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Psilocybin for clinical indications: A scoping review

Summary

This comprehensive review examined over 190 research studies on psilocybin (the active compound in magic mushrooms) as a medical treatment. The research shows promise for treating depression, anxiety, substance use disorders, and chronic pain, though most studies conducted so far have been small in size. While the evidence is encouraging, researchers emphasize the need for larger, better-designed clinical trials to fully understand psilocybin’s benefits and safety profile.

Background

Psychedelic drugs have been of interest in medicine since the early 1950s, with a recent resurgence in clinical research on psilocybin. Psilocybin, derived from hallucinogenic mushrooms and metabolized into psilocin, acts as a 5-HT2A serotonin receptor agonist with potential therapeutic applications. There has been growing legislative interest in psilocybin’s medical use, with 25 U.S. states considering psychedelic reform bills and Canada allowing access through the Special Access Program.

Objective

This scoping review aims to comprehensively assess the available literature on psilocybin for any clinical indication, including study designs, characteristics, indications studied, doses, and authors’ conclusions. The review seeks to identify research gaps and areas for further study to guide high-quality randomized trials on promising clinical uses for psilocybin.

Results

The review included 193 published studies and 80 ongoing studies. Only 12.4% of included studies were randomized controlled trials, with 37.3% being systematic reviews. The median sample size was 22 participants with 18 having taken psilocybin. Depression was the most common indication (28%), followed by substance use disorders (14.5%), mental health in life-threatening illness (8.8%), and headaches (6.2%). Positive or promising conclusions were reported in 59.1% of studies.

Conclusion

While substantial literature on psilocybin spans over six decades with increasing publications, most studies are preliminary with small sample sizes and few high-quality RCTs. Most research focuses on psychiatric disorders, but emerging interest exists in chronic pain conditions. Future research requires larger, high-quality randomized controlled trials in diverse patient populations and expansion to promising non-psychiatric indications.
  • Published in:Journal of Psychopharmacology,
  • Study Type:Scoping Review,
  • Source: PMID: 39135496, DOI: 10.1177/02698811241269751
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