Can psilocybin induce manic episodes?

From the Guidelines

Yes, psilocybin can potentially trigger manic episodes in some individuals, particularly those with pre-existing bipolar disorder or a personal or family history of psychotic disorders. Psilocybin is a psychedelic compound found in certain mushrooms that affects serotonin receptors in the brain, particularly the 5-HT2A receptors, which can lead to significant alterations in mood, perception, and cognition 1. The risk of mania appears higher in those with underlying mood disorders, though it can occasionally occur in people without known risk factors. Symptoms of psilocybin-induced mania may include elevated mood, decreased need for sleep, racing thoughts, grandiose ideas, increased energy, and impulsive behavior.

Key Considerations

• The therapeutic use of psilocybin requires health care providers to help prepare and then guide the patient through the treatment, which usually lasts 8 to 12 hours 1.
• Some concerns with psilocybin therapy are the risk for psychotic events and harmful behaviors in patients who do not receive appropriate guidance throughout the treatment process 1 and the potential for dependence.
• Given the limited evidence related to psilocybin safety and efficacy, the guideline recommends against its use outside of clinical trials 1.

Recommendations

• Anyone experiencing manic symptoms after psilocybin use should seek immediate medical attention, as mania can lead to dangerous behavior and requires professional management.
• People with bipolar disorder or family history of serious mental illness should generally avoid psilocybin or approach it with extreme caution under proper medical supervision.
• Further research is needed to fully understand the potential benefits and risks of psilocybin therapy, particularly in relation to manic episodes and other psychiatric conditions 1.

From the Research

Psilocybin and Mania

• Psilocybin, a psychedelic drug, has been studied for its potential therapeutic effects on various mental health conditions, including depression and obsessive-compulsive disorder 2, 3.
• However, there is concern about the potential risks of psilocybin use in individuals with bipolar disorder, particularly the risk of inducing mania 2, 3.
• A case report published in 2023 described a 21-year-old male with bipolar II disorder who developed a manic episode after ingesting psilocybin in the form of hallucinogenic mushrooms 2.
• Another study published in 2023 surveyed experiences of psilocybin use in people with bipolar disorder and found that one-third of respondents described new or increasing symptoms after psilocybin trips, including manic symptoms 3.

Risks and Benefits of Psilocybin Use

• The study found that psilocybin use was more helpful than harmful for many respondents, despite the potential risks 3.
• However, the study also highlighted the need for careful monitoring of symptoms and further research into the risks and benefits of psilocybin use in individuals with bipolar disorder 3.
• Other studies have focused on the treatment of acute mania with lithium and other medications, rather than psilocybin 4, 5, 6.
• These studies suggest that lithium can be an effective treatment for acute mania, but may have adverse effects such as tremor and somnolence 5.
• The use of lithium combined with second-generation antipsychotics may also be effective for treating manic episodes in patients with bipolar disorder 6.