Retrospective Survey Explores Psychedelics for OCD

In recent years, interest in psychedelic substances and their possible benefit in the treatment of psychiatric illnesses has been greatly revived. Expectations are high, particularly in obsessive-compulsive disorder where patients' therapeutic options are still limited. At the Brain Institute, Anne Buot, Luc Mallet (AP-HP) and their colleagues are collecting evidence that could pave the way for large-scale clinical studies; they show in a new study , published in Scientific Reports, that LSD and psilocybin have a strong potential to provide lasting relief of patients' symptoms.

Intrusive thoughts, involuntary repetitions of unwanted gestures and behaviors accompanied by strong anxiety... Obsessive compulsive disorder (OCD) affects around 2% of the population. It can be very debilitating and constitutes a vector of isolation, since patients' attention is disproportionately focused on obsessions, to the detriment of social relationships, work and leisure.

The treatment mainly consists of cognitive and behavioral therapy (CBT) which allows the patient to rehabilitate their thought patterns, combined with taking antidepressants. Unfortunately, its effects take a long time to appear, and 30 to 40% of patients do not respond to it at all.

“  In this context, an option proposed in clinical research in the 1970s is now resurfacing: the use of psychedelics , a family of psychotropic drugs ,” explains Anne Buot , post-doctoral student in cognitive neuroscience. But because these substances are banned in many countries, clinical studies are difficult to set up and we do not yet have robust data on their effectiveness. »

However, to organize double-blind randomized studies, the quality standard in clinical research, we still need to have encouraging preliminary data... and this, quickly. Uncertainty about the effectiveness of psychedelics, combined with possible media hype, risks encouraging recreational abuse - or poorly controlled use among vulnerable patients, without medical supervision. Finally, there is the risk of diverting patients from psychotherapeutic interventions that are nevertheless effective.

SPOTLIGHT ON INDIVIDUAL EXPERIENCE

Taking psychedelics induces an altered state of consciousness that leads the user to perceive the world in a radically different way for a few hours. This experience can be experienced as overwhelming, to the point of creating a feeling of rupture with past emotional states and encouraging the emergence of new thought patterns.

Previous studies suggest that the acute effects of psychedelics, present from the first dose, contrast with the delayed effects of treatments taken continuously, such as antidepressants. “  However, we do not know if there is a link between the subjective experience of users and real therapeutic effects ,” specifies Anne Buot.

Among them, we find the synthetic compound LSD, and psilocybin, from hallucinogenic mushrooms. “  They act, among other things, on certain serotonin receptors,” explains Luc Mallet , psychiatrist. Unfortunately, even in animals, we do not have sufficient data to predict their effectiveness in OCD. »

To increase their knowledge, the researchers decided to retrospectively analyze the experience of people who had used these substances in the past. The goal ? To understand whether they had perceived an improvement in their symptoms after taking LSD or psilocybin, whether this effect was lasting, and whether it could be predicted based on different factors. The lived experience of patients is indeed invaluable, and in the absence of objective clinical data, it is decisive for assessing the therapeutic potential of psychedelics and guiding research.

AN EFFICIENCY THAT TAKES SHAPE

“  We recruited, via an online questionnaire, 174 people who presented symptoms of OCD and who had used psychedelics occasionally or regularly. We questioned them about their mental health and the treatments followed – in addition to their socio-demographic characteristics , details Anne Buot. They were then asked to report the context in which they had taken these substances, the dose absorbed, the nature of their psychedelic experience and the perceived effects on OCD symptoms.  »

Among the effects reported by participants, a dissipation of obsessive thoughts and the need to engage in rituals, a reduction in anxiety and avoidance behaviors, and even better acceptance of OCD. “  30% of participants reported that these positive effects had lasted more than three months , which is very encouraging,” adds Luc Mallet. Finally, we observed that the dose of LSD or psilocybin absorbed was positively correlated with the intensity of the psychedelic experience and its pleasant nature.  »

These encouraging results must, however, be interpreted with caution. Indeed, the subjective evaluation of the therapeutic effects of psychedelics is likely to be guided by numerous biases, including the beliefs of the study participants.

“  The population we studied generally has a very positive and enthusiastic attitude towards these substances, sometimes regardless of their therapeutic effect. In addition, many of the participants are in situations of therapeutic impasse and have high expectations of LSD or psilocybin to improve their lives. This can considerably guide their testimony  ,” adds the psychiatrist.

TOWARDS ROBUST KNOWLEDGE AND THE DEFINITION OF GOOD PRACTICES

This bias is reinforced by the transformative symbolism of the psychedelic experience itself. Some people experience a feeling of euphoria, ecstasy, or connection with the universe that contrasts sharply with their ordinary experience of the world, and encourages them to perceive it with new eyes. “  Understanding to what extent the very nature of the psychedelic experience – strongly influenced by people's history, their culture and their imagination – affects the therapeutic effects will be essential ,” concludes Anne Buot. For this, we will need complementary approaches, in ethnography and psychology for example.  »

To reap the full benefit of potential new treatments and establish good usage practices, it will certainly be necessary to increase the number of rigorous clinical studies, but also to understand the biological mechanisms on which the long-term effects of psychedelic substances are based. Researchers believe they could increase neuroplasticity by promoting the remodeling of synaptic connections. But in this matter, everything remains to be discovered.

Reference: Buot A, Pallares C, Oganesyan A, et al. Improvement in OCD symptoms associated with serotoninergic psychedelics: a retrospective online survey. Sci Rep. 2023;13(1):13378. doi: 10.1038/s41598-023-39812-0

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