Psychedelics for IBS: Inside the First Clinical Trial with D

So continuing this reasoning, so why psilocybin might help physical symptoms? So this is something that acts, as we know, predominantly on the brain, even though There are these serotonin receptor subtypes that are in the gut as well.

But I think from what I understand at the moment, the main effect is not on the gut directly, but on the brain.

So how could an experience that's produced primarily in the brain reduce abdominal pain, alter bowel habits, or visceral hypersensitivity?

Yeah, I think we actually don't know as much as we think we do about where psilocybin acts primarily because I don't think it's really been studied robustly.

But as you mentioned, serotonin receptors are found in the brain as well as kind of throughout the body, including the gut.

And serotonin, you know, the main effect that is attributed to its psychedelic effects are its kind of changes of subjective behavior.

processing and sensation and things like that are the 5H2TA, sorry, 5HT2A receptors.

But actually psilocybin or psilocin, probably to say more accurately, which is the kind of active drug that it's converted to, it's relatively nonspecific across a wide variety of serotonergic receptors, including ones that are found distributed throughout the enteric nervous system, throughout immune cells, throughout microbiome kind of active cells.

And so I don't think we really can say that it's fully just in the brain.

I think probably lay people actually who have taken psilocybin would say it's definitely not just in the brain, right? Because people report a lot of body high when there's like the come up, especially when people take these drugs initially.

That's, you know, a lot of kind of sensations in the body.

People can have GI impact, right, when they first take psychedelics and, you know, and kind of the traditional and indigenous ways that these drugs are used, actually those GI quote unquote side effects are incorporated into the therapy, right? So I'm thinking of things like purging with ayahuasca, which is a big part of the experience is almost used as like a therapeutic effect or a way of like purging the body or purging the experience that the patient is trying to process.

So- All that to say that I don't think it is just active in the brain, but even if we say that that is primarily where it's acting, I think there's a variety of ways that it could be helpful for patients with IBS.

So maybe just I'll give a little bit of background about our study.

So to kind of contextualize it, our study is like many other studies of psilocybin, which is to say that it's I would say in large part, actually a therapy intervention where there are multiple sessions of preparatory therapy.

Each patient was paired with a dyad of two therapists, two psychotherapists that maintained throughout the study that same dyad.

So that pair of people Met with the patient for about three hours or four hours, split two sessions apart before the first dose.

And then they're with the patient for the entire day that they take the first dose of psilocybin, the medicine day.

They meet with them again after that dosing day, which the dosing day lasts about six to eight hours.

They have a couple of sessions of integrative therapy to kind of make sense of the experience that the patient went through.

another dosing day and more integration.

So there's a lot of sessions there of therapy where there's no drug happening.

And the reason for that is to really help the patient make the most out of the dosing day experience.

And by make the most out of it, I mean kind of psychologically have the best, safest experience where they feel secure and they feel able to explore wherever their mind is taking them and also kind of after the drug wears off to make sense of what happened and how to kind of contextualize it in their life and integrate it in their life.

And I think this can sound a little abstract if a patient doesn't have a psychedelic experience themselves before going into this.