Education / Research

Are Psychedelics Safe With Bipolar Disorder or a History of Psychosis?

Last reviewed

Bipolar disorder and psychosis are the two histories most often named as reasons to be careful with psychedelics, and the two questions people are searching for more and more. The honest answer is that the risk looks low for most people and real for some, and that the people most at risk are the ones least studied.

This page goes through what has been found. It is not medical advice, and it is not a green light. Every study links to its source.

Mania and bipolar disorder

Reviews

A review of manic symptoms after psychedelics

A systematic review looked at human studies of manic or hypomanic symptoms after psilocybin, LSD, mescaline, DMT, or MDMA. It included 23 studies, only a few of which could be pooled. The authors report rates of dysphoria, euphoria, hypomania, or mania ranging from about 6 percent in controlled psilocybin therapy trials for major depression to about 30 percent in naturalistic studies of people with bipolar disorder. When symptoms appeared they were usually short and settled on their own. In observational studies, higher risk went with bipolar I disorder, a family history of bipolar illness, using several substances, and unsupervised use.

Worth knowing

The two ends of that range count different things, such as euphoria in trials and new or increased symptoms in surveys, so they are not directly comparable. The naturalistic data is self-reported and the studies carried a substantial risk of bias. The authors conclude the risk of short-lived mood symptoms is low but real for susceptible people, and say long-term effects and repeated use need better study.

Small or open-label trials

Bipolar II depression: a small open-label trial

Of 19 people enrolled in a 12-week, open-label trial of one psilocybin session with psychotherapy for treatment-resistant bipolar II depression, results are reported for 15. Depression scores improved by an average of 24 points at week 3, with 12 people meeting the criteria for response and 11 for remission. Scores on a mania rating scale and on a suicidality scale did not change significantly, and the most common side effect was headache on the day.

Worth knowing

Fifteen people, no comparison group, and bipolar II only: the authors say it is premature to extend the results to bipolar I. Baseline mania and suicidality scores were low, which leaves little room to see change. The authors say larger studies are needed.

Psychosis

The safety review on our microdosing safety page also found that serious events, including psychosis, occurred in about 4 percent of trial participants who already had a neuropsychiatric condition, and in none of the healthy volunteers.

Case reports and surveys

A national survey: family history may matter most

A survey of 2,822 US adults, sampled to reflect the national population by sex, age, and ethnicity, included 613 who had used psychedelics. Lifetime use was not linked to psychotic symptoms in the past two weeks, though it was linked to more unusual visual experiences over a lifetime, and 1.3 percent of users said a professional had diagnosed them with hallucinogen persisting perception disorder. A family history of psychotic or bipolar disorders, though not a personal history, changed the picture: users with a family history had the highest recent psychotic symptoms.

Worth knowing

A one-time, self-reported survey, so it cannot show cause. The authors urge caution and call for studies that follow people over time and use genetic risk measures.

Psychopharmacology, Simonsson et al.

Psychedelic use and psychiatric risks →
Reviews

The safety guidelines researchers follow

Researchers at Johns Hopkins wrote safety guidelines for human studies of psychedelics. They describe the main risk as overwhelming distress during the experience, with prolonged psychosis a rarer risk. Their safeguards: screen out people with a personal or family history of psychotic disorders or other severe psychiatric conditions, build trust and prepare people carefully beforehand, use a safe physical setting, have at least two monitors present, and follow up afterward. The authors say lasting adverse reactions are rare when research follows these guidelines.

Worth knowing

These are 2008 guidelines for supervised research, not a protocol for use on your own. They show what careful studies do. They do not show that doing it yourself carries the same low risk.

What about microdosing?

We have not found studies of microdosing in people with bipolar disorder or a history of psychosis. The trials above used full-strength, supervised sessions in screened people, so they cannot tell us what repeated small amounts would do.

If this applies to you

If you or a close relative has bipolar disorder, schizophrenia, or a history of psychosis, please talk to a psychiatrist before trying anything. Do not stop or change a prescription on your own, and tell your prescriber what you are considering.

If you are thinking about harming yourself or are in crisis, call or text 988 in the US to reach the Suicide and Crisis Lifeline, any time.

Keep reading

This page is for adults 21 and older. It summarizes published research for education only. It is not medical or legal advice, and it makes no claim that any product sold by Luna treats, cures, prevents, or helps any condition. Laws about these mushrooms vary by place, and you are responsible for knowing yours.

Research moves quickly. We last checked this page against its sources on , and we will correct it if we get something wrong.