New treatments for OCD? Evidence for cannabinoids and psychedelics

The etiology of OCD is complex and appears to involve multiple biological pathways. Imbalances in central serotonin, dopamine, and glutamate activities are widely thought to play a causative role. Despite strong evidence supporting first-line OCD pharmacotherapies, approximately 40-60 % of OCD patients remain unresponsive and are considered treatment resistant (TR). Although a range of agents have been examined in TR-OCD, there is no gold-standard, indicating a need to broaden our clinical armamentarium. Cannabis has been used for centuries in many cultures for both medicinal and recreational purposes. Clinical interest in these agents has recently re-emerged. The current evidence for the use of cannabinoids in OCD is very small and includes survey-based, self-report studies with very few controlled trials. Additionally, after a long hiatus from psychiatric research, psychedelics have re-emerged as agents of interest within the past decade. A comprehensive scoping review of the OCD literature including published and grey literature was conducted and detailed in this paper. The current evidence associated with Cannabinoids, Psilocybin, Lysergic acid diethylamide (LSD), N,N-Dimethyltryptamine (N,N-DMT), and Methylenedioxyphenethylamine (MDMA) in the treatment of OCD is detailed. Much of the current evidence examining cannabinoids and psychedelics in OCD is from cross-sectional surveys and case reports, as well as some small clinical trials. There is a shortage of well-controlled, methodologically rigorous RCTs to properly test the efficacy of cannabinoids or psychedelics in OCD and related disorders. However, the current evidence appears to indicate a lack of evidence supporting the use of either synthetic or natural cannabinoids to treat OCD, but a stronger signal for the use of psilocybin in TR-OCD.