“A sense of the bigger picture:” A qualitative analysis of follow-up interviews with people with bipolar disorder who self-reported psilocybin use
This qualitative follow-up of 15 adults with bipolar disorder who self-reported using psilocybin mushrooms found mixed effects: notable improvements in depressive symptoms, emotional processing, perspective-taking and sleep/relaxation, alongside risks including sleep disruption, increased mania, hospitalisation and distressing sensory experiences. Contextual factors (dose, polysubstance use, solo versus social use, pre-use sleep deprivation) influenced outcomes, and the authors conclude that carefully designed clinical trials are needed to evaluate safety and preliminary efficacy.
Abstract
Objectives
People with bipolar disorder (BD) spend more time depressed than manic/hypomanic, and depression is associated with greater impairments in psychosocial functioning and quality of life than mania/hypomania. Emerging evidence suggests psilocybin, the psychoactive compound in “magic mushrooms,” is a promising treatment for unipolar depression. Clinical trials of psilocybin therapy have excluded people with BD as a precaution against possible adverse effects (e.g., mania). Our study centered the experiences of adults living with BD who consumed psilocybin-containing mushrooms, and aimed to (1) understand its subjective impacts on BD symptoms, (2) deepen understanding of Phase I survey results, and (3) elucidate specific contextual factors associated with adverse reactions in naturalistic settings.
Methods
Following an international survey (Phase I), follow-up interviews were conducted with 15 respondents (Phase II) to further understand psilocybin use among adults with BD. As part of a larger mixed-methods explanatory sequential design study, reflexive thematic analysis was used to elaborate findings.
Results
Three major themes containing sub-themes were developed. (1) Mental Health Improvements: (1.1) decreased impact and severity of depression, (1.2) increased emotion processing, (1.3) development of new perspectives, and (1.4) greater relaxation and sleep. (2) Undesired Mental Health Impacts: (2.1) changes in sleep, (2.2) increased mania severity, (2.3) hospitalization, and (2.4) distressing sensory experiences. (3) Salient Contextual Factors for psilocybin use included: (3.1) poly-substance use and psilocybin dose, (3.2) solo versus social experiences, and (3.3) pre-psilocybin sleep deprivation.
Conclusion
Our findings demonstrate both benefits and risks of psilocybin use in this population. Carefully designed clinical trials focused on safety and preliminary efficacy are warranted.
Research Summary of '“A sense of the bigger picture:” A qualitative analysis of follow-up interviews with people with bipolar disorder who self-reported psilocybin use'
Introduction
Bipolar disorder (BD) affects roughly 2.4% of the global population and is notable for far more days spent depressed than manic or hypomanic, with depressive episodes accounting for the bulk of long‑term morbidity, functional impairment and suicide risk. Existing pharmacological treatments for bipolar depression have limited efficacy and carry risks (including possible precipitated affective switching), and people with BD have been systematically excluded from modern psilocybin clinical trials because of safety concerns, particularly the theoretical risk that serotonergic psychedelics could trigger Treatment Emergent Affective Switching (TEAS; a switch from depression to hypomania or mania). Case reports of psychedelic‑associated manic reactions exist but are few and heterogenous, leaving important gaps in knowledge about how people with BD experience psilocybin in naturalistic contexts and what contextual factors may contribute to adverse events. A. and colleagues designed a mixed‑methods study to centre people with BD who have used psilocybin mushrooms and to explore subjective impacts, contextual factors associated with adverse reactions, and implications for future clinical trials. Following an international Phase I survey, this Phase II component used semi‑structured follow‑up interviews to gain in‑depth qualitative data about patterns of benefit and harm after full‑dose psilocybin experiences and to elucidate factors (for example, dose, concurrent substance use, sleep and social setting) that participants perceived as shaping outcomes.
Expert Research Summaries
Go Pro to access AI-powered section-by-section summaries, editorial takes, and the full research toolkit.
Full Text PDF
Full Paper PDF
Pro members can view the original manuscript directly in the browser.
Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- Author
- APA Citation
DellaCrosse, M., Pleet, M., Morton, E., Ashtari, A., Sakai, K., Woolley, J., & Michalak, E. (2022). “A sense of the bigger picture:” A qualitative analysis of follow-up interviews with people with bipolar disorder who self-reported psilocybin use. PLOS ONE, 17(12), e0279073. https://doi.org/10.1371/journal.pone.0279073
References (27)
Papers cited by this study that are also in Blossom
Passie, T., Seifert, J., Schneider, U. et al. · Addiction Biology (2002)
Johnson, M. W., Griffiths, R. R. · Neurotherapeutics (2017)
Madsen, M. K., Fisher, P. M., Burmester, D. et al. · Neuropsychopharmacology (2019)
Nichols, D. E. · Journal of Antibiotics (2020)
Johnson, M. W., Griffiths, R. R., Hendricks, P. S. et al. · Neuropharmacology (2018)
Yockey, R. A., King, K. A. · Journal of Psychedelic Studies (2021)
Carhart-Harris, R. L., Bolstridge, M., Rucker, J. et al. · Lancet Psychiatry (2016)
Carhart-Harris, R. L., Bolstridge, &. M., Day, C. M. J. et al. · Psychopharmacology (2017)
Davis, A. K., Barrett, F. S., May, D. G. et al. · JAMA Psychiatry (2021)
Daws, R. E., Timmermann, C., Giribaldi, B. et al. · Nature Medicine (2022)
Show all 27 referencesShow fewer
Reiff, C. M., Richman, E. E., Nemeroff, C. B. et al. · American Journal of Psychiatry (2020)
Studerus, E., Kometer, M., Hasler, F. et al. · Journal of Psychopharmacology (2010)
Brown, T., Shao, W., Ayub, S. et al. · Journal of Psychoactive Drugs (2017)
Szmulewicz, A. G., Valerio, M. P., Smith, J. M. · International Journal of Bipolar Disorders (2015)
Morton, E., Sakai, K., Ashtari, A. et al. · Journal of Psychopharmacology (2022)
Belser, A. B., Agin-Liebes, G. I., Swift, T. C. et al. · Journal of Humanistic Psychology (2017)
Ona, G., Bouso, J. C. · Neuroscience and Biobehavioral Reviews (2020)
Carhart-Harris, R. L., Roseman, L., Haijen, E. C. H. M. et al. · Journal of Psychopharmacology (2018)
Agin-Liebes, G. I., Ekman, E., Anderson, B. T. et al. · Journal of Humanistic Psychology (2021)
Watts, R., Day, C. M., Krzanowski, J. et al. · Journal of Humanistic Psychology (2017)
Ross, S., Bossis, A. P., Guss, J. et al. · Journal of Psychopharmacology (2016)
Griffiths, R. R., Johnson, M. W. · Journal of Psychopharmacology (2016)
Grob, C. S., Danforth, A. L., Chopra, G. S. et al. · JAMA Psychiatry (2011)
Madsen, M. K., Fisher, P. M., Stenbæk, D. S. et al. · European Neuropsychopharmacology (2020)
Baumann, M. H., Carrera, I., Scorza, C. et al. · Frontiers in Pharmacology (2018)
Maclean, K. A., Johnson, M. W., Griffiths, R. R. · Journal of Psychopharmacology (2011)
Griffiths, R. R. · Journal of Psychopharmacology (2008)
Cited By (4)
Papers in Blossom that reference this study
Aday, J. S., Mcafee, J., Conroy, D. A. et al. · Frontiers in Pain Research (2025)
Simonsson, O., Mosing, M. A., Osika, W. et al. · JAMA Psychiatry (2024)
Aaronson, S. T., van der Vaart, A., Miller, T. et al. · JAMA Psychiatry (2024)
Herrmann, Z., Levin, A. W., Cole, S. P. et al. · Psychedelic Medicine (2023)
Your Personal Research Library
Go Pro to save papers, add notes, rate studies, and organize your research into custom shelves.