Psilocybin, the active ingredient in hallucinogenic mushrooms, can rapidly and durably improve depression symptoms, but people with bipolar disorder have been excluded from clinical trials due to concerns about triggering mania. As psilocybin becomes more available, individuals with bipolar disorder may seek it for depression. A review of 17 published cases suggests a potential risk of activating manic episodes, warranting caution. However, the lack of systematic data indicates a need for a cautious trial using modern methods, focusing on those at lowest risk for mania, such as bipolar 2 disorder, given the significant impact of depression in this population.
Psilocybin, the active ingredient in hallucinogenic mushrooms, can rapidly and durably improve depression symptoms, but its safety in people with bipolar disorder is unknown because they have been excluded from clinical trials. The authors reviewed 17 published case histories and found potential risk for activating a manic episode, warranting caution. However, the lack of systematic data or common case examples indicating risk suggests that a cautious trial using modern methods, focused on those at lowest risk for mania (e.g., bipolar 2 disorder), is needed given depression's impact on this population.