Can psychedelics improve sexual functioning and satisfaction?

New York, April 15 (Online): In a recent study published in the journal Scientific Reports, researchers explored the influence of psychedelics on sexual functioning using a large, naturalistic study and a controlled clinical trial that compared the impacts of psilocybin and selective serotonin reuptake inhibitors (SSRI) on various facets of sexual functioning in patients with major depressive disorders.

Research on psychedelic substances has followed a relatively unsteady trajectory, with various clinical studies through the 1950s and up to the 1970s examining the use of lysergic acid diethylamide (LSD) for treating alcohol dependence and mood disorders.
Psychedelics also played a major role in the social movements of the 1960s, such as the anti-war protests and hippy culture. The 1971 Act on Controlled Substances passed by the United Nations, however, brought most of the scientific research on psychedelics to a halt.

Recent studies indicate a revival of research interest in the use of psychedelics as therapeutic avenues for mental health disorders. Studies have examined the effectiveness of psilocybin therapy in alleviating symptoms of depression and anxiety.
Psilocybin also showed comparable efficacy to the SSRI escitalopram in lowering symptoms of depression, with significantly better performance in secondary outcomes such as anhedonia, general functioning, and well-being.

Given that sexual dysfunction is a common symptom in patients with major depressive disorder, and it is also the side effect of most SSRIs, it is essential to explore the impact of psychedelics on sexual function.
About the study
In the present study, the researchers examined the use of psychedelics in naturalistic settings and ceremonies to understand its effect on various aspects of sexual functioning.
The association was further investigated in a six-week-long clinical trial comparing psilocybin with escitalopram. Sexual functioning was explored along the domains of sexual satisfaction, pleasure, arousal, body image, importance of sex, and sexual desires.

The researchers also aimed to understand whether psychedelics influenced sexual openness and desires for sexual exploration using a set of self-constructed questions. Additionally, the study evaluated the differences in this association among male and female patients.
Although not a core symptom, sexual dysfunction is very common in individuals with major depressive disorders, with the most frequently reported symptoms being difficulty getting aroused, lower libido, and a delay in or absence of orgasms in patients of both sexes.
Furthermore, sexual dysfunction is also known to be a common side effect of SSRIs such as fluoxetine, citalopram, and escitalopram.
Impairments in sexual function due to SSRIs are thought to be due to the downstream impact of SSRIs on dopaminergic and serotoninergic. Sexual dysfunction can also significantly lower self-esteem and impact the quality of relationships and life.
Sexual satisfaction has also been linked to lower depression rates among individuals of both sexes.

For the first part of the study, the researchers gathered data from individuals who attended a ceremony that involved the consumption of psychedelics such as magic mushrooms, psilocybin, ayahuasca, LSD, N, N-Dimethyltryptamine, etc.
The second part of the study involved data obtained from a double-blinded, controlled, phase II clinical trial that compared the effectiveness of psilocybin therapy against that of escitalopram therapy against major depressive disorder.
Results
The results from the naturalistic study showed that the use of psychedelics brought about improvements in various domains of sexual satisfaction and functioning, including body image, partner satisfaction, and improvements in communication and pleasure during sex.
The clinical trial included in the study also supported these findings and reported that the post-acute effects of psilocybin therapy with respect to sexual functioning were positive, while those of escitalopram therapy were not.

The findings suggested that while both psilocybin and escitalopram therapy resulted in comparable reductions in the symptoms of depression, escitalopram had a significant negative impact on sexual functioning.
However, the researchers also stated that these results on the negative impact of escitalopram must not be generalized to all SSRIs since various SSRIs have been developed that do not cause sexual dysfunction to the same extent as escitalopram.
The difference in the impacts of escitalopram and psilocybin on sexual functioning could be linked to the different mechanisms by which they alleviate depression.

SSRIs inhibit serotonin re-intake, increasing serotonin concentrations and promoting serotonin activity in the post-synaptic phase.
This impacts the downstream serotoninergic and dopaminergic functioning, subsequently impacting acetylcholine, testosterone, and nitric oxide levels that affect libido.

Conclusions
Overall, the results showed that the use of psilocybin in treating major depressive disorder might have a positive impact on sexual functioning.
While this association needs to be explored further through validated measures, the findings do support the fact that psychedelics not only reduce the symptoms of major depressive disorder but could also be potentially important treatment options for other disorders that have reduced sexual functioning.