Current status and future prospects of research on psilocybin's regulation of neurotransmitters and their receptors related to the pathogenesis of tinnitus.

Abstract

Subjective tinnitus is a common auditory disorder characterised by the subjective perception of noise in the absence of external sound sources. Its prevalence has been rising annually due to noise exposure, medication misuse, and population ageing. Current tinnitus treatments employ antidepressants, anticonvulsants, and vasodilators, yet most demonstrate limited efficacy with significant side effects. There is an urgent clinical need for novel therapeutic agents targeting new mechanisms and pathways. In recent years, the natural psychedelic tryptamine psilocybin has garnered attention for its rapid and sustained therapeutic effects following single-dose administration in clinical trials for depression and end-of-life anxiety. Its mechanism involves selectively activating 5-HT2A receptors, triggering substantial glutamate release and subsequently upregulating brain-derived neurotrophic factor (BDNF). This markedly increases dendritic spine density and synaptic protein expression in the hippocampus and prefrontal cortex, thereby restoring neural plasticity. This review systematically integrates the aforementioned neuroplasticity mechanisms with cross-mechanisms of neuroplastic alterations associated with tinnitus, emphasising its synergistic regulatory effects on excitatory neurotransmitters and their receptors (glutamate, dopamine) as well as inhibitory neurotransmitters and their receptors (gamma-aminobutyric acid (GABA)).

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