Magic mushrooms, which contain the hallucinogenic psilocybin, are having a moment. Psilocybin was recently decriminalized in Seattle, and researchers across the country have been studying it to see if it can help treat conditions such as depression and anxiety.
Microdosing psilocybin, which involves taking small doses of psychedelics to experience their potential beneficial side effects, has become trendy among people hoping to alleviate anxiety or increase creativity.
But is microdosing safe? Does psilocybin actually help treat mental health conditions? Here’s what you need to know.
What is psilocybin?
Psilocybin is a drug that occurs naturally in some types of mushrooms that grow throughout the world, including in the Pacific Northwest. It is a hallucinogenic at larger doses, which means it causes visual and auditory hallucinations. Taking psilocybin can also distort someone’s sense of time and how they perceive the world around them.
People can have profound, life-altering experiences and realizations while on psilocybin, says Dr. Nathan Sackett, acting assistant professor in the UW School of Medicine Department of Psychiatry and Behavioral Sciences — but that doesn’t mean taking the drug always makes someone feel good.
“The experience of being on psychedelics is not pleasure-inducing. It doesn’t necessarily feel good and it can be scary or uncomfortable or emotionally intense,” he says.
Since the ’50s and ’60s, American scientists have been studying magic mushrooms, which were brought to popular attention in part by María Sabina, an Indigenous Mazatec shaman who used psilocybin-containing mushrooms in healing ceremonies and shared her knowledge with westerners.
Once psilocybin entered the public sphere as a party and casual drug and became part of counterculture movements, the federal government passed laws classifying it as illegal. Since then, psilocybin has been listed as a schedule I drug by the United States Drug Enforcement Administration (DEA).
Seattle’s decriminalizing of psilocybin doesn’t mean the drug is legal, but it does mean it isn’t a local law enforcement priority. So far the only state to legalize psilocybin is Oregon, which passed a law in late 2020 to make it legal in therapeutic situations.
Can psilocybin treat depression and anxiety?
Psilocybin shows potential for helping people who have anxiety or treatment-resistant depression, Sackett says. The idea is to use it along with other therapies rather than as a standalone treatment.
Traditionally, psilocybin has been studied for its ability to ease fear and anxiety in people who have terminal illnesses, but recently researchers have been exploring how it could help people who have anxiety, depression or are dealing with emotional trauma.
Studies from 2016 found that psilocybin can significantly and quickly reduce feelings of hopelessness, anxiety and depression in people diagnosed with cancer, while a small 2020 study found that it can also help people who have treatment-resistant major depressive disorder.
Sackett is currently working on a study with Dr. Anthony Back and others from the Cambia Palliative Care Center of Excellence to determine if psilocybin can help reduce distress in front-line healthcare workers who have been experiencing burnout due to the pandemic.
The profound mind- and perception-altering experiences psilocybin can induce are one reason it has potential for treating mental illness, Sackett says.
“The drug can act as a catalyst for the therapeutic process. A single dose of psychedelic-assisted psychotherapy can equate to multiple sessions of psychotherapy alone, and this session can bring up intense things and can lead to profound insights for people,” he explains.
The key to psilocybin’s effectiveness is its pairing with other therapies. In clinical trials and sessions with patients, the process typically goes like this, according to Sackett: The patient meets with a therapist to establish initial trust and talk about their goals, then the therapist administers the psilocybin and stays with the patient for the entire experience, which can last hours. After that, the patient follows up with the therapist for additional sessions that don’t involve the drug.
“With any psychiatric pathology, over time it becomes increasingly difficult to get out of that mindset and it hijacks someone’s sense of self. Psilocybin allows them time to step outside of their internal narrative and see that something different is possible,” Sackett says.
Sackett, who specializes in treating addiction disorders, sees potential in using psilocybin to help people recover from addiction substances like alcohol, since psilocybin can help enhance someone’s motivation to change their behavior, which is one of the trickiest parts of recovery.
Is psilocybin safe?
Though more research needs to be done to confirm psilocybin’s safety, the studies that have been done to date have found that it is, overall, safe.
Psilocybin can create some unpleasant but mild symptoms in some people, including things like headache, dizziness, nausea, anxiety, sleepiness or overresponsive reflexes.
This is where taking psilocybin with the help of a therapist is beneficial. Therapists can help people prepare ahead of time for how to respond to potential side effects and guide people through it if they occur.
For someone to get the full benefit from their psilocybin-induced experiences, they may need to experience and work through some anxiety or distress which, while unpleasant, shouldn’t be harmful if undergone in a safe, controlled environment, Sackett explains.
“In a way, some of the anxiety is part of the therapeutic effect. It’s like cognitive behavioral therapy and exposure therapy. Part of the therapeutic role is to sit with that discomfort and come to the other side and realize you’ll be OK,” Sackett says.
Who shouldn’t take psilocybin?
There are some people who should not take psilocybin, though, including people who have existing heart problems (since psilocybin can temporarily raise someone’s blood pressure and heart rate). Due to its hallucinogenic effects, it also isn’t a good idea for someone who has schizophrenia, has experienced psychosis or has a family history of either.
As for potential addictiveness, though psilocybin’s status as a schedule I drug means the DEA believes it has a “high potential for abuse,” Sackett says this isn’t necessarily true. One reason for this is that psilocybin is thought to affect the brain’s serotonin levels rather than dopamine levels.
“Psychedelics don’t interact with same reward pathways as drugs like alcohol, tobacco, cocaine or opioids; psychedelics are in a separate class of drugs and their risk of overuse or abuse is significantly less,” he adds.
(It’s also worth noting that marijuana, which has been legal in Washington state since 2012, is also listed as a schedule I drug.)
Should I try microdosing?
You may have heard of microdosing psilocybin, a trend that involves taking very small amounts of it to, theoretically, alleviate symptoms of anxiety or depression or help someone tap into their creativity. The doses are typically so small that they do not involve hallucinations.
There is very little research on whether microdosing is effective, Sackett says, which means it isn’t the best idea to try it without consulting a doctor.
“I worry a little about the cultural narrative that psychedelics are a cure-all. They’re powerful tools that can be used to do therapeutic good, but they need to be given in a controlled environment, with safety checks and balances,” Sackett says. “I worry people will feel emboldened to go take LSD. It has to be done thoughtfully and it’s not for everyone; there has to be screening.”
Some people have anecdotally reported mental health benefits from microdosing, but others have claimed it worsens or causes problems such as insomnia, anxiety or migraines.
The bottom line
While psilocybin shows promise as a therapeutic agent for helping people who have depression or anxiety or are going through a terminal illness, more research needs to be done to determine its safety and how best to administer it.
Sackett is hopeful for the future and the potential that psilocybin has. He is working with Dr. Jürgen Unützer, chair of the UW School of Medicine Department of Psychiatry and Behavioral Sciences, to build a novel therapeutics research program that will explore the pairing of novel compounds like psilocybin and ketamine with behavioral interventions to treat addictions.
“My goal is to examine a variety of different psychedelics in conjunction with different forms of therapy to improve outcomes in patients,” he says.