Psilocybin Mushrooms: A Journey from Ancient Traditions to Modern Clinical Use

Psilocybin mushrooms, often referred to as magic mushrooms, have a rich history throughout various ancient cultures, particularly within spiritual and healing practices. This rich history, coupled with emerging clinical research, is paving a new way in mental health treatment. Understanding both the historical and modern contexts of psilocybin use can offer valuable insights for pharmacists and other clinicians.

Chemical formula of psilocybin / cendeced - stock.adobe.com

Ancient Uses of Psilocybin Mushrooms

Mesoamerican Cultures

One of the earliest and most documented uses of psilocybin mushrooms can be traced back to Mesoamerican cultures, such as the Aztecs and the Maya. The Aztecs referred to these mushrooms as "teonanácatl," which translates to "flesh of the gods." They were integral to religious ceremonies and rituals and believed to allow communication with deities and the spirit world. The Spanish conquerors, led by Hernán Cortés, observed these practices in the early 16th century and noted the profound spiritual experiences induced by the mushrooms.¹

Central and South American Indigenous Tribes

Beyond the Aztecs, other indigenous tribes in Central and South America have used psilocybin mushrooms for centuries. The Mazatec people of Oaxaca, Mexico, are particularly noted for their ongoing use of these mushrooms in traditional healing ceremonies. Maria Sabina, a Mazatec curandera (healer), played a significant role in introducing psilocybin mushrooms to the Western world in the 1950s, when her rituals were documented by and shared with R. Gordon Wasson, an amateur mycologist and banker.^2,3

Psilocybin in Modern Clinical Research

The resurgence of interest in psilocybin mushrooms in the 21st century is driven by the growing evidence of their therapeutic potential. Modern research has shown that psilocybin can have profound effects on mental health, offering new hope for conditions that are often resistant to conventional treatments. It’s important to note that the therapeutic potential is found with 1 to 2 doses of psilocybin in conjunction with psychological support.⁴

Depression and Anxiety

Numerous studies have highlighted the potential of psilocybin in treating depression and anxiety, particularly in cases where traditional treatments have failed. A landmark study by Johns Hopkins University found that psilocybin-assisted therapy significantly reduced symptoms of depression and anxiety in patients with life-threatening cancer.⁵ Similarly, a study published in JAMA Psychiatry reported that psilocybin produced substantial and sustained decreases in depression symptoms among participants.⁶

Post-Traumatic Stress Disorder (PTSD)

Although the use of midomafetamine (MDMA) for post-traumatic stress disorder (PTSD) treatment has gained more attention, preliminary research indicates that psilocybin may also be beneficial.⁷ The mechanism involves facilitating emotional processing and reducing the fear response associated with traumatic memories, though more research is needed to establish its efficacy specifically for PTSD.

It should be noted, however, that the FDA issued a complete response letter in response to a new drug application for MDMA-assisted therapy to treat PTSD in adults in early August.⁸ The agency cited insufficient data and requested an additional phase 3 trial to “further study the [drug’s] safety and efficacy.” Lykos Therapeutics, the company behind the application, has committed to addressing the FDA’s concerns and continuing development of the therapy.

Addiction

Emerging research indicates that psilocybin may be effective in treating various forms of addiction. One study conducted by Johns Hopkins University showed that psilocybin-assisted therapy helped individuals quit smoking, with a high rate of success maintained over a long-term follow-up period.⁹ Yet another demonstrated that psilocybin could reduce heavy drinking days in individuals with alcohol use disorder.¹⁰

Connecting Ancient Practices to Modern Clinical Use

The ancient use of psilocybin mushrooms was deeply rooted in ritual and community, aspects that modern clinical settings are beginning to recognize as crucial for effective therapy. The controlled, supportive environments of traditional ceremonies helped participants navigate their psychedelic experiences, facilitating healing and spiritual growth. This understanding is mirrored in contemporary psychedelic-assisted therapies, where set (mindset) and setting (environment) are considered vital to the therapeutic process.

Set and Setting

The concept of "set and setting," popularized by Timothy Leary in the 1960s, highlights the importance of the mental state and physical environment in which psychedelics are consumed.¹¹ Ancient cultures inherently understood this, using ritualistic contexts to create a safe and supportive space for the psychedelic experience in their community settings. Modern clinical trials and therapeutic practices emphasize similar principles, ensuring that patients receive psilocybin in a safe and controlled environment with supportive guidance held by trusted professionals.

Integration

Another parallel between ancient and contemporary psychedelic use is the emphasis on integration. Ancient rituals often included periods of silent reflection and/or discussion post-ceremony, helping individuals integrate their experiences into their daily lives. Modern psychedelic therapy incorporates planned integration sessions, where patients work with therapists to make sense of their experiences and apply insights gained to their personal and psychological challenges.

It’s important to note that in many indigenous settings, there is not a large emphasis on the “integration” phase of psychedelic care. This is because the psychedelic experience is already embedded and integrated into cultural norms, so the philosophy of integration is inherently part of the cultural context.

The Role of Pharmacists and Clinicians

As psilocybin moves towards mainstream acceptance, the role of pharmacists and clinicians becomes increasingly significant. Understanding the historical context and the emerging scientific evidence is crucial for providing safe and effective care, while also respecting the origin of these compounds.

Education and Advocacy

Pharmacists and clinicians are in a unique position to educate patients and the public about the potential benefits and risks of psilocybin. Staying informed about the history, latest research, and regulatory developments in psychedelic care allows health care professionals to advocate for evidence-based treatments and contribute to the growing acceptance of psilocybin services.

In addition to education, embracing the concept of "sacred reciprocity" can enhance advocacy efforts. Sacred reciprocity, a principle found in many indigenous cultures, emphasizes mutual respect and balance in relationships. In the context of psychedelic care, this means honoring the cultural heritage and traditional knowledge associated with psilocybin mushrooms. Clinicians and pharmacists can advocate for ethical practices that respect indigenous contributions and ensure that benefits are shared with these communities.

Conclusion

Psilocybin mushrooms have a profound history that spans ancient spiritual practices to modern therapeutic applications. As research continues to uncover the potential benefits of psilocybin, pharmacists and other clinicians have an essential role in bridging ancient wisdom with contemporary science. By fostering an understanding of both the historical context and the latest clinical evidence, health care professionals can help guide the responsible and effective use of psilocybin in today's regulatory landscape.

READ MORE: Mental and Behavioral Health Resource Center

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References

1. Carod-Artal, F. J. (2015). "Hallucinogenic drugs in pre-Columbian Mesoamerican cultures." Neurología.

2. Wasson, R. G. (1980). "The Wondrous Mushroom: Mycolatry in Mesoamerica." McGraw-Hill.

3. Estrada, A. Maria Sabina, Her Life and Chants. Inner Traditions; 1981.

4. Raison CL, Sanacora G, Woolley J, et al. Single-dose psilocybin treatment for major depressive disorder: A randomized clinical trial. JAMA. 2023;330(9):843–853. doi:10.1001/jama.2023.14530

5. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513

6. Davis AK, Barrett FS, May DG, et al. Effects of psilocybin-assisted therapy on major depressive disorder: A randomized clinical Ttial [published correction appears in JAMA Psychiatry. 2021 Feb 10:569. doi: 10.1001/jamapsychiatry.2020.4714]. JAMA Psychiatry. 2021;78(5):481-489. doi:10.1001/jamapsychiatry.2020.3285

7. Khan AJ, Bradley E, O'Donovan A, Woolley J. Psilocybin for trauma-related disorders. Curr Top Behav Neurosci. 2022;56:319-332. doi:10.1007/7854_2022_366

8. Lykos Therapeutics announces Complete Response Letter for midomafetamine capsules for PTSD. News Release. Lykos Therapeutics. August 9, 2024. Accessed August 27, 2024. https://news.lykospbc.com/2024-08-09-Lykos-Therapeutics-Announces-Complete-Response-Letter-for-Midomafetamine-Capsules-for-PTSD

9. Johnson MW, Garcia-Romeu A, Cosimano MP, Griffiths RR. Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. J Psychopharmacol. 2014;28(11):983-992. doi:10.1177/0269881114548296

10. Bogenschutz MP, Forcehimes AA, Pommy JA, Wilcox CE, Barbosa PC, Strassman RJ. Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. J Psychopharmacol. 2015;29(3):289-299. doi:10.1177/0269881114565144

11. Leary T, et al. The Psychedelic Experience: A Manual Based on the Tibetan Book of the Dead. University Books; 1964.