A new study published in Journal of Psychopharmacology is the first to characterize the psychological effects of psilocybin among people with bipolar disorder. The findings indicate that many people with bipolar disorder who use psilocybin, the primary psychoactive component in psychedelic “magic mushrooms,” believe the experience is beneficial. However, many also report adverse outcomes, such as manic symptoms.
Psilocybin-assisted therapy for depression is gaining attention due to promising research results in the last decade. A growing body of evidence suggests that, combined with supportive therapy, the consumption of certain psychedelic compounds in a controlled setting can lead to better mental health outcomes for individuals suffering from various mental disorders. However, it is unclear whether psilocybin holds any promise for those with bipolar disorder.
“Psychedelics such as psilocybin have a long history of use in indigenous medicine and traditions. Unfortunately, despite some early evidence of their therapeutic potential, regulatory barriers halted research for decades,” says study author. Emma Mortona Canadian Institutes of Health Research Banting Postdoctoral Fellow at the University of British Columbia and member of the Translational Psychedelics Research Program.
“We are now in the midst of an exciting resurgence of research into psilocybin, and some studies have shown that it can improve symptoms of depression. This is of great interest to research into bipolar disorder, as depressive symptoms can be particularly distressing and detrimental to quality of life for people with bipolar disorder.”
“Before we run clinical trials to investigate the effectiveness of psilocybin for people with bipolar disorder, we need to know if it is safe for them to use, since some drugs that have a similar neurobiological mechanism of action can trigger manic episodes,” explained Morton. “That’s why we reached out to members of the community to ask about their experiences.”
For their study, the researchers used a blog post on the CREST.BD website and social media ads to recruit a sample of 541 individuals who were at least 18 years old, had a self-reported diagnosis of bipolar disorder, and had used psilocybin to achieve “a full psychedelic trip.” The most commonly reported diagnostic subtype was bipolar II disorder, which is characterized by a pattern of depressive episodes and hypomanic episodes. Most participants (56.6%) indicated that they were taking psychiatric medication at the time of psilocybin use.
The most common reason for using psilocybin was to help with personal development, followed by having fun. The least common reason for using psilocybin was escapism (to avoid pain or discomfort). On a five-point scale from “Not at all” to “Extremely harmful,” participants rated the harmfulness of their psilocybin experience at an average of 1.6. In contrast, they rated the perceived helpfulness of their psilocybin experience as 4 on average.
However, 32.2% of participants reported experiencing negative or adverse outcomes during or during the 14 days following a psilocybin trip. New or increasing manic symptoms were the most common side effect. 18 people reported using emergency services during or during the 14 days following a psilocybin trip.
Individuals who reported negative outcomes did not differ from those who did not experience adverse events in terms of age, sex, diagnostic subtype, psychotic spectrum diagnoses, number of lifetime psychiatric hospitalizations, number of lifetime psilocybin sessions, or adherence to prescribed psychiatric medication.
“Unfortunately, we are not yet at a point where doctors can prescribe psilocybin to their patients, and in many places it is still classified as an illegal drug,” Morton told PsyPost. “While our study shows that some people with bipolar disorder reported positive experiences using psilocybin, others experienced significant adverse outcomes, so using this drug may be risky.”
“For psilocybin to reach a point where it has regulatory approval for clinical use with people with bipolar disorder, more research (in the form of clinical trials) is needed. Positively, our research group is taking steps toward doing that research: we have recently initiated the first clinical trial investigating the safety and feasibility of psilocybin for the treatment of depressive symptoms in people with bipolar disorder.”
The study included an open-ended question, which asked, “Is there anything else you would like us to know about your experiences using psilocybin/hallucinogenic ‘magic’ mushrooms?” Almost 60% of the participants answered this last item.
“As part of our survey, we gave people the opportunity to leave comments about anything they thought might be important to our research,” explained Morton. “Although our survey found that many people experienced negative or unwanted outcomes from psilocybin use, we were surprised by how many people left comments describing the benefits that psilocybin had for their mental health, personal development or spiritual growth.”
“In fact, many people described ‘mixed experiences’, where using psilocybin had both positive and negative aspects. For example, some people may have experienced the psilocybin experience as very intense and at times distressing, but still experienced benefits to their mental health afterwards. We believe this will be a very important issue for the field to address – things like psychological preparation sessions and debriefing can be important in helping people cope with overwhelming experiences, as well as process the personal meaning of their experiences.”
But the study, like all research, includes some caveats.
“Our survey asked about experiences with the use of psilocybin outside of clinical settings,” Morton told PsyPost. “Unlike a clinical trial, naturalistic use does not occur under carefully controlled conditions. This means that we cannot be sure whether the negative results reported were due to psilocybin use, or something else. To explore this issue in more detail, the team conducted our also follow-up interviews with a small group of people.”
In the follow-up study, which is published in PLOS Onethe researchers conducted semi-structured interviews with 15 participants regarding the subjective effects of the psychedelic drug.
“We learned that contextual factors such as dose, setting, use of other substances or pre-existing sleep problems may have played a role in whether people experienced positive or negative outcomes,” explained Morton. “This finding underscores how important it will be to conduct further research under controlled conditions to be more confident about the potential risks and benefits of using psilocybin for bipolar disorder.”
“Research into the therapeutic potential of psilocybin has been limited due to its legal status,” Morton added. “Our research therefore relied on asking the community to share their experiences with the use of psilocybin. It was important for us to show respect and gratitude to people who participated by making the research process accessible, fair and representative of people with different experiences.”
“To do this, we partnered with CREST.BD, a collaborative research network that has worked hand-in-hand with people with bipolar disorder. People with lived experience of bipolar disorder contributed to the design of our survey, interpretation and publication of findings, and webinars for to share the results of our research with the community.
The study, “Risks and benefits of psilocybin use in people with bipolar disorder: An international web-based survey on experiences of ‘magic mushroom’ consumer”, was authored by Emma Morton, Kimberly Sakai, Amir Ashtari, Mollie Pleet, Erin E Michalak, and Josh Woolley.