In the mid-20th century, psychedelic substances such as LSD garnered attention in clinical circles for their potential to treat mood disorders and alcohol dependence. However, their association with the countercultural movements of the time, notably the hippie subculture, led to their abrupt cessation in scientific exploration following the enactment of the 1971 United Nations Controlled Substances Act. Yet, recent years have seen a resurgence of interest in psychedelic therapy, with numerous studies highlighting its promise as a mental health intervention. When administered alongside therapeutic support, psychedelics are believed to catalyze therapeutic experiences, including emotional catharsis and profound psychological insights. Among these substances, psilocybin therapy has emerged as particularly promising in addressing anxiety and depressive symptoms. Notably, it has demonstrated efficacy comparable to, if not superior to, traditional SSRIs like escitalopram in alleviating depressive symptoms and enhancing overall well-being.
Major depressive disorder (MDD) stands as a leading cause of disability globally, marked by periods of profound low mood, motivation, and pleasure. While not a core symptom of MDD, sexual dysfunction (SD) frequently accompanies the disorder, impacting libido, arousal, and orgasm in both men and women. Moreover, SD often arises as a side effect of SSRIs, commonly prescribed for MDD, potentially complicating treatment adherence and exacerbating depressive symptoms. Furthermore, SD has been linked to diminished well-being, influencing quality of life, self-esteem, and relationship satisfaction. Given the significant role of sexual satisfaction in psychological well-being and overall life satisfaction, its importance spans both healthy individuals and those grappling with depression.
While qualitative evidence hints at the potential positive impact of psychedelic use on sexual feelings and behaviors, quantitative studies in this realm remain scarce. Prior research suggests that psychedelics can foster mindfulness, empathy, openness to new experiences, and positive attitudes towards the body and lifestyle, all of which could influence sexual experiences and attitudes. To address this gap, two studies were undertaken aimed at investigating the effects of psychedelic use on various aspects of sexual functioning and satisfaction.
The first study gathered data from individuals consuming psychedelics in naturalistic settings, such as attending psychedelic ceremonies, to assess their impact on sexual functioning and satisfaction. Concurrently, the scientists examined the same research question in a trial comparing psilocybin therapy with a 6-week course of the SSRI escitalopram in MDD patients. Sexual functioning was evaluated across multiple domains, encompassing experienced pleasure, satisfaction, arousal, communication of desires, importance of sex, and body image. Additionally, the study explored shifts in perceptions of sexual intercourse beyond functioning, such as heightened interest in sexual exploration and spirituality. The aim was to furnish valuable clinical insights into the side effects of psychedelic therapy vis-à-vis traditional treatments and to deepen our understanding of psychedelics’ potential benefits for sexual well-being.
Results:
Participants
Study 1:
The analysis incorporated 261 participants from combined survey samples who completed baseline, 4-week, and 6-month assessments. Out of an initial pool of 1463 participants, 718 completed the key 4-week endpoint, with 322 completing the 6-month follow-up. Accounting for those who completed follow-up but not baseline or the key endpoint, the scientists analyzed data from 261 participants, 43% of whom were female and 55.6% male. The majority hailed from the United States (43.8%), held full-time employment (63.4%), and identified as White (90.7%).
Study 2:
Employing an intention-to-treat analysis, consistent with the primary publication of this clinical trial, the study encompassed 30 patients in the psilocybin group and 29 in the escitalopram group, constituting the entire sample of 59 patients. Among the enrolled patients, 39% were on psychiatric medication, which they ceased at least two weeks before the trial, while 7% had to discontinue psychotherapy as per predefined criteria. In the escitalopram group, four participants discontinued medication due to adverse effects, while in the psilocybin group, one participant regularly used cannabis during the trial, and three missed the second dosing day due to COVID-19 lockdown restrictions. The average age was 41 years, with 34% female participants and 85% identifying as White. All patients provided written informed consent. Sixteen patients reported no partner at baseline or follow-up, thus were excluded from the analysis of questions related to pleasure, communication, and satisfaction. Nonetheless, all 59 patients were evaluated for remaining items and retrospective changes in sexual functioning.
Changes in Sexual Functioning and Perceptions
Study 1:
Friedman rank tests unveiled statistically significant differences across time in the survey samples for all variables except “importance of sex.” The most notable changes were observed in perceptions of sex as a spiritual or sacred experience, satisfaction with appearance and partner, and experience of pleasure. Pairwise Wilcoxon signed-rank tests indicated that scores at both 4 weeks and 6 months surpassed baseline levels for each item, except for importance.
Correlations with Changes in Well-being (Study 1):
Significant Bonferroni-corrected Spearman rank correlations were identified between items of the BISF-W and the Flourishing Scale. Particularly, sexual communication with partners, satisfaction with appearance, openness to new sexual experiences, and viewing sex as spiritual correlated positively with overall well-being.
Study 2:
Subjects in the psilocybin condition exhibited greater positive changes across all items except perceived importance of sex, as indicated by positive beta estimates. Post-hoc analyses revealed significant enhancements in partner satisfaction, communication, and viewing sex as spiritual specifically in the psilocybin group. Additionally, both psilocybin and escitalopram conditions demonstrated improvements in appearance satisfaction, with a trend towards heightened importance of sexuality in the escitalopram group. Psilocybin treatment also engendered increased pleasure during sexual activity. Patients receiving psilocybin reported elevated levels of interest, arousal, activity, and satisfaction compared to those receiving escitalopram, while experiencing reduced sexual anxiety.
Concerning sexual dysfunction, patients in the escitalopram group were more prone to severe symptoms compared to those in the psilocybin group. Correlation analyses indicated that changes in depressive symptoms strongly correlated with improvements in sexual arousal and interest, albeit not necessarily with sexual satisfaction, activity, or anxiety.
The research endeavors to delve into the effects of psychedelic use on sexual functioning and satisfaction through two distinct studies involving varied populations. While one study focused on individuals using psychedelics for recreational and well-being purposes, the other involved patients grappling with depression. The former adopted a naturalistic observational survey method, while the latter was a controlled clinical trial. Both studies unearthed enhanced sexual functioning and satisfaction following psychedelic use.
Participants in the recreational study reported significant improvements in communication with their partners, heightened pleasure during sex, increased satisfaction with their partners and physical appearance, and a greater openness to new experiences in their sex lives post-psychedelic use. These enhancements persisted at both the 4-week and 6-month marks post-experience. Nonetheless, there was no notable alteration in the overall importance attributed to sex. Gender-based analyses indicated no significant differences in these effects except for a return to baseline levels of partner satisfaction among female participants at the 6-month mark. These changes correlated with improvements in well-being post-psychedelic use, corroborating prior research linking sexual functioning and psychological well-being.
Despite inherent limitations in survey studies, such as the absence of control conditions and potential biases, endeavors were made to replicate these findings in controlled settings with a different population. In the controlled trial involving depressed patients, those treated with psilocybin therapy exhibited similar improvements in sexual functioning and satisfaction as noted in the naturalistic study. In contrast, patients treated with the SSRI escitalopram did not experience significant positive changes in sexual domains except for satisfaction with their appearance.
Moreover, patients treated with psilocybin reported heightened sexual interest, activity, arousal, and satisfaction compared to those treated with escitalopram, who exhibited declines in these domains. Additionally, anxiety related to sexual activity diminished for psilocybin-treated patients but escalated for escitalopram-treated patients. Notably, patients treated with escitalopram were more likely to report elevated levels of sexual dysfunction post-treatment compared to those treated with psilocybin.
The observed disparities in sexual functioning between the two treatments could be ascribed to their distinct mechanisms of action. SSRIs like escitalopram are known to induce sexual dysfunction through their effects on serotonin levels in the central nervous system, while psilocybin acts as a serotonin 2A receptor agonist. Despite limited research on the effects of 5-HT2A receptor agonists on sexual activity, anecdotal reports suggest positive effects under psychedelics, contradicting animal studies indicating suppression of sexual activity. Further research is warranted to comprehensively understand these effects.
The noted improvements in sexual functioning following psychedelic use may be elucidated by the drugs’ ability to amplify mindfulness, connectedness, and emotional processing. These effects, coupled with enhancements in attachment styles, might contribute to increased sexual satisfaction. Furthermore, participants reported perceiving sex as a more spiritual or sacred experience after psychedelic use, aligning with prior research indicating amplified spiritual beliefs under psychedelics.
Nonetheless, the study harbors several limitations, including the lack of comprehensive and validated measures, demographic biases, and potential confounding factors. Future research should address these limitations and explore the long-term effects of psychedelics on sexual functioning in more diverse populations. Additionally, clear ethical standards and guidelines are imperative to mitigate potential risks associated with psychedelic use in therapeutic and recreational contexts.
Source: https://www.nature.com/articles/s41598-023-49817-4