Decision-Making around Psychedelics for Depression and Anxiety: a Model Based on Online Discussions

People who use psychedelics to self-treat depression and anxiety often arrive at that decision after being dissatisfied with standard mental health care. An analysis of 98 posts from online discussion threads revealed a four-stage decision-making process: first, frustration with conventional treatment; second, exploring limited information about psychedelic options; third, trial-and-error use despite safety uncertainties; and fourth, either continuing or stopping self-treatment. Those who continued adapted their practices over time. Decisions were guided by personal and peers' experiences rather than scientific evidence, and many avoided healthcare and official sources due to stigma and legal concerns. The findings suggest a need for user-informed decisional support to reduce harm.

Study at a glance

Abstract

Little is known about how people decide to use psychedelics to self-treat depression and anxiety, though the practice is growing. We explored online community discussions of members’ decisions around self-treatment with psychedelics for depression or anxiety. We used constructivist grounded theory to select and analyze 98 members’ posts across 95 discussion threads (99, 552 words) and identified a four-stage decision-making model. In stage one, decision-making began after dissatisfaction with standard mental health treatment. In stage two, members considered various psychedelic self-treatment options but explained that information was limited. In stage three, they engaged in trial and error when making decisions, despite uncertainties around safety. In stage four, they continued or discontinued self-treatment. Those who continued adapted their practice to their evolving treatment needs. Firsthand and peers’ experiences informed decisions. Available scientific evidence initially validated the psychedelic self-treatment but were not instructive. Many avoided healthcare and official information sources due to stigma and legal concerns. Research and knowledge translation efforts are needed to identify general concerns with self-treatment and provide user-informed decisional support to reduce harm and maximize benefit. Services supporting psychedelic self-treatment decisions can leverage our findings to create resources based on people’s lived experiences.