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\title{Long-COVID Symptoms Improved after MDMA and Psilocybin Therapy: a case
report}



\author[1]{Harman Chopra}%
\author[2]{Timothy Furnish}%
\author[3]{Monica Verduzco-Gutierrez}%
\author[4]{David Jevotovsky}%
\author[2]{Joel Castellanos}%
\affil[1]{Johns Hopkins School of Medicine}%
\affil[2]{University of California San Diego Health System}%
\affil[3]{UT Health San Antonio}%
\affil[4]{NYU Grossman School of Medicine}%


\vspace{-1em}



  
  \date{June 18, 2024}


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\textbf{Introduction}

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory
illness caused by the severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2). The virus was first identified in Wuhan, China in December
2019 and has since spread globally, leading to a worldwide pandemic. The
majority of individuals who contract COVID-19 experience mild to
moderate symptoms and recover within a few weeks. However, a significant
proportion of individuals continue to experience symptoms long after the
acute phase of the illness has resolved, a condition known as Long-COVID
or post-acute sequelae of SARS-CoV-2 infection
(PASC).\textsuperscript{1} Long-COVID symptoms can be diverse and can
range from mild to severe, and can include fatigue, depression, anxiety,
joint pain, headaches, and cognitive impairment.

There are currently no effective or broad treatment options for Long
COVID, but some symptom-related management has been trialed. Traditional
treatment options, including rehabilitation, physical therapy, and
medications, may not be fully effective for all
individuals.\textsuperscript{2} The pathophysiology of Long-COVID is
still being elucidated and there is a need for alternative treatment
options. A recent review has suggested that psilocybin and
3,4-Methylenedioxymethamphetamine (MDMA) may be an effective treatment
option for the mental health challenges associated with
COVID.\textsuperscript{3} Psychedelics have been traditionally used in
spiritual and religious practices, but in recent years, there has been a
resurgence of research on the therapeutic potential of
psychedelics.\textsuperscript{4} Psychedelics have shown promise in the
treatment of various medical conditions such as depression, anxiety,
PTSD, and addiction.\textsuperscript{4} This case report describes the
experience of a 44-year-old female who developed Long-COVID symptoms
after contracting COVID-19 and her experience managing her symptoms and
using psychedelics as a treatment. To our knowledge, this is the first
case report describing the potential efficacy of psychedelics for
Long-COVID symptoms.

\textbf{Results}

A 44-year-old female, who was previously healthy, developed Long-COVID
symptoms after contracting COVID-19 in February 2022. The patient had a
history of migraines, which occurred 2-4 times per month since
adolescence. She had received three vaccinations (Pfizer for the first
two and Moderna for the third) but still contracted the virus. The
patient's symptoms at the time of diagnosis of acute COVID-19 included a
sore throat, headache, fever, cough, post-nasal drip, fatigue, body
aches, altered sense of taste (everything tasted extremely salty), and
diminished sense of smell.

After the acute phase of the illness resolved, the patient continued to
experience post-COVID symptoms, including anxiety, depression, insomnia,
joint pain (hips, knees, shoulders, jaw), cognitive issues (brain fog,
poor reading comprehension and endurance, word-finding, and short-term
memory), headaches, and a sharp decrease in libido. The patient also
reported an intense unique headache, which was different from her
migraines. This headache was a global pressure-like feeling that
occurred almost daily for at least two hours without nausea,
photophobia, or phonophobia. These symptoms had persisted for (fill in
the blank but I think 3) months. The patient tried various traditional
treatment options to manage her symptoms, including graded return to
activity and medications. She was taking antihistamines (daily for 3
months) for insomnia during this time. Her headaches improved 60\% with
sumatriptan 85 mg and naproxen sodium 500 mg, but persisted. The patient
also tried non-traditional treatments such as fasting,
meditation/long-slow walks in the forest, chiropractic, acupuncture,
osteopathic treatments, and massage. She found the fasting, meditation,
and long slow walks only mildly helpful, and the improvement persisted
only as long as the activity occurred. The patient was referred to a
Long-COVID clinic, but due to long waitlists (Late August/Early
September) was never seen. In the meantime, the patient decided to try
psychedelics as a form of treatment under the guidance of a therapist
who recommended a protocol of 3,4-Methylenedioxymethamphetamine (MDMA)
and golden teacher psilocybin cubensis dried mushrooms.

The patient's first dosing session was on May 5, 2022, where she
consumed 1 gram of dried whole golden teacher psilocybin cubensis
mushrooms from an online store. The patient reported an improvement in
her depression, fatigue, and joint pains. However, she also reported
chills and shivering with a sensation of being cold while ''coming up.''
The patient's second dosing session was 24 days later on May 29th where
she consumed a single dose of MDMA 125 mg, 1 hour later 2 grams of whole
dried golden teacher psilocybin cubensis mushrooms prepared in a tea,
and 1 hour later a second dose of 2 grams of whole dried golden teacher
psilocybin cubensis mushrooms prepared in a tea. The substances were
said to be verified by getyourdrugstested.com.

The patient reported a slower build-up without shivering and reported
feeling very detached from Long-COVID symptoms. The patient's experience
while under the influence of MDMA and psilocybin was reported as
feelings of being in a childlike state, having an intense connection to
nature, and of being in an alternate reality. After this second dosing
session, the patient reported significant improvement in her post-COVID
symptoms including fatigue, depression, anxiety, joint pain, and
headaches. The patient was able to return to work and her cognitive
function improved, allowing her to resume her PhD studies. The patient's
insomnia also improved, and she was able to stop taking antihistamines.
The patient's unique headache, which was different from her migraines,
decreased in severity and frequency. Overall, her symptom improvement
was approximately 80\%.

After several months of improvement, the patient reported experiencing a
relapse of her post-COVID symptoms associated with a non-COVID flu-like
illness including fatigue, depression, and anxiety. Additionally, her
unique headache returned, although it was less severe and not as
frequent as before. The patient decided to try another dosing session
with psychedelics, this time, 2 g of dried golden teacher psilocybin
cubensis mushrooms which led to a significant improvement in her
symptoms. The patient reported an improvement of about 90\% \textbf{i} n
her overall well-being, compared to her initial presentation. The
patient was again able to return to work and continue with her PhD
studies.

\textbf{Discussion}

Long-COVID, also known as PASC, is a condition where individuals
continue to experience symptoms of COVID-19 long after the acute phase
of the illness has resolved. The symptoms of Long-COVID can be diverse
and can range from mild to severe, making it challenging to manage and
treat. Traditional treatment options for Long-COVID include
rehabilitation, physical therapy, and medications for specific symptoms
such as pain and fatigue.\textsuperscript{5} However, these treatment
options may not be effective for all individuals, and there is a need
for alternative treatment options.

A recent review has suggested that psychedelics could be an effective
treatment option for the mental health sequelae of
COVID-19.\textsuperscript{3} Psychedelics have been traditionally used
in spiritual and religious practices, but in recent years, there has
been a resurgence of research on the therapeutic potential of
psychedelics. Psychedelics have shown promise in the treatment of
various medical conditions such as depression, anxiety, PTSD, and
addiction.

The mechanisms by which psychedelics could improve Long-COVID symptoms
are not understood. The pathophysiology of Long-COVID symptoms include
chronic neuroinflammation and neurologic
dysfunction.\textsuperscript{6}Psychedelics are known to modulate the
activity of neurotransmitters such as serotonin and dopamine, leading to
changes in brain connectivity and potentially increasing neural
plasticity. Psychedelics activate areas of the brain that are involved
in self-referential processing, emotional regulation, and alter
connectivity within and between intrinsic brain networks such as the
default mode network (DMN).\textsuperscript{7} It has been hypothesized
that the ability of psychedelics to alter DMN connectivity infers
benefit in chronic neuropathic conditions by improving efficiency of
these networks.\textsuperscript{7} There is research showing alterations
in default mode network connectivity in patients with Long-COVID
symptoms.\textsuperscript{8} Other research has pointed to the effects
of psychedelics on gene expression as a means of influencing synaptic
plasticity and neural inflammation as well as decreasing acute phase
reactants, which could underlie the sustained benefits seen in studies
of depression and other chronic neuropathic
conditions.\textsuperscript{9}

\textbf{Conclusion}

Long-COVID is a complex condition that can be challenging to manage and
treat. Traditional treatment options may not be effective for all
individuals, and there is a need for alternative treatment options. We
report a case of a patient using psychedelics and seeing dramatic
improvement in her Long-COVID symptoms. Further research is needed to
determine if psychedelics are safe and effective for Long-COVID and to
understand the potential mechanisms of action.

\textbf{Acknowledgements}

None

\textbf{Authorship Contribution Statement}

Harman Chopra: formal analysis, writing, investigation, resources. Tim
Furnish: supervision, writing -- review \& editing. Monica
Verduzco-Gutierrez: supervision, writing -- review \& editing. David S.
Jevotovsky: writing, visualization. Joel Castellanos: resources,
conceptualization, supervision, writing -- review \& editing.

\textbf{Author Disclosure}

Nothing to disclose.

\textbf{Funding}

This research did not receive any specific grant from funding agencies
in the public, commercial, or not-for-profit sectors.

\textbf{References}

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