Risks and benefits of psilocybin use in people with bipolar disorder: An international web-based survey on experiences of ‘magic mushroom’ consumption

A web-based survey of 541 people with bipolar disorder who had used psilocybin found that one-third reported new or worsening symptoms afterward, especially manic symptoms, insomnia, and anxiety. No difference in adverse event rates emerged between bipolar I and bipolar II. Emergency medical care was rare (3.3%). Despite adverse effects, respondents rated psilocybin use as more helpful than harmful. The findings suggest psilocybin may offer subjective mental health benefits for some people with bipolar disorder, but clinical trials should closely monitor symptoms because they may emerge or intensify.

Study at a glance

Abstract

Background: Psilocybin, the primary psychoactive component of psychedelic ‘magic mushrooms’, may have potential for treating depressive symptoms, and consequent applications for bipolar disorder (BD). Knowledge of the risks and benefits of psilocybin in BD is limited to case studies. Aim: To support the design of clinical trials, we surveyed experiences of psilocybin use in people with BD. Methods: An international web-based survey was used to explore experiences of psilocybin use in people with a self-reported diagnosis of BD. Quantitative findings were summarised using descriptive statistics. Qualitative content analysis was used to investigate free-text responses, with a focus on positive experiences of psilocybin use. Results: A total of 541 people completed the survey (46.4% female, mean 34.1 years old). One-third (32.2%; n = 174) of respondents described new/increasing symptoms after psilocybin trips, prominently manic symptoms, difficulties sleeping and anxiety. No differences in rates of adverse events overall were observed between individuals with BD I compared to BD II. Use of emergency medical services was rare ( n = 18; 3.3%), and respondents (even those who experienced adverse effects) indicated that psilocybin use was more helpful than harmful. Quantitative findings elaborated on perceived benefits, as well as the potential for psilocybin trips to contain both positively and negatively received elements. Conclusions: The subjective benefits of psilocybin use for mental health symptoms reported by survey participants encourage further investigation of psilocybin-based treatments for BD. Clinical trials should incorporate careful monitoring of symptoms, as data suggest that BD symptoms may emerge or intensify following psilocybin use.