbi.nlm.nih.gov/35166158/. 10.1177/02698811211073759.

Henríquez-Hernández, L. A., Rojas-Hernández, J., Quintana-Hernández, D. J., & Borkel, L. F. (2023). Hofmann vs. Paracelsus: do psychedelics defy the basics of toxicology?—a systematic review of the main ergolamines, simple tryptamines, and phenylethylamines. Toxics, 11(2), 148. https://www.mdpi.com/2305-6304/11/2/148. https://doi.org/10.3390/toxics11020148.

Jefsen, O. H., Elfving, B., Wegener, G., & Müller, H. K. (2021). Transcriptional regulation in the rat prefrontal cortex and hippocampus after a single administration of psilocybin. Journal of Psychopharmacology, 35 (4), 483-493. https://pubmed.ncbi.nlm.nih.gov/33143539/. 10.1177/0269881120959614.

Kraehenmann, R., Preller, K. H., Scheidegger, M., Pokorny, T., Bosch, O. G., Seifritz, E., & Vollenweider, F. X. (2015). Psilocybin-induced decrease in amygdala reactivity correlates with enhanced positive mood in healthy volunteers. Biological psychiatry, 78(8), 572-581. https://www.sciencedirect.com/science/article/pii/S0006322314002753. https://doi.org/10.1016/j.biopsych.2014.04.010.

Johnson, M. W., Griffiths, R. R., Hendricks, P. S., & Henningfield, J. E. (2018). The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act. Neuropharmacology, 142, 143-166. https://pubmed.ncbi.nlm.nih.gov/29753748/. 10.1016/j.neuropharm.2018.05.012.

Lee, H. M., & Roth, B. L. (2012). Hallucinogen actions on human brain revealed. Proceedings of the National Academy of Sciences, 109(6), 1820-1821. https://pubmed.ncbi.nlm.nih.gov/22308478/. 10.1073/pnas.1121358109.

Lobo, F. (2021). Os psicodélicos vão revolucionar a psiquiatria? Central de Conteúdo. https://www.ipea.gov.br/cts/pt/central-de-conteudo/artigos/artigos/291-os-psicodelicos-vao-revolucionar-a-psiquiatria.

Lowe, H., Toyang, N., Steele, B., Valentine, H., Grant, J., Ali, A., & Gordon, L. (2021). The therapeutic potential of psilocybin. Molecules, 26(10), 2948. Recuperado de https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156539/. 10.3390/molecules26102948.

Ly, C., Greb, A. C., Cameron, L. P., Wong, J. M., Barragan, E. V., Wilson, P. C., & Olson, D. E. (2018). Psychedelics promote structural and functional neural plasticity. Cell reports, 23(11), 3170-3182. https://www.cell.com/cell-reports/pdf/S2211-1247(18)30755-1.pdf. https://doi.org/10.1016/j.celrep.2018.05.022.

Nichols, D. E. (2020). Psilocybin: From ancient magic to modern medicine. The Journal of antibiotics, 73(10), 679-686. https://pubmed.ncbi.nlm.nih.gov/32398764/. 10.1038/s41429-020-0311-8.

Oga, S.; Camargo, M. M. A.; Batistuzzo, J. A. O. (2021). Fundamentos de toxicologia. (5a ed.), Atheneu.

Perkins, D., Sarris, J., Rossell, S., Bonomo, Y., Forbes, D., Davey, C., & Castle, D. (2021). Medicinal psychedelics for mental health and addiction: Advancing research of an emerging paradigm. Australian & New Zealand Journal of Psychiatry, 55(12), 1127-1133. https://pubmed.ncbi.nlm.nih.gov/33745287/ 10.1177/0004867421998785.

Psiuk, D., Nowak, E. M., Dycha, N., Łopuszańska, U., Kurzepa, J., & Samardakiewicz, M. (2022). Esketamine and Psilocybin—The Comparison of Two Mind-Altering Agents in Depression Treatment: Systematic Review. International Journal of Molecular Sciences, 23(19), 11450. https://pubmed.ncbi.nlm.nih.gov/36232748/. 10.3390/ijms231911450.

Reiff, C. M., Richman, E. E., Nemeroff, C. B. et al. (2020). Psychedelics and psychedelic-assisted psychotherapy. American Journal of Psychiatry. 177: 391–410. https://www.mdpi.com/1422-0067/23/19/11450. https://doi.org/10.3390/ijms231911450.

Ross, S., Bossis, A., Guss, J., Agin-Liebes, G., Malone, T., Cohen, B., & Schmidt, B. L. (2016). Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. Journal of psychopharmacology, 30(12), 1165-1180. https://pubmed.ncbi.nlm.nih.gov/27909164/. 10.1177/0269881116675512.

Souza, J. L. B. (2019). A psilocibina e o seu potencial terapêutico em saúde mental. [Trabalho de Conclusão de Curso, Universidade Federal do Ceará]. https://repositorio.ufc.br/handle/riufc/46077.

Therapeutic Goods Administration (2023). Notice of final decisions to amend (or not amend) the current Poisons Standard in relation to psilocybine and MDMA. Australian Department of Health and Aged Care. https://www.tga.gov.au/sites/default/files/2023-02/notice-of-final-decision-to-amend-or-not-amend-the-current-poisons-standard-june-2022-acms-38-psilocybine-and-mdma.pdf .

World Health Organization. (2017). Depression and other common mental disorders: global health estimates. World Health Organization. https://iris.who.int/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf?sequence=1&isAllowed=y.

Ziff, S., Stern, B., Lewis, G., Majeed, M., & Gorantla, V. R. (2022). Analysis of Psilocybin-Assisted Therapy in Medicine: A Narrative Review. Cureus, 14(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901083/. 10.7759/cureus.21944.

Published

09/02/2024

How to Cite

TEIXEIRA, G. B. .; PASSOS, A. C. de B. .; FARIAS, B. V. .; GIRÃO , A. B. C. F. .; MARÇAL, L. da S. .; ALBUQUERQUE, K. O. dos S. .; FERREIRA, M. A. D. . Use of psylocybin in the treatment of psychiatric disorders: Literature review. Research, Society and Development, [S. l.], v. 13, n. 2, p. e2813244971, 2024. DOI: 10.33448/rsd-v13i2.44971. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/44971. Acesso em: 11 may. 2024.

Issue

Section

Review Article