Psilocybin in pharmacotherapy of obsessive-compulsive disorder

Abstract

Obsessive-compulsive disorder (OCD) is a chronic mental disease that affects approximately 2% of the population. Obsessions and compulsions are troublesome for patients and may disturb their everyday activities. The pathogenesis of this disease is still not fully elucidated, but dysfunctions of serotonin-, dopamine- and glutamate-mediated neurotransmission together with early maladaptive schemas seem of importance. Pharmacological treatment includes drugs affecting the serotoninergic, dopaminergic, and glutamatergic systems, such as selective serotonin reuptake inhibitors (SSRIs). Providing that up to 40% of patients with OCD are resistant to the currently available medications, there is a need for novel and effective therapies. Recent discoveries suggest that psilocybin, a non-physically addictive psychoactive substance, may ameliorate disease symptoms. When used in appropriate doses and under strict clinical control, psilocybin appears as a valuable treatment for OCD. This narrative article provides a thorough overview of OCD's etiology, current treatment options, and the emerging evidence supporting psilocybin's efficacy in managing OCD symptoms.

Keywords: Obsessive-compulsive disorder; Psilocin; Psilocybin; Serotonin.

Fig. 1

Early maladaptive schemas divided into 5 domains according to Young’s schema theory [39]

Fig. 2

Neurobiological and molecular mechanisms of OCD pathogenesis focusing on serotoninergic disruptions. Amyg– amygdala, CSTC– cortico-striato-thalamic circuit, FC– frontal cortex, HIPP– hippocampus, HT– hypothalamus, IC– insular cortex, LS– limbic system, MTG– middle temporal gyrus, NAc– nucleus accumbens, OCD– obsessive-compulsive disorder, OFC– orbitofrontal cortex, PAC– paracingulate gyrus, PU– putamen, RN– raphe nuclei, STR– Striatum, THA– thalamus. Created with BioRender.com