Psychedelics and sexual functioning: a mixed-methods study

Introduction

Barba and colleagues begin by situating the research within the recent revival of clinical interest in classic psychedelics after decades of limited study. Earlier clinical and anecdotal work suggests that substances such as psilocybin can reduce depressive symptoms and improve wellbeing, and qualitative accounts have reported changes in sexual attitudes and experiences after psychedelic use. Sexual dysfunction is common in major depressive disorder (MDD) and is a frequent adverse effect of selective serotonin reuptake inhibitors (SSRIs), creating both quality-of-life and treatment-adherence concerns. Despite these converging lines of interest, the post‑acute effects of psychedelics on sexual functioning had not previously been tested quantitatively. The present paper set out to address that gap by combining data from two independent investigations with complementary designs: a large naturalistic prospective survey of people planning psychedelic experiences in community and ceremonial settings (Study 1), and a Phase II double‑blind randomised controlled trial (Study 2) that compared psilocybin therapy with the SSRI escitalopram in patients with MDD. The authors aimed to assess post‑acute changes in multiple domains of sexual functioning and satisfaction, and to compare effects between psilocybin and escitalopram within the RCT context. By bringing together observational and experimental data, they intended to provide an initial quantitative estimate of whether psychedelic use influences sexual wellbeing beyond acute drug effects.