127. Psilocybin for Anorexia: Inside UCSF's Trial

Dr. Amanda Downey on UCSF's psilocybin trial for anorexia, why caregivers enroll, and what the medicine can and can't reach in eating disorders.

Episode Summary

Eating disorders are the deadliest psychiatric illness we have. Someone in the United States dies of one every 52 seconds, and two of every three people who get conventional treatment never fully recover. Anorexia nervosa has had no new FDA-approved treatment since the 1990s. That is the ground this conversation stands on, and it is why I sat down with Dr. Amanda Downey at Town Hall Seattle. Dr. Downey is a pediatrician and psychiatrist at UCSF and a lead investigator on an active Phase 2 trial studying psilocybin for anorexia in young adults. We talk about why her trial enrolls caregivers as participants, what psilocybin might reach that decades of treatment have not, and where the science is still honestly uncertain. This one is close to me. I recovered from anorexia myself, and I know how little the map has changed.

🔵 Key Takeaways

Psilocybin is being studied as the first potential breakthrough for anorexia in a generation, but every honest researcher in the room is holding equipoise, not hype. The molecule is one component of a system, not a cure.

The trial's design is unusually intensive because the population is unusually vulnerable. Two high-dose sessions, three preparation sessions before each, real-time heart monitoring, and blood draws throughout. Between 8 and 20 weeks of contact per participant.

Families are part of the treatment. Young people rarely get better if they return to the same system in which the illness grew, so caregivers enroll and prepare too.

Improving cognitive flexibility does not guarantee behavior change. People report expanded thinking and a better quality of life. Whether that translates to weight restoration is the open question this trial is built to answer.

Access without support is the real risk. Psilocybin floods the body with sensation, and people with anorexia are often profoundly disconnected from the body. Unsupported, that experience can compound harm rather than heal it.

🔵 Timestamps

[00:00] Why eating disorders are the deadliest psychiatric illness, and the numbers that frame the night

[01:00] Meeting Dr. Amanda Downey and how she came to eating disorder and psychedelic work

[03:00] The patient who inspired the study, and the moment the idea was first spoken aloud

[04:30] Funding a trial the government will not pay for, almost entirely through patients and families

[05:30] Trial design, and why caregivers enroll as participants

[07:30] The scale of the scaffolding: 20 to 25 milligram doses and weeks of contact

[08:00] Safety at the core, hypoglycemia, and real-time cardiac monitoring

[09:00] The working hypothesis, cognitive flexibility, and the default mode network

[11:00] Ketamine versus psilocybin, and why durability may be the difference

[25:30] Audience question on integration, plasticity, and extralegal use

[26:30] Harm reduction for parents, and where to find a legal path

[27:00] Could this help ARFID and other eating disorders?

[28:30] Adverse reactions and the terror of five hours of amplified embodiment

[31:00] Cognitive flexibility that did not translate to behavior change

[34:00] San Francisco decriminalization and the trial timeline

[38:00] Why eating disorders get so little funding, and who the illness actually affects

[43:00] Supporting the family system, and chatter about 5-MeO-DMT

[46:30] Closing reflection: what psilocybin opens, and what eating disorders require to close

🔵 Guest

Dr. Amanda Downey is a pediatrician and psychiatrist specializing in adolescents and young adults with eating disorders. She is the assistant medical director of the UCSF Eating Disorders Program, a member of UCSF’s Translational Psychedelic Research Program, and a lead investigator on an active Phase 2 trial of psilocybin therapy for young adults with anorexia nervosa, ages 18 to 25.

Learn more about UCSF psilocybin and anorexia trial @ clinicaltrials.ucsf.edu

🔵 Resources

Ask April: How Do I Find a Psychedelic Guide? — column on legal access, licensed facilitators, and the Oregon versus Colorado distinction

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