Psilocybin in neuropsychiatry: a review of its pharmacology, safety, and efficacy
CNS Spectrums – July 11, 2022
Source: OpenAlex
Summary
Psilocybin, a potent hallucinogen and tryptamine alkaloid, shows significant promise in neuropsychiatry, psychology, and medicine. Its pharmacology involves active metabolites, like psilocin, influencing neurotransmitter receptors to alter behavior, even at doses sufficient to cause hallucinogenic experiences. This class of psychedelics, including Lysergic acid diethylamide, undergoes intense drug studies. Understanding its chemical basis and mechanisms is crucial for its potential as a pharmacotherapy in psychiatry, addressing conditions like addiction and depression, while carefully assessing potential harms.
Abstract
Abstract Psilocybin is a tryptamine alkaloid found in some mushrooms, especially those of the genus Psilocybe. Psilocybin has four metabolites including the pharmacologically active primary metabolite psilocin, which readily enters the systemic circulation. The psychoactive effects of psilocin are believed to arise due to the partial agonist effects at the 5HT2A receptor. Psilocin also binds to various other receptor subtypes although the actions of psilocin at other receptors are not fully explored. Psilocybin administered at doses sufficient to cause hallucinogenic experiences has been trialed for addictive disorders, anxiety and depression. This review investigates studies of psilocybin and psilocin and assesses the potential for use of psilocybin and a treatment agent in neuropsychiatry. The potential for harm is also assessed, which may limit the use of psilocybin as a pharmacotherapy. Careful evaluation of the number needed to harm vs the number needed to treat will ultimately justify the potential clinical use of psilocybin. This field needs a responsible pathway forward.