The benefits and risks of psilocybin (magic mushroom) therapy for mental health
Psilocybin, the active compound in “magic mushrooms,” has gained significant attention in recent years for its potential therapeutic benefits in treating mental health conditions such as severe depression, post-traumatic stress disorder (PTSD) and substance abuse.
However, while early research suggests promise, experts warn that psilocybin is not without risks and much remains unknown about its long-term effects and safety.
The South African Society of Psychiatrists (Sasop), through psychiatrist Dr Melané van Zyl, has emphasised the importance of approaching psilocybin therapy with caution.
While the potential benefits are intriguing, the lack of robust, large-scale studies makes it difficult to endorse its widespread use in clinical settings fully.
In recent years, there has been growing interest in psychedelics, substances that alter perception, mood and cognitive processes, for their potential mental health benefits.
Psilocybin, colloquially known as shrooms, in particular, has been the subject of several small studies suggesting it may help "reset" brain connections related to mood, anxiety, trauma and addiction.
Many study participants report breakthroughs in self-awareness, mood improvement and spiritual experiences.
However, Van Zyl cautions that these studies are limited by small sample sizes and short follow-up periods.
“We know from emerging, but limited, scientific evidence that psychedelics like psilocybin may have therapeutic benefit in the treatment of a range of mental illnesses when combined with psychotherapy (‘talk therapy’),” she says.
However, she also points out that the lack of long-term, large-scale clinical trials means we do not yet fully understand the safety profile of psilocybin, particularly when used outside of controlled environments.
The risks of using shrooms
Despite the excitement surrounding its potential, psilocybin is not without risks. The hallucinogenic properties that make it an attractive option for therapy can also lead to harmful side effects, especially when used without proper medical supervision.
One of the primary concerns is the drug’s ability to induce a "bad trip", during which individuals may experience heightened anxiety, fear, paranoia and even suicidal thoughts.
These experiences can cause distress during and after the psychedelic session, making psilocybin a potentially dangerous option for some individuals.
“The potential harm of unsupervised or recreational psilocybin use stems from the ‘distorted sense of reality’ and diminished sense of control that the drug induces, which can lead some people into erratic or dangerous behaviour,” Van Zyl explains.
She also notes that people with a history of mental health disorders, particularly psychosis, may be at higher risk of severe reactions.
Additionally, the lack of established guidelines for dosage and frequency of psilocybin use poses risks. Without randomised controlled trials, the gold standard in medical research, experts cannot definitively say what constitutes a safe dose or how often psilocybin should be administered.
This leaves room for misuse or inappropriate application, especially in non-clinical settings.
Rising popularity and unregulated use
Despite these concerns, the use of psychedelics is on the rise. A recent study in California found that emergency room visits related to hallucinogens increased by 54% between 2016 and 2022, with hospitalisations rising by 55%.
This trend suggests that while more people are experimenting with substances like psilocybin, the consequences can be dangerous, particularly when used recreationally or without proper guidance.
In the United States, the popularity of non-LSD hallucinogens among young adults has doubled between 2018 and 2021, reaching its highest prevalence in 30 years.
This growing social acceptance of psychedelics, combined with the lack of clear legal pathways for therapeutic use, contributes to the unregulated and potentially unsafe use of these substances.
Controlled use in clinical settings
Some countries have begun to allow the controlled medical use of psilocybin under strict guidelines. In 2023, Australia became the first country to permit psychiatrists to prescribe psilocybin for treatment-resistant depression.
However, this treatment is only available when conventional therapies have failed, and it must be administered under medically supervised conditions.
Similar regulations exist in countries like Canada, Switzerland and New Zealand, where psilocybin can be prescribed for limited therapeutic or research purposes.
In these settings, psilocybin is typically combined with psychotherapy, which helps patients process their experiences and integrate insights gained during the session.
“Psychological support, such as psychotherapy, is an essential component of the treatment,” says Van Zyl.
This support includes preparing the patient for the experience, administering the drug in a safe environment and offering aftercare to help patients understand their experience.
Yet, even in these controlled environments, the treatment is not without risks. Therapists must be prepared to handle not only the psychological effects of psilocybin but also potential physical side effects like nausea, vomiting or increased blood pressure.
The need for further research
While the initial findings on psilocybin are promising, Sasop and other experts urge caution.
“Until there is sufficient compelling clinical evidence, and systematic research to overcome the current limitations, Sasop does not, at this stage, endorse the widespread use of psychedelic-assisted therapy,” Van Zyl explains.