Expert: Psilocybin Treatment May Support Patients With Obesity Who Have Tried Everything, Need Further Support

Pharmacy Times interviewed Clive Ward Able, MD, BPharm, president of Clintell, consultant to NeonMind Inc, and a trained pharmacist and physician, on his research into the use of psychedelic compounds to treat obesity and optimize human health.

Ward Able noted that the use of psychedelic medicine to treat obesity has 2 potential mechanisms of approach. The first is by giving a psychedelic compound as part of psychotherapy, such as psilocybin, at a psychedelic dose—this approach is called drug-enhanced psychotherapy. At this dose, it works as an agonist against serotonergic receptors, and, specifically, the 5-HT2A receptors.

“What that does is it gives you the psychedelic event, which seems to be able to help along with psychotherapy,” Ward Able said. “Secondly, it also has effects on the 5-HT2C receptors, which are very much related to satiety or hunger and the control of hunger. So there, we can look at a different formulation where we use a much lower dose, probably 10% to 15% of what would normally be used for a psychedelic dose, but you do that on a daily or 4 times a week dosing.”

This lower dose may potentially lead to an increase in satiety, causing a patient to be less hungry, according to Ward Able. Additionally, it has the potential to give the patient a sense of well-being.

However, to date, there's been no clinical research done on the effects of psychedelic medicine on obesity, but there have been promising in-vitro pre-clinical studies on rats. In these pre-clinical trials, the rats were fed a highly palatable, high calorie diet in which they could eat as much as they liked. They were then treated with 2 different doses of psilocybin—a high dose that would be equivalent to a human psychedelic dose—and a lower dose that would target the 5-HT2C receptors.

“What was found with those is that both the high dose and the low dose led to less weight gain in both of those arms that were treated with the psilocybin,” Ward Able said. “The decrease in the weight gain gives us a very good, strong signal that this actually is working the way we expect it to work. Now we've got to translate this into clinical studies, and that's what we're going to be doing next in our proof of concept study.”

Ward Able explained that before he began working on research in the psychedelic medicine field, he had thought it was a very contained, small group of researchers working in the field.

“But actually, there's a lot of work that's been going on, and we have to tip a hat to a lot of researchers who worked under a really strict regulatory environment, and still managed to continue some of this research, despite it being completely closed down in the 60s and 70s,” Ward Able said. “One of the things that NeonMind Inc. looked at was obesity, because it's a pandemic now, not just an epidemic within the North American region, but a pandemic worldwide.”

The health implications of the global pandemic of obesity are significant, not only for the patient, but for every health care system and the country as a whole, Clive Ward Able explained.

However, he noted that not every patient who is obese is dissatisfied with their weight or finds that it poses a problem in their life. In light of this, a potential psychedelic medicine treatment for obesity would provide an option for patients who are interested in losing weight and keeping it off, something that they have not been effectively able to do in the past.

“The idea is that this has to come from the patient. If the patient wants help for it, this will be able to help them get to a place where they really want to be,” Ward Able said. “But I'm not talking about every single obese patient, because there are a lot of obese patients who are happy the way they are, and they don't necessarily want to lose weight. But there's a large component of those, such as in depressed patients, who have certain triggers that get them to overeat or not to exercise, etc.”

Ward Able noted that the target of obesity treatment is not necessarily to bring every patient under a body mass index of 25. Instead, this treatment can hopefully allow patients to get to a healthier weight and maintain it, with an added sense of wellbeing that they may desire after losing weight.

“This is where I think psychedelics can add to what is being done now,” Ward Able said. “Psychotherapies are being used for the treatment of obesity or weight management, but people tend to fall back into their old behaviors again, although they do work. What I'm calling drug enhanced psychotherapy or psilocybin-assisted psychotherapy adds another facet to that psychotherapy, which should be able to instill much longer lasting positive behaviors, such as an improved diet, whether that's quantity or quality, or within expenditure of energy, such as increasing your amount of exercise.”