The lack of viable treatment options also has a significant financial impact, with a report by STRIPED revealing that eating disorders cost the US economy almost $65 billion each year.
However, there are early indications that psychedelics may offer some hope for people living with the disorder.
Psychedelics for mental health
Psychedelics continue to receive recognition as potential candidates to treat psychiatric conditions, with Australia recently becoming the first country in the world to legalise the use of psychedelics for certain mental health issues.
In addition, last month US senators Cory Booker and Rand Paul introduced an updated version of the Breakthrough Therapies Act, with US Reps Nancy Mace and Madeleine Dean also releasing companion legislation in the House.
If passed, the bipartisan bill would amend the federal Controlled Substances Act (CSA) to enable the Drug Enforcement Administration (DEA) to reclassify from Schedule I to Schedule II drugs and biologics, including therapeutic psychedelics, that receive breakthrough therapy designation or are authorized for expanded access by the US Food and Drug Administration (FDA).
According to the bill’s sponsors, the “legislation would remove regulatory hurdles that inhibit research and compassionate use access to potentially lifesaving treatments that are heavily restricted by Schedule I of the CSA.”
Psych Symposium 2023
At Psych Symposium 2023, Europe’s leading event in psychedelic medicine, Claudia Canavan led a panel discussion called ‘Treating Eating Disorders: Building Patterns & Reducing Prevalence’.
The panel featured Rebecca Park, associate professor and honorary consultant psychiatrist at Oxford University, Yoel Golbert, co-investigator at Sheba Medical Center department for eating disorders, and Rivki Stern, CEO at Shortwave Pharma.
Both Park and Golbert are currently involved in studies looking at psilocybin, a small-molecule hallucinogenic chemical in certain mushrooms, as a potential treatment for anorexia.
At the event, both professionals stressed the importance of having a ‘rigorous’ protocol and screening process – to recruit participants for the trial and ensure their safety throughout.
Working at the Center for Psychedelic Studies, Imperial College London, Park says her role has not been in guiding or psychotherapy, but helping them choose the best patients, assessing them and charting their progress.
“The protocol includes a lot of screening, medical and therapeutic, as well as the involvement of a support person – all of which has to pass for a person to participate,” she says.
Golbert, who is currently working on a phase 2 clinical trial investigating the feasibility of psilocybin and MDMA for anorexia, also acknowledges that this particular patient population requires a ‘tremendous amount of support’.
“Something we thought to be very crucial was to have proper nutritional support for all participants,” he says.
“Obviously all participants also go through medical and psychiatric screenings before getting them into trial. We also offer a weekly session throughout the duration of the trial with a clinical dietician – trying to promote motivation and get them to widen the spectrum of what they eat, which is naturally very miniscule. That is essentially the design – with hopefully positive indications.”
In addition, as anorexia has the highest medical risk of any psychiatric disorder, Park says participants must be sufficiently stable – both physically and mentally.
“Although they may be low weight, they must be at a stable low weight and safe in that place. But we must consider the psychological fragility of somebody who has been ill since they were around 12 or 13 and maybe in and out of treatment,” she says.
“A patient must be robust enough in themselves to withstand what is quite an intense experience and to be helped. Our study is also alongside treatment as usual, which in the NHS is not almost optimal.
“We must consider – does this person have enough in their lives to go back to, if it works. And if it doesn’t work, are they robust enough to withstand the disappointment. The study can raise hopes and if we dash hopes in somebody who is already pretty hopeless, that is really hard.”
Park adds that trust is vital, with many participants having received NHS care that has not been a ‘great experience’ for them.
“It’s incredibly important that the individual trusts the process and trusts the people who are conducting the study. That understanding is crucial,” she says.
The panel also discussed possible mechanisms by which psychedelic-assisted psychotherapy might allow anorexia sufferers to experience some relief and progress.
“There is an aberrant reward element in anorexia - whereby people get initially a kick out of restriction, and they're hoping that mechanism works for them, but then they've got stuck, rather like an addiction. There is a compulsivity element that takes over, which people cannot break through,” Park says.
“What you see neurologically, when you do imaging, is a very stuck system – consistent with their rigid behaviour and thought patterns. The other profound thing, which is particularly unique about anorexia, is there is a desync between what's felt in the body and the head.
“So, the lower weight goes, the more out of sync people become with their bodies, which of course makes it fairly easy to starve to death.”
Therefore, Park’s hope with psilocybin, is that some of these stuck networks would be released and patients are able to feel more in touch with their bodies – in a way which will allow them to start to recover.
Golbert adds that a key aspect of psilocybin is its ability to incite introspection, allowing people to look inwards and understand ‘process signalling’ coming out of the body – something he says is ‘very damaged’ with anorexia patients.
“There are encouraging indications that this drastic change in brain connectivity and brain activity during psilocybin sessions can create this window of neuroplasticity reduction in rigidity, which is something that these patients are very characterized by – that incredibly rigid thinking and rigid cognitive patterns,” he says.
“Psilocybin has powerful anxiety reducing properties and inspired self-compassion and self-connection. It creates a certain window of tolerance in which patients have a better and more robust capacity for processing complex emotions and trauma.”
While there are encouraging indications, Park admits that there is currently an ‘ideal and a reality’ – the reality being that psilocybin is not available after a trial.
“We will do our best to be there for patients – in a remote capacity – but these individuals are under a different clinical team and that rests on the availability of that clinical team,” she says.
For Golbert, if psilocybin can lower in-patient admissions, he believes the psychedelic therapy could be implemented as a kick-start, allowing patients to become more ‘motivated and robust’ to carry on treatment themselves.
“This could have a great economic impact and is hopefully something we might see in the future,” he says.
Moving forward, both panellists acknowledge that these studies are preliminary - focused on initial safety and tolerability.
“It is early days. I think there's a lot of ways that things could go wrong if people are not supported after the therapy. They could have a bad trip or a nasty experience - which would make them retreat right back into eating disorders. So we must be cautious, cautiously optimistic, but cautious,” Park says.
Golbert echoes these concerns, saying that one of the characteristics of anorexia is that it is a very maladaptive coping mechanism.
“There is a risk when you strip people of their coping mechanisms too quickly without offering anything to replace that, then you're definitely in uncharted territory and potentially dangerous waters,” he says.
“There is a risk of relapse or people breaking down. So we must keep in mind when carrying this forward – that a patient having a strong support system afterwards is crucial. Psilocybin has a lot to offer– but there must be a clear framework around this intervention.”
Moving forward, while both trials are in early stages, there is excitement around the potential of this psychedelic treatment.
“My hope would be that there's enough funding for decently organized and designed studies to get really good quality data without rushing through to a miracle cure. My fear is that if things are rushed too quickly there will be adverse results coming out of poorly designed studies. But I think it will be an interesting next few years coming up in the field, Park says.