Investigation of self-treatment with lysergic acid diethylamide and psilocybin mushrooms: Findings from the Global Drug Survey 2020

Concurrent stress modulates the acute and post-acute effects of psilocybin in a sex-dependent manner

There is renewed interest in psychedelics, such as psilocybin, as therapies for multiple difficult-to-treat psychiatric disorders. Even though psychedelics can induce highly pleasant or aversive experiences, depending on multiple personal and environmental factors, there is little research into how such experiences impact post-acute mood-altering actions. Here we aimed at offsetting this gap. First, we tested whether acute psilocybin effects differed between sexes. Adult male and female C57BL/6J mice received saline or psilocybin (5 mg/kg; i.p.), and head-twitch response (HTR) frequency was quantified. Notably, while psilocybin increased HTR frequency in both sexes, the effect was greater in females. We then tested if stress exposure during acute drug effects impacted post-acute psilocybin actions. Following drug treatment, mice were returned to their homecage or restrained for 1 h. Anxiety- and depression-like behaviors were assessed starting 24 h following drug administration, using the marble burying, novelty-suppressed feeding, and splash tests. Psilocybin induced anxiolytic-, but not antidepressant-like, which were fully blocked by stress in males, but only partially so in females. Lastly, we assessed the acute stress-psilocybin interaction on plasma corticosterone levels in a separate cohort of mice, treated as above. Both stress and psilocybin independently increased corticosterone levels, without additive or interactive effects being observed for either sex. Our data reveals the role of sex and peri-acute negative experiences in the acute and post-acute actions of psilocybin. These findings underline the importance of non-pharmacological factors, such as the quality of the psychedelic experience, in the mood-altering effects of psychedelics, holding significant for both their therapeutic and recreational use.

Psychedelic iatrogenic structural dissociation: an exploratory hypothesis on dissociative risks in psychedelic use

This paper introduces the hypothesis of Psychedelic Iatrogenic Structural Dissociation (PISD), proposing that psychedelics may reactivate dissociated traumatic material, increasing the risk of psychological destabilization in trauma-exposed individuals. Grounded in structural dissociation theory, this framework suggests that psychedelics can disrupt the balance between daily functioning (the Apparently Normal Personality, ANP) and trauma-related responses (the Emotional Personality, EP), leading to the resurfacing of unintegrated memories. A review of recent studies highlights persistent adverse effects associated with psychedelic use, including emotional dysregulation, identity fragmentation, derealization, and perceptual disturbances, particularly among individuals with early trauma histories. To mitigate these risks and facilitate trauma processing, integration practices, body-focused therapies, and structured social support systems are proposed as key interventions. Additionally, emerging neurophysiological models suggest that psychedelics may reconfigure dissociative processes through the modulation of entrenched patterns, potentially facilitating trauma integration or increasing vulnerability to destabilization, depending on individual and contextual factors. These findings underscore the necessity of trauma-informed screening, preparation, and integration protocols to enhance the safety and efficacy of psychedelic therapies, particularly for vulnerable populations.

Serotonergic Psychedelics Rapidly Modulate Evoked Glutamate Release in Cultured Cortical Neurons

The serotonergic psychedelics psilocybin, LSD and DMT hold great promise for the development of new treatments for psychiatric conditions such as major depressive disorder, addiction and end-of-life anxiety. Previous studies in both animals and humans have confirmed the effects of these drugs on neuronal activity and plasticity. However, the understanding of the mechanisms of action of these substances is limited. Here we show rapid effects of psychedelics on presynaptic properties, using live cell imaging at the level of single synapses in primary rat cortical neurons. Using the genetically encoded reporter of synaptic vesicle fusion synaptopHluorin, we detected a reduced fraction of synaptic vesicles that fused in response to mild or strong electrical stimulation 3-30 min after application of serotonergic psychedelics. These effects were transient and no longer present 24 h after treatment. While DMT only reduced the total recycling pool, LSD and psilocin also reduced the size of the readily releasable vesicle pool. Imaging with the sensors for glutamate, iGluSnFR, and presynaptic calcium, synGCaMP6, showed that while psilocin and DMT increased evoked glutamate release, LSD and psilocin reduced evoked presynaptic calcium levels. Interestingly, psilocin also affected short-term plasticity leading to a depression of responses to paired stimuli. The rapid and drug-specific modulation of glutamatergic neurotransmission described in this study may contribute to distinct anxiolytic and antidepressant properties of serotonergic psychedelics.

Down the Rabbit Hole: A Large-Scale Survey of Psychedelic Users' Patterns of Use and Perceived Effects

The ever-changing landscape surrounding legality and accessibility of psychedelics and their increasing popularity make it imperative to better understand the nature of psychedelic use by the general population. To this end, 1,486 eligible respondents (Mage = 29.58, 67.1% male) residing in the United States completed an online survey designed to assess the types of psychedelics used, methods of administration and dosing, frequency of use, intentions for use, context/environments in which they are used, perceived acute effects, frequency of those effects and distress about them, and their perceived residual effects and distress about them. Respondents predominantly endorsed using MDMA, LSD, DMT, and psilocybin. The predominant methods of administration were oral. Most reported using psychedelics for recreational purposes. The most endorsed acute effects were hallucinations, increased heart rate, positive mood, and visual tracers, while the most endorsed residual effects were headaches/migraine, dry mouth, nausea, hallucinations, and anxiety. Participants were most distressed by negative mood states, vomiting, and nausea when under the acute effects of psychedelics, but mean distress ratings were low. These results can help inform clinical trials, reform policy regarding legal access to psychedelics, and track changes in these metrics as sociocultural and legal landscapes continue to shift.

Psychedelic-related deaths in England, Wales and Northern Ireland (1997-2022)

BACKGROUND

Psychedelic drugs are increasingly visible in society once more, but their risks and adverse effects have received less attention than perhaps they should. While fatalities associated with psychedelics appear rare, a systematic approach to characterising their aetiology is required to inform harm minimisation efforts.

AIMS

This study aimed to analyse prevalence and characteristics of psychedelic-related deaths in England, Wales, and Northern Ireland, between 1997 and 2022.

METHODS

We analysed coroner reports submitted to the National Programme on Substance Use Mortality where psychedelic serotonergic agonist drugs were involved in the death, and conducted a thematic framework analysis to explore potential factors associated with their occurrence.

RESULTS

We identified 28 cases where psychedelics were implicated (75 %, N = 21) or potentially implicated (25 %, N = 7) in the death; 19 of these involving psychedelic tryptamines (LSD 39 %, N = 11; Psilocybin 21 %, N = 6; DMT 7 %, N = 2), and 9 psychedelic phenethylamines (incl. NBOMes 18 %, N = 5). Most deaths were deemed accidental by the coroner (86 %, N = 24), including both traumatic injuries and drug toxicities; most cases involved multiple implicated drugs (68 %, N = 19); and most of the deceased were under 30 years of age (82 %, N = 23). Thematic framework analysis identified nine themes in the deaths across three categories. 'Polysubstance use' was the most common theme (82 % of cases, N = 23/28), followed by a suboptimal 'physical environment' (70 % of cases where this information was available, N = 14/20).

CONCLUSIONS

The profound and often unpredictable effects of psychedelics pose a unique profile of risks and adverse reactions. Nevertheless, psychedelic-related deaths remain very rare in comparison to other recreational drugs, and frequently involve polydrug use. Implications for harm reduction and policy are discussed.

The Psych Behind Psychedelics: Exploring Hallucinogen Use as a Marker for Untreated Mental Health Disorders

Objective

Are individuals who use hallucinogens self-medicating their mental illness and are they more likely to abuse other illegal substances?

Design setting participants

Data from the National Survey on Drug Use and Health (NSDUH), collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) database was queried for correlations with hallucinogen use. Using age group as a control variable, different variables were run through a crosstab in order to find significant data pointing to the implications of hallucinogen use.

Results

The data from the crosstab analysis showed three key findings about hallucinogen use: Those with mental illness or substance abuse issues were substantially more likely to use hallucinogens, the hallucinogen use greatly increased with the pandemic along with further mental health issues, and those who used hallucinogens were more significantly likely to abuse other illegal substances, primarily in a younger population.

Conclusion

The positive correlation between mental health issues and hallucinogen use emphasizes the need for better mental health services, especially after the COVID-19 pandemic.The positive correlation between hallucinogen use and other drug use indicates the widespread drug abuse problem, especially within a younger population in which drugs pose a larger neurological threat.

Psilocybin Mushrooms and Public Health in Brazil: Insights from a Retrospective Analysis of Adverse Events and Their Implications for Regulatory Discussions

Current drug policy classifies psilocybin, a compound found in psychoactive mushrooms, as having high abuse potential while overlooking its therapeutic properties. We evaluated the risk of psilocybin mushrooms to Brazilian public health compared to other toxic agents and assessed the need for regulatory discussions. This retrospective cross-sectional study followed STROBE guidelines, using data from the Notifiable Diseases Information System (SINAN) on adverse events reported from 2007 to 2022. Participants were categorized into a general drug abuse group, which was further divided into psilocybin and unknown mushroom subgroups. Clinical outcomes included non-hospitalization, hospitalization, and death, with associations analyzed via the Chi-square test. Out of 112,451 individuals seeking medical attention for drug abuse-related events, men predominated (n = 79,514; 70.7%), with alcohol being the primary agent (n = 71,824; 49.2%). The psilocybin mushroom group included 13 participants, and the unknown mushroom group included 51. Hospitalization rates were 19.5% (n = 21,923) for drug abuse, 46.2% (n = 6) for psilocybin mushrooms (0.02% of all hospitalizations) (99% CI: 10.6%-81.6%), and 23.5% (n = 12) for unknown mushrooms (99% CI: 8.3%-38.7%). Mortality was 1.8% (n = 2035) for drug abuse group, with no fatal events in the psilocybin or unknown mushroom groups. Deaths were mainly linked to cocaine (33.3%). These findings suggest a low risk for psilocybin mushrooms, though underreporting may be a factor. This study underscores the need for evidence-based regulatory discussions to ensure safe access to psilocybin for clinical and ceremonial use.

Australian psychologists' attitudes towards psychedelic-assisted therapy and training following a world-first drug down-scheduling

INTRODUCTION

This study explores the attitudes of psychologists towards psychedelics and psychedelic-assisted therapy (PAT) following the world-first regulatory changes in 2023 in Australia which permitted psilocybin and 3,4-methylenedioxy-methamphetamine (MDMA) to be used in clinical services.

METHODS

A purposive sample of 20 Australian psychologists was recruited using snowball sampling. Semi-structured interviews were conducted which explored participants' attitudes, knowledge and concerns about PAT. Data were coded and analysed to identify and develop theme categories.

RESULTS

Most psychologists exhibited positive attitudes towards psychedelics and their therapeutic potential, viewing them as promising for addressing chronic mental health conditions like depression. However, there was a notable concern regarding the limited evidence on efficacy and potential adverse experiences, as well as the complexity of the individualised treatment protocol. Despite enthusiasm, many psychologists had limited detailed knowledge about the interventions themselves. The need for comprehensive education and training programs, including exposure to psychedelic experiences and credible higher education institutions, was emphasised to ensure competence in administering PAT.

DISCUSSION AND CONCLUSIONS

Psychologists displayed notably positive attitudes towards PAT, likely reflecting both shifting perceptions of psychedelics and self-selection bias within the sample. Despite this optimism, concerns were raised about psychiatric risks and the necessity for comprehensive and reputable training and supervision. The cohort showed openness to both novel treatments and innovative training methods, underscoring the importance of enhancing educational frameworks to ensure effective implementation of PAT.

Psychedelic group-based integration: ethical assessment and initial recommendations

A number of organizations have developed or are developing psychedelic integration groups, held in person or online. In parallel, there have been calls to make enhanced integration available in the community after clinical trials. Here, we explore a potential reason why individuals may seek out these groups: namely, the feelings of disconnection and loneliness that may arise after the psychedelic experience (noting that there may be other reasons that individuals may seek out these groups). Integration groups can offer significant benefits to participants (e.g. a sense of community, shared coping strategies); however, there may also be a number of associated risks. In this essay, we aim to explore the benefits and risks of integration groups, and offer a preliminary set of guidelines to physicians, researchers and individuals to help assess and evaluate these groups.

Association between lifetime hallucinogen use and psychological distress varies by sexual identity in a nationally representative sample

BACKGROUND

Clinical trials demonstrate that psychedelic-assisted therapy can improve mental health outcomes; however, few studies have recruited sexually diverse samples or reported information on sexual identity.

AIMS

The purpose of this analysis was to examine the relationship between hallucinogen use and mental health outcomes with respect to sexual identity.

METHODS

We conducted a cross-sectional analysis using data from the 2021 National Survey on Drug Use and Health to examine the relationship between hallucinogen use and psychological distress.

RESULTS

In a sample representative of 253,824,662 U.S. adults, the majority was heterosexual (92%), aged 50-64 (25%), women (51%), non-Hispanic White (62%), college educated (31%), and had an annual household income of $75,000 or higher (39%). The majority reported no lifetime hallucinogen use (82%) and no past month severe psychological distress (93%). Sexual identity modified the relationship between hallucinogen use and psychological distress. After stratifying by sexual identity and adjusting for covariates, hallucinogen use was associated with reduced odds of psychological distress in the heterosexual population (OR = 0.76, 95% CI: 0.59, 0.96) but the relationship was not significant in the sexual minority population.

CONCLUSION

We found that in a nationally representative sample, psychedelic use was associated with reduced odds of psychological distress in heterosexual individuals only. Future research should investigate why hallucinogen use was not protective in sexual minority groups given their disproportionate burden of poor mental health outcomes.

Attitudes of European psychiatrists on psychedelics: a cross-sectional survey study

Research and public interest in psychedelic-assisted psychotherapy (PAP) are growing. This study investigated attitudes toward psychedelics among a diverse and multinational sample of psychiatrists currently working in Europe. We conducted an anonymous, web-based survey consisting of demographic information, a test of basic knowledge on psychedelics, and the previously validated 20-item Attitudes on Psychedelics Questionnaire (APQ), which was validated for the first time in English within this sample. We included N = 419 participants from 33 countries in the study. One-third of participants (34%) reported past use of psychedelics. The APQ sub-scale with the highest score was Openness to Psychedelics, while Risk Assessment of Psychedelics was rated lowest. Regression modelling, explaining 31.3% of variance in APQ scores, showed that younger male psychiatrists who identified as spiritual, were better at recognizing and classifying substances as psychedelics and had previously used psychedelics had more positive attitudes on psychedelics. No professional variables besides self-reported previous experience with PAP or psychedelic research predicted APQ scores. European psychiatrists, therefore, show a general openness to psychedelics and PAP, but are concerned by the potential risks associated with them. Our findings overall suggest that psychedelics are a subject where it is difficult to remain impartial. Protocol registration: The study was pre-registered at the Open Science Framework (available online at https://osf.io/upkv3 ).

Content analysis of Reddit posts about coadministration of selective serotonin reuptake inhibitors and psilocybin mushrooms

RATIONALE

Treatments with the serotonergic psychedelic psilocybin are being investigated for multiple neuropsychiatric disorders. Because many patients with these disorders use selective serotonin reuptake inhibitors (SSRIs), understanding interactions between psilocybin and SSRIs is critical for evaluating the safety, efficacy, and scalability of psilocybin-based treatments. Current knowledge about these interactions is limited, as most clinical psilocybin research has prohibited concomittant SSRI use.

OBJECTIVES

We aimed to explore potential interactions between psilocybin and SSRIs by characterizing peoples' real-world experiences using psilocybin mushrooms and SSRIs together.

METHODS

We conducted a systematic search of Reddit for posts describing psilocybin mushroom and SSRI coadministration. We identified 443 eligible posts and applied qualitative content analysis to each.

RESULTS

8% of posts reported negative physical or psychological effects resulting from coadministration. These included 13 reports that may reflect serotonin toxicity, and 1 concerning for a psychotic/manic episode. 54% of posts described reduced intensity of the acute psilocybin experience, but 39% reported unchanged intensity with SSRI coadministration.

CONCLUSIONS

Psilocybin's interactions with SSRIs are likely complex and may depend on multiple factors. Prospective studies are needed to evaluate whether psilocybin treatments are reliably safe and effective in the setting of SSRI use.

Clinical effect of nursing methods integrating health belief models on self-care of maintenance hemodialysis patients: A retrospective study

This study aimed to explore the clinical effectiveness of nursing methods that incorporate health belief models on the self-care practices of maintenance hemodialysis patients. The objective was to enhance patients' health beliefs, strengthen their healthy behaviors and habits, improve their unhealthy daily behaviors, and provide robust theoretical and practical foundations for future nursing practices in this area. A retrospective analysis was conducted on 150 hemodialysis patients from our hospital, from January 2019 to February 2023. The participants were divided into 2 groups: a control group (N = 75) using routine nursing methods, and an experimental group (N = 75) using methods integrated with health belief models. Both groups were comparable in terms of demographic and baseline clinical characteristics such as gender, marital status, age, education level, total scores of self-care ability, and dialysis duration, with no significant differences observed (P > .05). Data collection tools included a general information questionnaire and a self-care ability scale, and clinical effectiveness was measured through specific indicators such as parathyroid hormone, blood phosphorus, urea, potassium, calcium, and IWGR%. Post-intervention, the experimental group demonstrated significant improvements in self-care capabilities across various dimensions and most clinical indicators compared to the control group, with the exception of parathyroid hormone and blood urea levels. The study concludes that integrating health belief models into nursing practices significantly enhances the self-care abilities of maintenance hemodialysis patients, improves several clinical parameters, and holds promise for fostering better patient outcomes and guiding future clinical nursing practices.

Coming back together: a qualitative survey study of coping and support strategies used by people to cope with extended difficulties after the use of psychedelic drugs

Introduction

A growing body of literature is investigating the difficulties that some individuals encounter after psychedelic experiences. Existing research has explored the nature and predictors of these difficulties; however, a research gap exists in understanding how individuals endeavour to cope with such difficulties.

Methods

The current study collected data from an international cohort of 608 participants who reported experiencing difficulties that persisted for at least one day after a psychedelic experience. They provided written data on how they used coping strategies to alleviate these difficulties. The qualitative analysis of the written data on coping was conducted using Structured Tabular Thematic Analysis.

Results

A wide range of individual and social coping strategies were employed that were found helpful. The most common individual strategies were meditation and prayer, followed by self-educational activities such as reading and journaling. The most prevalent forms of social coping involved seeking support from friends or family members, followed by obtaining assistance from a therapist or coach. Features of social coping that were reported to be helpful included feeling heard/accepted, a non-judgemental attitude and sharing similar experiences.

Discussion

Our findings hold potential for informing the design of therapeutic interventions and educational resources aimed at enhancing positive outcomes for those experiencing extended difficulties after psychedelic use.

The Economics of Treatment for Depression

The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12-17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments' relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.

Therapeutic potential of psychedelics: History, advancements, and unexplored frontiers

Psychedelics (serotonergic hallucinogens) are psychoactive substances that can alter perception and mood, and affect cognitive functions. These substances activate 5-HT2A receptors and may exert therapeutic effects. Some of the disorders for which psychedelic-assisted therapy have been studied include depression, addiction, anxiety and post-traumatic stress disorder. Despite the increasing number of studies reporting clinical effectiveness, with fewer negative symptoms and, additionally, minimal side effects, questions remain to be explored in the field of psychedelic medicine. Although progress has been achieved, there is still little understanding of the relationship among human brain and the modulation induced by these drugs. The present article aimed to describe, review and highlight the most promising findings in the literature regarding the (putative) therapeutic effects of psychedelics.

UK medical students' self-reported knowledge and harm assessment of psychedelics and their application in clinical research: a cross-sectional study

OBJECTIVE

To capture UK medical students' self-reported knowledge and harm assessment of psychedelics and to explore the factors associated with support for changing the legal status of psychedelics to facilitate further clinical research.

DESIGN

Cross-sectional, anonymous online survey of UK medical students using a non-random sampling method.

SETTING

UK medical schools recognised by the General Medical Council.

PARTICIPANTS

132 medical students who had spent an average of 3.8 years (SD=1.4; range: 1-6) in medical school.

RESULTS

Most students (83%) reported that they were aware of psychedelic research and only four participants (3%) said that they were not interested in learning more about this type of research. Although medical students' harm assessment of psychedelics closely aligned with that of experts, only 17% of students felt well-educated on psychedelic research. Teachings on psychedelics were only rarely encountered in their curriculum (psilocybin: 14.1 (SD=19.9), scale: 0 (never) to 100 (very often)). Time spent at medical schools was not associated with more knowledge about psychedelics (r=0.12, p=0.129). On average, this sample of medical students showed strong support for changing the legal status of psychedelics to facilitate further research into their potential clinical applications (psilocybin: 80.2 (SD=24.8), scale: 0 (strongly oppose) to 100 (strongly support)). Regression modelling indicated that greater knowledge of psychedelics (p<0.001), lower estimated harm scores (p<0.001), more time spent in medical school (p=0.024) and lower perceived effectiveness of non-pharmacological mental health treatments (p=0.044) were associated with greater support for legal status change.

CONCLUSIONS

Our findings reveal a significant interest among UK medical students to learn more about psychedelic research and a strong support for further psychedelic research. Future studies are needed to examine how medical education could be refined to adequately prepare medical students for a changing healthcare landscape in which psychedelic-assisted therapy could soon be implemented in clinical practice.

Predicting the Intensity of Psychedelic-Induced Mystical and Challenging Experience in a Healthy Population: An Exploratory Post-Hoc Analysis

Introduction

In psychedelic therapy, mystical as well as challenging experience may influence therapeutic outcome. However, predictors of such experience have not been sufficiently established. Determining predictors of their intensity is, therefore, potentially beneficial in targeting psilocybin therapy for depression.

Methods

In a post hoc data analysis of a Phase 1, randomised, double-blind, placebo-controlled, between-groups clinical trial, dosage, personality traits, affect, and individual data were analysed as possible clinical predictors. Eighty-nine healthy volunteers were randomised to receive a single dose of placebo, 10 mg of psilocybin, or 25 mg of psilocybin. ANOVA was used to analyse the relationship between dosage and mystical and/or challenging experience, and correlation analysis for all other variables.

Results

The intensity of both mystical and challenging experience was strongly associated with higher dosage. Age was negatively correlated with intensity of challenging experience. Correlation between identified personality traits and either mystical or challenging experience was minimal, with the exception of positive correlation between neuroticism and challenging experience at higher dose. Neither positive nor negative affect indicated correlation with the intensity of either type of experience.

Discussion

A limitation of this study is its post hoc, exploratory design; recommendations for further research are provided.