Psychedelics and OCD

Despite great strides in research, theory and field work, obsessive-compulsive disorder (or OCD) remains a hard condition to understand. Whether one considers it to be an anxiety-based condition signaling a need for survival, or a distress-based condition shaped by an extreme uneasiness and an inability to return to a state of calm, OCD seems to evade not only a comprehensive definitive, but an agreed-upon treatment. At present, FDA-approved OCD treatments include selective serotonin reuptake inhibitors (SSRI medication) and cognitive behavioral therapy (CBT), in addition to the FDA-cleared transcranial magnetic stimulation (TMS), all of which have been recognized for their safety and efficacy. Yet with popular solutions such as SSRIs achieving a modest remission rate, and many patients with OCD considered treatment-resistant, experts are turning to less conventional options, discovering how the interplay between psychedelics and OCD may yield greater relief for patients.

Psychedelics and OCD

OCD: A Short (Agreed Upon) Definition

Though much about OCD remains disputed, a single, basic axiom has been accepted as its core attribute: OCD, first and foremost, is a mental health disorder that combines obsessive thoughts and compulsive behavior.

Essentially, these two key elements mean that those contending with this condition face a barrage of deeply troubling thoughts, the need to repetitively act out certain behaviors in an attempt to quiet these thoughts, or both.

The four most common OCD-related obsessions are:

  • Cleanliness and contamination.
  • Catastrophizing (worrying something terrible will happen to oneself or a loved one).
  • Order and “just right” thinking (the idea that ‘all must be in place,’ otherwise there cannot be calm).
  • Taboo thoughts (usually about a morally reprehensible, socially unacceptable, or blasphemous action).

There are seemingly inexhaustible examples of compulsive behavior, meant to assuage the unpleasant feelings that arise from the patient’s unwanted focus on their OCD-related obsession. OCD-related compulsions can manifest as repetitive handwashing, counting the letters in a given sentence, repeating a certain phrase (either aloud or to oneself), and many others.

An Uphill Battle Toward Symptom Relief

OCD is typically a chronic condition, especially when patients do not seek treatment for it. The American Psychiatric Association (APA) states that without treatment, remission rates stand at 20%, with additional sources finding OCD remission rates to fall somewhere between 10%-20%.

When treated with serotonin reuptake inhibitor medication (SRIs), remission rates have been shown to be somewhat higher, at 38%. This statistic, though, remains relatively modest, particularly when coupled with the finding that one third of patients with OCD are considered to be treatment-resistant, a status that mainly means they do not benefit from conventional OCD medication, or find its side effects to be too adverse to continue.

All this is to say that many patients with OCD do not receive enough symptom relief from the more established therapeutic routes. As a result, scientists are looking into psychedelic medications as a less-explored avenue that holds a great deal of potential. 

The Benefits and Considerations of Psychedelics for OCD

When it comes to OCD, a key advantage that psychedelic treatment offers is letting go. On a theoretical level, since OCD seems to revolve around the inability to relinquish control over one’s mind in the face of adverse thought content, it makes sense to circumvent the mental structures placed in one’s mind, via defense mechanisms and automatic thinking, with a drug that reaches deep within one’s unconscious.

That said, psychedelic mental health research—and particularly psychedelic OCD research—is still in its infancy, and much more needs to be verified before it can be considered a broad alternative to current, first-line OCD treatments, such as SSRIs and CBT. All psychedelic drug treatment options should be carried out in a safe environment and administered by a licensed mental health professional with experience in this form of therapy.

The Benefits and Considerations of Psychedelics for OCD

Psilocybin as a Psychedelic Treatment for OCD

Out of the different psychedelic treatments currently being explored for their mental health benefits, a substance called psilocybin is particularly looked at for its potential to alleviate symptoms of OCD.

Also referred to as “magic mushrooms”, psilocybin is found in different types of mushrooms. Psilocybin is thought to affect the brain’s serotonergic pathways, binding with serotonin receptors, thereby preventing its reuptake and prolonging its activation. As serotonin has already been implicated as a central factor in the appearance of OCD symptoms, psilocybin is believed to work through its effect on this particular neurotransmitter.

As a psychedelic substance, larger doses of psilocybin can cause hallucinations. It can also bring about a feeling of euphoria, and spiritual or introspective experiences.

Combining psilocybin with psychotherapy can help the patients better understand the psychedelic imagery and content that arises as a result of the drug and decipher what troubling and even traumatic experiences continue to plague them—perhaps in the form of unrelenting OCD thoughts and obsessions.

Studies have cited that psilocybin can cause immediate improvement in OCD severity, as opposed to the weeks that usually take for SSRI medication to take effect. The psychedelic has particularly been shown to alleviate OCD symptoms of doubt and rumination. Such results can, for example, allow patients with OCD to go about their day without an unending concern over whether they did, in fact, lock their front door, or over the chance of catching an infection from using a public toilet.

Psilocybin has also been found to be safe and well-tolerated, somewhat in contradiction to its more concerning reputation as a psychedelic. That said, it can cause certain concerning side effects. These include panic, paranoia, drowsiness, anxiety, and psychosis—also known as a “bad trip.” Due to these and other possible side effects, patients with a history of bipolar disorder, mania, or psychosis are discouraged from treating their OCD with psilocybin.