“A sense of the bigger picture:” A qualitative analysis of follow-up interviews with people with bipolar disorder who self-reported psilocybin use

Abstract

Objectives People with bipolar disorder (BD) spend more time depressed than manic/hypomanic, and depression is associated with greater impairments in psychosocial functioning and quality of life than mania/hypomania. Emerging evidence suggests psilocybin, the psychoactive compound in “magic mushrooms,” is a promising treatment for unipolar depression. Clinical trials of psilocybin therapy have excluded people with BD as a precaution against possible adverse effects (e.g., mania). Our study centered the experiences of adults living with BD who consumed psilocybin-containing mushrooms, and aimed to (1) understand its subjective impacts on BD symptoms, (2) deepen understanding of Phase I survey results, and (3) elucidate specific contextual factors associated with adverse reactions in naturalistic settings. Methods Following an international survey (Phase I), follow-up interviews were conducted with 15 respondents (Phase II) to further understand psilocybin use among adults with BD. As part of a larger mixed-methods explanatory sequential design study, reflexive thematic analysis was used to elaborate findings. Results Three major themes containing sub-themes were developed. (1) Mental Health Improvements: (1.1) decreased impact and severity of depression, (1.2) increased emotion processing, (1.3) development of new perspectives, and (1.4) greater relaxation and sleep. (2) Undesired Mental Health Impacts: (2.1) changes in sleep, (2.2) increased mania severity, (2.3) hospitalization, and (2.4) distressing sensory experiences. (3) Salient Contextual Factors for psilocybin use included: (3.1) poly-substance use and psilocybin dose, (3.2) solo versus social experiences, and (3.3) pre-psilocybin sleep deprivation. Conclusion Our findings demonstrate both benefits and risks of psilocybin use in this population. Carefully designed clinical trials focused on safety and preliminary efficacy are warranted.

Single-Dose Synthetic Psilocybin With Psychotherapy for Treatment-Resistant Bipolar Type II Major Depressive Episodes

“…A survey-based report of anecdotal use of psychedelics in patients who reported having BD showed one-third of respondents reporting manic symptoms, insomnia, or anxiety after psilocybin exposure, along with some indications of mental health benefit . These surveys report both positive and negative effects from psychedelics in individuals with putative BD.…”

“…Administration of a psychedelic agent under carefully controlled and supportive conditions may yield distinct effects compared A survey-based report of anecdotal use of psychedelics in patients who reported having BD showed one-third of respondents reporting manic symptoms, insomnia, or anxiety after psilocybin exposure, 31 along with some indications of mental health benefit. 32 These surveys report both positive and negative effects from psychedelics in individuals with putative BD. The positive effects from anecdotal reports include decreased depression, increased emotional processing, and development of new perspectives, which were seen in most of our study participants.…”

Review of Psilocybin Use for Depression among Cancer Patients after Approval in Oregon

“…For example, a pilot study at the University of California, Los Angeles, reignited interest in psilocybin treatment for advanced-stage cancer patients, leading to renewed efforts in psilocybin research [58]. Furthermore, the FDA granted the breakthrough therapy designation for psilocybin in the treatment of depression, indicating its potential as a novel therapeutic approach [79,80].…”

Adolescent Psychedelic Use and Psychotic or Manic Symptoms

“…There are concerns that a personal or family history of these conditions may elevate the risk of psychotic or manic episodes following administration of psychedelics, but exclusion of such individuals from clinical trials of psychedelic-assisted therapy also limits the possibility of quantifying psychiatric risks . Apart from recent clinical research on psilocybin-assisted therapy in patients with bipolar II disorder, available empirical evidence is mainly based on research designs prone to familial confounding and similar biases . It is therefore important to use genetically informative approaches to better understand the nature and causal underpinnings of observed associations.…”

“…4,5 Apart from recent clinical research 6,7 on psilocybinassisted therapy in patients with bipolar II disorder, available empirical evidence is mainly based on research designs prone to familial confounding and similar biases. [8][9][10][11] It is therefore important to use genetically informative approaches to better understand the nature and causal underpinnings of observed associations.…”