Open access
Research article
First published online December 14, 2022

Risks and benefits of psilocybin use in people with bipolar disorder: An international web-based survey on experiences of ‘magic mushroom’ consumption

Emma Morton Sakai, […], and Josh Woolley all authors and affiliations
Volume 37, Issue 1




Psilocybin, the primary psychoactive component of psychedelic ‘magic mushrooms’, may have potential for treating depressive symptoms, and consequent applications for bipolar disorder (BD). Knowledge of the risks and benefits of psilocybin in BD is limited to case studies.


To support the design of clinical trials, we surveyed experiences of psilocybin use in people with BD.


An international web-based survey was used to explore experiences of psilocybin use in people with a self-reported diagnosis of BD. Quantitative findings were summarised using descriptive statistics. Qualitative content analysis was used to investigate free-text responses, with a focus on positive experiences of psilocybin use.


A total of 541 people completed the survey (46.4% female, mean 34.1 years old). One-third (32.2%; n = 174) of respondents described new/increasing symptoms after psilocybin trips, prominently manic symptoms, difficulties sleeping and anxiety. No differences in rates of adverse events overall were observed between individuals with BD I compared to BD II. Use of emergency medical services was rare (n = 18; 3.3%), and respondents (even those who experienced adverse effects) indicated that psilocybin use was more helpful than harmful. Quantitative findings elaborated on perceived benefits, as well as the potential for psilocybin trips to contain both positively and negatively received elements.


The subjective benefits of psilocybin use for mental health symptoms reported by survey participants encourage further investigation of psilocybin-based treatments for BD. Clinical trials should incorporate careful monitoring of symptoms, as data suggest that BD symptoms may emerge or intensify following psilocybin use.


Bipolar disorder (BD) is a chronic illness that affects approximately 2.5% of the world’s population (Clemente et al., 2015Merikangas et al., 2011). While manic symptoms are the defining feature of BD, patients with BD typically spend more time depressed (Judd et al., 20022003), and patients themselves rate depression as the most burdensome mood state (Mączka et al., 2010). Depressive symptoms (even subsyndromal) are associated with functional impairments, suicidality and negative impacts to quality of life (Altshuler et al., 2006Bonnín et al., 2012Hadjipavlou and Yatham, 2008Pallaskorpi et al., 2017Piccinni et al., 2007), and are equally or more disabling than hypomania and mania (Ruggero et al., 2007).
Currently available pharmacotherapies for depression in BD have limitations (Frye et al., 2014Yalin and Young, 2020). Lithium and antipsychotics are associated with significant side effects (Kemp, 2014Ketter et al., 2014), while antidepressants carry the risk of breakthrough manic symptoms (Tondo et al., 2010). Even with treatment, many patients do not adequately respond or regain full functioning (Huxley and Baldessarini, 2007Wingo et al., 2010). Novel therapeutic approaches for depressive symptoms in BD are urgently needed (Frye et al., 2014Yalin and Young, 2020), and patients have nominated the identification of alternative treatments as a research priority (Nestsiarovich et al., 2017).
Psilocybin therapy, which typically includes a brief course of psychotherapy paired with one or two administrations of the 5HT2A receptor agonist and psychedelic drug psilocybin (Johnson et al., 2008), is a promising treatment for a variety of mental health conditions including major-depressive disorder and treatment-resistant unipolar depression (Carhart-Harris et al., 201620182021Davis et al., 2021a,bGukasyan et al., 2022), substance use disorders (Bogenschutz and Johnson, 2016Johnson et al., 2014) and depression and anxiety secondary to a serious medical illness like cancer (Griffiths et al., 2016Grob et al., 2011Ross et al., 2016) and HIV (Anderson et al., 2020). Psilocybin has also been shown to induce long-lasting improvements in wellbeing in healthy humans (Griffiths et al., 2008). Together, these findings suggest that psilocybin therapy could have beneficial effects for depressive symptoms in BD as well as for the quality of life impacts and co-morbid substance use disorders that are very common and debilitating in this population.