Update: Psilocybin and Bipolar Disorder Survey

on February 3, 2023
Update: Psilocybin and Bipolar Disorder Survey

Psychedelics, including psilocybin-containing ‘magic mushrooms’, have a long history of use in indigenous medicines and cultures. However, until recently it was difficult to research these substances in clinical settings due to prohibitions around their use. We are now in the midst of a psychedelic research resurgence – scientists are interested in their potential to treat mental health conditions, including bipolar disorder.

However, before scientists can run a full-scale clinical trial, we first need to know whether psilocybin is safe for people living with bipolar disorder. To date, investigators have been cautious about trialing this substance with people with a bipolar diagnosis out of concerns that this substance may induce manic symptoms and have excluded people with this diagnosis or a family history from studies. This is because psilocybin acts on serotonin receptors, similar to many antidepressant medications, which are also associated with ‘treatment-emergent affective switching’ or TEAS. TEAS is a phenomenon where someone with bipolar disorder suddenly changes from experiencing depressive symptoms to manic symptoms, or vice versa.

In order to learn more about the impacts of psilocybin use, CREST.BD partnered with researchers from the University of California, San Francisco (UCSF) Translational Psychedelics Research Program to conduct an international, web-based survey. A total of 541 people living with bipolar disorder who had experiences consuming ‘magic mushrooms’ completed questions about their intentions, experiences, and perceptions of this substance.

Participants described using psilocybin for a range of reasons, most commonly to aid in personal growth. Other common motivations included fun and mental health treatment. When asked to rate how helpful they found psilocybin, the average rating was four on a scale of one (‘Not at all helpful’) to five (‘Extremely helpful’). However, our data also suggests some need for caution around this substance. Almost a third of participants reported some kind of adverse or unwanted effect after using psilocybin, including new or increasing manic symptoms, sleep disturbances, and anxiety. Very few of these symptoms resulted in the use of emergency services: only eighteen people described going to the emergency room or needing hospitalization. Similarly, the overall harmfulness of psilocybin was rated 1.6 on a scale of one (‘Not at all harmful’) to five (‘Extremely harmful’) (Morton et al., 2022). These findings suggest some positive impacts of psilocybin use, but future research is needed to figure out what factors may contribute to the likelihood of negative impacts. Until we know more, a cautious approach to psilocybin use is needed.

Interestingly, nearly 60% of participants responded to a final open ended question which asked “Is there anything else you would like us to know about your experience(s) of using psilocybin/hallucinogenic ‘magic’ mushrooms?” We were surprised by how many people chose to describe their positive experiences, and we applied qualitative analytic methods to describe commonalities in people’s comments. We observed that many people believed psilocybin had helped them with their mental health, spiritual growth, and personal development. A number of people described ‘mixed’ experiences, where their use of psilocybin had both positive and negative aspects. For example, some people found the experience of psilocybin use overwhelming or even distressing, but they still found that their mental health or self-awareness improved afterward.

Taken together, this survey study suggests researchers planning clinical trials of psilocybin in bipolar disorder should do a few things to minimize risks and maximize potential benefits. First, unwanted effects are unfortunately common, so researchers should follow up with participants or their support person to make sure they can help if someone experiences mania, sleep changes, or other symptoms. Second, it will be really important to find ways to support people during and after the dosing experience. Potentially, trial therapists can help people practice coping strategies before the dosing experience, and provide reassurance if something distressing occurs. Researchers at UCSF are putting these recommendations in place in their current clinical trial evaluating the feasibility and safety of psilocybin for depressive symptoms in individuals living with bipolar disorder type II. This study is underway, and we hope to bring you more updates soon.

Over the next few months, we’ll be talking to other experts in psilocybin research about their own findings, and what the implications may be for bipolar disorder treatment. Stay tuned!


Morton, E., Sakai, K., Ashtari, A., Pleet, M., Michalak, E. E., & Woolley, J. (2022). Risks and benefits of psilocybin use in people with bipolar disorder: An international web-based survey on experiences of ‘magic mushroom’ consumption. Journal of Psychopharmacology, 37(1), 49–60. https://doi.org/10.1177/02698811221131997

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