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Psilocybin, the active substance in magic mushrooms, are showing much promise in mental health therapy

Left: Ekaterina Malievskaia, Chief Innovation Officer and Co-founder at COMPASS Pathways; Right: Clara Burtenshaw, Partner and Investor at Neo Kuma Ventures

Dr Ekaterina Malievskaia, Chief Innovation Officer and co-founder of mental healthcare company Compass Pathways, discovered psychedelics when researching alternative treatments for her son’s depression and obsessive compulsive disorder (OCD). She was running out of options, as her son was not responding to conventional treatment.

“The more my son was treated in the best institutions, the worse he was getting,” says Malievskaia. Her son isn’t alone – many people are struggling with mental health issues, and a large number of them have found conventional treatments such as ineffective.

For instance, the side effects of selective serotonin reuptake inhibitor (SSRIs), a commonly prescribed antidepressant, include weight gain, fatigue and worsening anxiety. In some cases, these SSRIs exacerbate depressive symptoms or are simply not effective. Psilocybin has been used recreationally and for religious purposes for decades, if not centuries. But it was only in recent times that studies into the drug have been commissioned. A 2006 study from the University of Arizona, where nine patients suffering from OCD were given controlled doses of psilocybin. Researchers saw an acute decrease in symptoms for four to 24 hours, with some remaining symptom-free for days. Larger scale research is already under way – Yale University is conducting a study on the use of low doses of psilocybin for 30 OCD patients, with the study to be concluded by 2023. Malievskaia shared these compelling findings on the healing potential of psilocybin during a virtual conversation with the Greater Club on 16 June.  The event was moderated by Clara Burtenshaw, who is a partner of Neo Kuma Ventures, Europe’s first and largest psychedelics-focused venture capital fund.

The history of psilocybin use

Psilocybin is a controlled substance in many regions. In the United States, it is considered a Schedule 1 controlled drug, in the same class as marijuana and heroin. Indigenous cultures have been using magic mushrooms, which can be found growing in the natural environment, in shamanic rituals for centuries. These mushrooms were brought to the west and synthesised by Swiss chemist Albert Hofmann in 1958. Hofmann, a chemist working for Sandoz, encountered the substance at a traditional healing ceremony in Mexico.  Hofmann also synthesised lysergic acid diethylamide, or LSD, another psychedelic that’s being researched for mental health therapy. Magic mushrooms are also used recreationally for its hallucinogenic effects and the induction of euphoric feelings, during a “trip” that lasts from six to eight hours. However, many users have also experienced nausea, paranoia and anxiety, stemming from a negative “headspace”, which is why trained therapists administer psilocybin in a calm, non-stimulating environment.

How mental illness is treated with psilocybin

During the treatment session, a controlled dose of psilocybin in a capsule is given to the patient. The patient lies on a comfortable sofa, uses eyeshades to block out any visual distractions, and listens to a playlist designed to elevate the treatment experience.

Source: COMPASS research site treatment room (reconstruction of a dosing session)

The psilocybin brings out painful emotions and experiences that may have been suppressed. The patient processes these traumatic feelings, with a trained therapist standing by to lend emotional support when the journey gets too uncomfortable. Unpacking these feelings are the key to healing past wounds, and allows the patient to address the root cause of their problems. “Patients remain alert and aware, and are able to look at their life events from a different point of view,” says Malievskaia.  “And that allows people to generate their own shift in perspective, which in turn, allows them to generate their own insights and own solutions,” she continues. Patients return the next day to discuss the experience and any insights that may have surfaced, once the effects of the psilocybin have worn off. “So it’s a combination of a drug and therapy, which is a unique paradigm,” she says.

A revolutionary drug in the making

Through her work in mental health research, Malievskaia has found a higher dose psilocybin to be effective for treatment-resistant depression. In a recently-concluded clinical trial phase, 233 patients with treatment-resistant depression were randomly given low, medium and high doses. She found that patients who were given 25 mg of psilocybin, considered a high dose, experienced significant immediate relief of symptoms, which they maintained for up to three months.  “The absence of symptoms of depression is the gold standard – the holy grail of therapeutic intervention of treatment-resistant depression,” she says. Compass Pathways is also studying the effects of psilocybin on other mental disorders, such as anorexia nervosa, drug and alcohol addiction and post-traumatic stress disorder.

A possible solution to the mental health crisis

Burtenshaw says psilocybin treatment is potentially game-changing. Mental health disorders are some of the most common illnesses, but they are particularly difficult to treat.  The World Health Organization has found that 20 percent of the world’s children and adolescents suffer from a mental health condition, with suicide the leading cause of death among 15 to 29 year-olds. She notes that mainstream drug development has stagnated, and there are no major antidepressants in the pipeline.

“Globally, 17 percent of the population take antidepressants as the cheapest treatment, but less than two thirds of people respond to that type of treatment,” says Burtenshaw.

“Psilocybin treatment may result in fewer “talking therapy”, or psychotherapy sessions, easing the burden on mental healthcare systems and making treatment more accessible”, she adds. Talking therapy is where a trained counsellor or therapist helps a patient work through difficult emotions, by listening to their thoughts, feelings and perceptions. “If you can pair the psilocybin with psychotherapy and get people to feel better with fewer sessions, it means we can treat so many more people with fewer resources,” she says.

How psilocybin can treat other ailments

Neo Kuma has invested in medical research into the use of psilocybin in other therapies. Bright Minds, one of Neo Kuma’s investee companies, is exploring psilocybin as a serotonin agonist to treat epilepsy. Awakn Life Sciences Corp, another one of Neo Kuma’s investee firms, researches psychedelics to treat drug and alcohol addiction. In addition to the above, Neo Kuma is exploring psilocybin’s use in the treatment of cluster headaches, as well as low-dose psilocybin for anti-inflammatory purposes.

Challenges in regulation and approval

The biggest obstacle psilocybin faces is regulatory acceptance. The mass production and sales of the substance is highly illegal, although growing magic mushrooms for personal use remains a legal grey area. With time and further investigation, Malievskaia is hopeful that psilocybin will be accepted into mainstream use. For instance, Compass Pathways has recently collaborated with King’s College London and the National Health Service, the United Kingdom’s publicly-funded healthcare system. The partnership is a step towards psilocybin’s further research and potential decriminalisation. Another obstacle is the lack of mental health professionals who are trained to use psilocybin properly. Malievskaia notes that more mainstream therapists will undergo training, but they do need to adhere to a patient care framework, in order to ensure consistency and safety.

“We need to choose the right therapist who has the patient’s best interests at heart, and who is not in the business of unleashing psychedelics on an unsuspecting population,” she says.

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