Precision Functional Brain Mapping in Psilocybin (Psilocybin PFM)

The Washington University

Status and phase: Completed; Early Phase 1

Conditions: Psilocybin

Treatments: Drug: Methylphenidate; Drug: Psilocybin

Study type: Interventional

Funder types: Other

Identifiers

NCT04501653

GF0010787 (Other Identifier)

202002165

Details and patient eligibility

About

This project will employ functional brain imaging to study the mechanism and immediate and long-term effects of psilocybin, a serotonin receptor 2A agonist, on cortical and cortico-subcortical brain networks in healthy adults.

Full description

Psilocybin shows promise as a safe, transformational therapeutic across several psychiatric conditions. However, little is know about its mechanism of action. This study aims to establish a neuroimaging paradigm for use in future clinical research testing the effectiveness of psilocybin in various clinical applications.

In this study, we will assess both acute (during psilocybin exposure) and sustained (one week post-exposure) effects of 5-HT2A receptor agonism on brain circuits using resting state functional connectivity and precision functional mapping (PFM). Using a randomized, controlled crossover study design, a small number of healthy volunteers will receive either psilocybin or methylphenidate (MTP) and will undergo MRI (structural, task, blood flow, extended resting state). After two weeks, participants will return for a second exposure with the alternate of what they received in the first session. This study involves up to five separate imaging sessions.

Functional connectivity will be measured using the following PFM approach:

1. Extended functional magnetic resonance imaging (fMRI) image acquisition
2. Aggressive data cleaning
3. Analysis designed to examine functional brain connectivity at the individual level

This will allow us to map the effects of 5-HT2A receptor agonism on cortical and cortico-subcortical brain networks at the individual level with precision that is unparalleled in the current literature. This is the first step in developing a precision neuroimaging approach for mechanistic understanding of psilocybin's therapeutic effects.

If successful, this pharmacoimaging paradigm will have potential utility across psychiatric conditions, allowing us to better understand whether and how psilocybin might "bend the curve" in treatment course, preventing persistent suffering, disability, and suicide.

Enrollment: 11 patients

Sex: All

Ages: 18 to 40 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. men and woman between 18 and 40 years of age;
2. Have used a psychedelic substance within the previous 5 years but not within the last 6 months
3. No active psychiatric conditions requiring treatment with psychotropic medications (may be included if psychiatric condition is stable and participant is willing to discontinue medication for 1 month prior to participation with permission from their treating provider);
4. Able to provide informed consent.

Exclusion criteria

1. Presence of medical conditions that may confound results of imaging study or that are contraindications to psilocybin exposure (e.g. neurological, renal, hypertension, metabolic or cardiovascular disease or pregnancy);
2. No prior exposure to classic psychedelics (psilocybin, LSD, ayahuasca, mescaline);
3. Presence of psychiatric conditions that may confound interpretation of results or that are contraindications to psilocybin exposure (e.g. major mood disorder, current substance use disorder, personal or immediate family history (parents, siblings) of any schizophrenia spectrum disorders);
4. Use of psychotropic medication during the study;
5. Presence of contraindications to MRI scanning (implantable devices, bone hardware, IUD).
6. Prior adverse reactions to psychedelics, based on the Challenging Experiences Questionnaire administered during initial screening

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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11 participants in 2 patient groups

Psilocybin first

Experimental group

Description:

Participants will receive 25 mg of psilocybin at the first of two neuroimaging sessions, taken orally in capsule form. Participants in this arm will receive the control drug (methylphenidate) at their second drug exposure neuroimaging session.

Treatment:

Drug: Psilocybin

Drug: Methylphenidate

Methylphenidate first

Active Comparator group

Description:

Participants in this group will be randomized to receive 40 mg of methylphenidate at the first of two neuroimaging sessions, taken orally in capsule form. Participants in this arm will receive the active comparator (psilocybin) at their second drug exposure neuroimaging session.

Treatment:

Drug: Psilocybin

Drug: Methylphenidate