Serotonergic psychedelic treatment for obesity and eating disorders: potential expectations and caveats for emerging studies

The compulsive eating paradigm: can psychedelics help in treating obesity?

Obesity is a multifactorial disorder involving a behavioural aetiology in subsets of patients that traditional therapeutic approaches have failed to address. Drawing parallels with addiction, the rewarding aspects of a chronic energy-dense diet can compromise dopaminergic reward circuits, eventually causing individuals to become habitually responsive to food-related stimuli despite adverse health consequences. The maladaptive prediction of reward and motivational salience that becomes associated with food-related stimuli can exert top-down influence on perception and attention, promoting compulsive eating behaviour. Emerging research suggests that psychedelics, e.g., psilocybin and LSD, induce non-ordinary mental states where the influence of such behaviours could potentially be reduced and modified. Based on current evidence, mechanisms have been proposed which suggest that psychedelics might relax the top-down influence of high-level predictions encoded within neuronal hierarchies and sensitise them to bottom-up information flow. Additionally, psychedelics are thought to open a window of psychological flexibility, allowing people to potentially become open to new cognitive and behavioural strategies that can be offered via assisted psychotherapy. Therefore, psychedelics-assisted psychotherapy may encourage beneficial changes to eating behaviour, in those with maladaptive eating habits. While promising in theory, new research is needed to assess the potential efficacy of psychedelics-assisted psychotherapy in treating compulsive eating behaviour.

Exploring the neurobiological correlates of psilocybin-assisted psychotherapy in eating disorders: a review of potential methodologies and implications for the psychedelic study design

Eating disorders (EDs) are a group of debilitating mental illnesses characterized by maladaptive eating behaviors and severe cognitive-emotional dysfunction, directly affecting 1-3% of the population. Standard treatments are not effective in approximately one third of ED cases, representing the need for scientific advancement. There is emerging evidence for the safety and efficacy of psilocybin-assisted psychotherapy (PAP) to improve treatment outcomes in individuals with EDs. However, the limited knowledge of the neurobiological mechanisms underlying the therapeutic effects of PAP restricts the ability to confirm its clinical utility. This narrative review presents an overview of methodologies used to elucidate the pathophysiological mechanisms of EDs or the effects of psilocybin that could be employed to probe the neurobiological correlates of PAP in EDs, including magnetic resonance imaging and molecular neuroimaging techniques, electrophysiological approaches, and neuroplasticity markers. Finally, the implications of these methodologies are described in relation to the unique features of the psychedelic study design, challenges, limitations, and future directions to advance the field. This paper represents a valuable resource for scientists during study conceptualization and design phases and stimulates advancement in the identification of effective therapeutic interventions for EDs.

The Role of Music in Psychedelic-Assisted Therapy: A Comparative Analysis of Neuroscientific Research, Indigenous Entheogenic Ritual, and Contemporary Care Models

Music is deeply rooted in the human experience as well as a fundamental part of psychedelic-assisted therapies (PAT) and entheogenic ceremonies. Although a large body of research exists highlighting the importance of music from rehabilitative, psychological, neurobiological, anthropological, religious, and sociological contexts, there is limited scientific literature regarding the specific relevance of music in PAT and indigenous entheogenic ritual as a means of enhancing clinical outcomes. As demand for mental health services continues to grow and awareness of the medicinal benefits of psychedelic substances to treat mental and neurological conditions increases, a new wave of interest has emerged to support the development of care models, including how music is used during PAT. Music is a reliable cornerstone in therapeutic and ritualistic spaces using psychedelics, however there is still an immense opportunity to cultivate PAT models with interdisciplinary, evidence-informed perspectives and thoughtful analysis of music use in treatment. To contribute to this development, this review evaluates neuroscientific, psychological, and anthropological research on the neural and cognitive underpinnings of music as well as music use with psychedelics both in modern research settings and indigenous entheogenic ceremonies. In addition, personalized approaches to music protocols in PAT, how music use in traditional rituals may help inform best practices, and the need for researchers to specify music protocols in treatment models are detailed. Consideration of carefully respecting the bridging of indigenous practices and current medical models is discussed to highlight areas for future development.

Psychedelics and the treatment of eating disorders: considerations for future research and practice

Recent trials have shown promising results for the use of psychedelic-assisted therapies in treating severe refractory psychiatric illnesses, and there has been growing interest in examining the effectiveness of these therapies in treating eating disorders. To move forward in a safe, ethically sound, and scientifically rigorous manner, the field must address critical considerations. In this Comment article, we outline important risks and ethical considerations, along with methodological aspects that require careful consideration in the design of psychedelic-assisted therapy trials. We conclude by providing provisional guidelines for clinical research trials to help shape the future of this work, with the aim of investigating and employing the use of psychedelics for treating eating disorders in a manner that protects clients and research participants while maximizing methodological rigour.

History, Hype, and Responsible Psychedelic Medicine: A Qualitative Study of Psychedelic Researchers

Background Psychedelic medicine is a rapidly growing area of research and policy change. Australia recently became the first country to legalize the prescription of psychedelics and serves as a case study of issues that may emerge in other jurisdictions. Despite their influence as a stakeholder group, there has been little empirical exploration of psychedelic researchers' views on the development of psychedelic research and the ethical concerns. Methods We thematically analysed fourteen interviews with Australian psychedelic researchers. Results Three themes were constructed from the data: 1) coming out of the shadow of the 1960s, 2) challenges and affordances in engaging stakeholders, and 3) growing pains in innovation and translation. Conclusion The results illustrated tensions arising from the rapid growth of psychedelic research from a small group of dedicated individuals with a similar worldview, to a multi-interest, regulated industry. Participants' experiences and viewpoints were influenced by the history of psychedelic research, and this was met with an overarching concern for protecting the field from premature discontinuation, as well as maximizing potential positive impacts. Targets for stakeholder collaboration and initiatives to support responsible innovation in psychedelics include equitable access, sustainable industry involvement, productive research agendas, responsible reporting of evidence, and risk-taking within the relative safety of clinical trials.

Effects of psilocybin on body weight, body composition, and metabolites in male and female mice

There is growing interest in the therapeutic potential of psilocybin for the treatment of a wide variety of medical problems, and even for the promotion of wellbeing among healthy individuals. Interestingly, among the many proposed indications, both obesity and anorexia nervosa (AN) have been discussed. However, the effect of psilocybin on appetitive behavior and metabolism is not well known. Here, we report the effects of psilocybin on body weight, intake and output, body composition, and metabolic function among lean male and female wild-type mice. In the days immediately following treatment, both male and female mice receiving a single intraperitoneal dose of psilocybin were consistently heavier than saline controls, with no effect of psilocybin on intake or output. Co-administration of the 5-HT2A/2C receptor antagonist ketanserin had no effect on this outcome. Body composition analysis revealed that psilocybin significantly increased lean and water mass among males, with a similar trend among females. A metabolic panel revealed increased creatine kinase (CK), aspartate aminotransferase (AST), and chloride among male and female psilocybin treated mice. Together, these findings begin to investigate the potential mechanisms of psilocybin's effects on body weight and metabolic measures. Such understanding will be critical for the safe, efficacious, and well-informed use of psilocybin in clinical and non-clinical settings.

Psychedelics in the treatment of eating disorders: Rationale and potential mechanisms

Eating disorders are serious illnesses showing high rates of mortality and comorbidity with other mental health problems. Psychedelic-assisted therapy has recently shown potential in the treatment of several common comorbidities of eating disorders, including mood disorders, post-traumatic stress disorder, and substance use disorders. The theorized therapeutic mechanisms of psychedelic-assisted therapy suggest that it could be beneficial in the treatment of eating disorders as well. In this review, we summarize preliminary data on the efficacy of psychedelic-assisted therapy in people with anorexia nervosa, bulimia nervosa, and binge eating disorder, which include studies and case reports of psychedelic-assisted therapy with ketamine, MDMA, psilocybin, and ayahuasca. We then discuss the potential therapeutic mechanisms of psychedelic-assisted therapy in these three eating disorders, including both general therapeutic mechanisms and those which are relatively specific to eating disorders. We find preliminary evidence that psychedelic-assisted therapy may be effective in the treatment of anorexia nervosa and bulimia nervosa, with very little data available on binge eating disorder. Regarding mechanisms, psychedelic-assisted therapy may be able to improve beliefs about body image, normalize reward processing, promote cognitive flexibility, and facilitate trauma processing. Just as importantly, it appears to promote general therapeutic factors relevant to both eating disorders and many of their common comorbidities. Lastly, we discuss potential safety concerns which may be associated with these treatments and present recommendations for future research.