A new study published in the Journal of psychopharmacology is the first to characterize the psychological effects of psilocybin in people with bipolar disorder. The findings indicate that many people with bipolar disorder who consume psilocybin, the primary psychoactive component of psychedelic “magic mushrooms,” believe the experience is beneficial. However, many also report adverse effects, such as manic symptoms.
Psilocybin-assisted therapy for depression is gaining attention because of promising research results over the past decade. A growing body of evidence suggests that, when combined with supportive therapy, taking certain psychedelic compounds in a controlled environment may lead to better mental health outcomes for individuals suffering from various mental disorders. However, it’s unclear if psilocybin holds any promise for people with bipolar disorder.
“Psychedelics such as psilocybin have been used in indigenous medicines and traditions for a very long time. Unfortunately, despite some early evidence of their therapeutic potential, regulatory barriers blocked research for many decades,” 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 middle of an exciting resurgence of psilocybin research, and some studies have shown that it can improve symptoms of depression. This is very important for bipolar research because depressive symptoms can be particularly distressing and detrimental to the quality of life of people with bipolar disorder.”
“Before we conduct clinical trials to investigate the effectiveness of psilocybin for people with bipolar disorder, we need to know if it’s safe for them to use because some drugs with a similar neurobiological mechanism of action can trigger manic episodes,” Morton explained. . “That’s why we turned to community members 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 to achieve this. “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%) reported using psychiatric drugs at the time of taking psilocybin.
The most commonly cited reason for using psilocybin was personal development, followed by pleasure. The least frequently cited 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 as an average of 1.6. In contrast, they rated the perceived helpfulness of their psilocybin experience as an average of 4.
However, 32.2% of participants reported experiencing negative or unwanted outcomes during or in the 14 days following a psilocybin trip. New or increasing manic symptoms were the most common side effect. Eighteen people reported using emergency services during or in 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, gender, diagnostic subtype, psychotic spectrum diagnoses, number of lifetime psychiatric hospitalizations, number of lifetime psilocybin trips, or adherence to prescribed psychiatric medications.
“Unfortunately, we are not yet at the point where doctors can prescribe psilocybin to their patients, and in many places it is still classified as an illegal substance,” Morton told PsyPost. “While our study shows that some people with bipolar disorder reported positive experiences from using psilocybin, while others experienced significant poor outcomes, so using this substance can be risky.”
“In order for psilocybin to reach a point where it is regulatory approved for clinical use in people with bipolar disorder, more research (in the form of clinical trials) is needed. On a positive note, our research group is taking steps to do that research: we recently started 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, asking “Is there anything else you would like us to know about your experience(s) of using psilocybin/hallucinogenic ‘magic mushrooms’?” Almost 60% of the participants responded to this last item.
“As part of our survey, we gave people the opportunity to leave comments on anything they thought might be important to our research,” explains Morton. “Despite the fact that our research showed that many people experienced negative or unwanted outcomes from using psilocybin, we were surprised how many people left comments describing the benefits psilocybin had for their mental health, personal development or spiritual growth.”
“In fact, many people described ‘mixed experiences’, with psilocybin use having both positive and negative aspects. For example, someone may have found their psilocybin experience very intense and at times disturbing, but still experience benefits to their mental health afterwards. We think 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 deal with overwhelming experiences, and process the personal significance of their experiences.”
But the study, like all studies, has some caveats.
“Our survey asked about experiences of using psilocybin outside of clinical settings,” Morton told PsyPost. “Unlike a clinical trial, naturalistic use does not take place in carefully controlled conditions. That means we can’t be sure whether the reported negative results were due to psilocybin use or something else. To further investigate this issue, our team also conducted follow-up interviews with a small group of people.”
In the follow-up study, published in PLOS Oneresearchers conducted semi-structured interviews with 15 participants about the subjective effects of the psychedelic substance.
“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,” explains Morton. “This finding highlights how important it will be to conduct additional research under controlled conditions to gain greater confidence in the potential risks and benefits of using psilocybin for bipolar disorder.”
“Research on the therapeutic potential of psilocybin is limited due to its legal status,” Morton added. “Our research was therefore based on asking the community to share their experiences of using psilocybin. It was important to us to show respect and appreciation for people who participated by making the research process accessible, fair and representative of people with diverse experiences.”
“To do this, we partnered with CREST.BD, a collaborative research network with a history of working hand-in-hand with people with bipolar disorder. People with lived experience of bipolar disorder contributed to our survey design, interpretation and publication of findings, and webinars to share the results of our research back with the community.
The study, “Risks and Benefits of Psilocybin Use in People With Bipolar Disorder: An International Web-Based Survey of ‘Magic Mushrooms’ Consumption Experiences,” is written by Emma Morton, Kimberly Sakai, Amir Ashtari, Mollie Pleet, Erin E Michalak and Josh Woolley.