Adolescents

This report summarises what the Blossom database shows about psychedelics and adolescents, and, just as importantly, what it does not show. The short version: adolescents are a developing-brain, high-need population that the modern psychedelic field has studied almost entirely from the outside. The one mature clinical thread in under-18s is ketamine and esketamine for depression and acute suicidality, where the benefits are real but modest and often matched by active-placebo arms. For classic psychedelics and MDMA there is essentially no completed controlled therapeutic evidence in minors. Both halves of that sentence matter.

A note before the evidence

This page is a research summary, not medical advice, and nothing here is a treatment recommendation. Psychedelics are not approved treatments for anyone under 18, and several carry real risks that are amplified in a still-developing brain. Adolescent use of these substances outside a research setting can be dangerous. If you or a young person you care for is struggling, including with thoughts of suicide, please speak to a qualified clinician or a local crisis service rather than acting on anything described here.

How to read the numbers on this page

Blossom currently tracks 132 papers and 19 clinical trials tagged to this topic, and those counts appear on this page. They are broader than they look. The adolescent tag is leaky: it catches papers about recreational use, epidemiology, developmental toxicology, drug-safety surveillance and even adult trials that merely mention young people, not just studies testing a psychedelic as a therapy for adolescents. Once you strip those out, the genuinely adolescent-specific evidence is a much smaller set, on the order of a couple of dozen papers, and within that set the only prospective controlled trials are for ketamine and esketamine. Read the numbers as a measure of how much ground the database covers, not as a count of adolescent treatments.

Why adolescents are studied differently

Adolescence is not just a younger version of adulthood. The brain is still maturing into the mid-twenties, with synaptic pruning and the strengthening of long-range connections continuing throughout the teenage years. That makes the developing brain potentially more sensitive to drugs that act powerfully on serotonergic and glutamatergic signalling, and it makes the long-term consequences harder to predict. Layered on top is a heavy clinical need: the World Health Organization reports that around one in seven 10 to 19-year-olds lives with a mental disorder and that suicide is the third leading cause of death in 15 to 29-year-olds[1]WHO.

Those two facts pull in opposite directions. The need invites bold thinking about new treatments; the biology and the ethics demand caution. In practice the ethics usually win, and minors are excluded from psychedelic trials almost as a default. That is why the evidence base for adolescents is so much thinner than for adults, and why it leans so heavily on observation, epidemiology and extrapolation rather than on randomised trials. It is also why the appropriate posture for this whole field is humility: the gap in the evidence is not an oversight to be rushed past, it is a deliberate, protective feature of how research in young people is done.

Ketamine and esketamine: the only mature clinical thread

If there is a real adolescent story in this database, it is ketamine. The most rigorous single result is a 2026 Phase 2b trial of intranasal esketamine in 147 adolescents at imminent risk of suicide[2]J. Am. Acad. Child Adolesc. Psychiatry (2026), which compared esketamine against an active placebo, midazolam, on top of standard care. The higher esketamine doses produced a statistically significant 5.8-point advantage on the childhood depression rating scale at 24 hours (95% CI -11.19 to -0.35), but, tellingly, suicidality fell sharply in every arm, with no significant advantage for the drug. A separate randomised trial of repeated intravenous esketamine in 54 adolescents[3]J. Am. Acad. Child Adolesc. Psychiatry (2024) did find greater reductions in both suicidal ideation and depression than midazolam.

The negative and null results matter just as much. A 2026 emergency-department pilot of a single ketamine infusion in 20 adolescents[4]BMC Psychiatry (2026) did not significantly reduce suicidal ideation at 40 minutes; its clearest signal was fewer subsequent hospitalisations, and the authors framed it explicitly as a feasibility study. An earlier open-label series of intravenous ketamine in 13 adolescents with treatment-resistant depression[5]J. Child Adolesc. Psychopharmacol. (2018) reported a 42 per cent drop in depression scores, but only 5 of the 13, around 38 per cent, actually met the response threshold. A systematic review concluded that the whole paediatric ketamine evidence base came to just six studies and 46 participants, with a mean age of about 15.7[6]Psychiatry Research (2022).

Two cautions frame all of this. First, ketamine and esketamine are NMDA-receptor dissociatives, not classic serotonergic psychedelics, so their adolescent data say little or nothing about psilocybin, LSD or MDMA. Second, the adult ketamine literature, which is far larger, is itself dogged by placebo: a meta-analysis found that placebo response could account for up to 72 per cent of the total treatment response in ketamine and esketamine depression trials[7]Frontiers in Psychiatry (2024). The fairest summary is that ketamine offers a genuine but small and short-lived benefit in acute adolescent crises, is being studied carefully, and is not a cure.

Classic psychedelics in minors: almost no controlled evidence

For psilocybin and LSD, the honest statement is that there is no completed controlled trial in adolescents. The nearest active work is an early-phase study using a psilocybin-augmented mental-imagery intervention for young people who self-harm, which is recruiting rather than reporting results. Everything else is indirect: epidemiology, naturalistic surveys that are overwhelmingly of adults, safety surveillance and a handful of historical case series.

History is worth a glance, because it is sobering rather than encouraging. In 1962 a study gave LSD-25 to twelve autistic, largely mute children[8]Archives of General Psychiatry (1962), hoping the drug might unlock speech. It produced an assortment of somatic and psychic effects, but the hoped-for shift from muteness to language did not happen. The lesson is not that the compounds are worthless, but that enthusiasm has run ahead of evidence in this population before, and that the careful, consent-focused, trial-based path is the one that protects young people.

Ayahuasca in ritual settings: the oldest and most-cited data

The single richest source of classic-psychedelic data on actual minors comes from Brazil, where the Santo Daime and Uniao do Vegetal churches use ayahuasca as a sacrament and where some adolescents grow up within that practice. A cluster of 2005 studies compared these adolescents with matched controls and found lower frequencies of anxiety and attentional problems[9]J. Psychoactive Drugs (2005), no differences across a neuropsychological battery[10]J. Psychoactive Drugs (2005), and lower past-year alcohol use, 46.3 against 74.4 per cent[11]J. Psychoactive Drugs (2005).

It is tempting to present this as evidence that a psychedelic is safe or even good for teenagers. It is not. The studies are observational, come from one cultural setting and largely one research group, are now about two decades old, and cannot disentangle the brew from the strong, protective social structure of a religious community. A later developmental-toxicology review judged that ritual ayahuasca does not appear to be seriously toxic to humans[12]J. Psychoactive Drugs (2013) while emphasising how limited the human data on adolescents and on prenatal exposure remain. The practice of permitting children and pregnant women to consume ayahuasca in these churches[13]J. Psychoactive Drugs (2011) has itself been the subject of genuine ethical dispute. This is data about ceremonial cultural use, not about a clinical treatment, and it should be read that way.

MDMA: adult promise, adolescent absence

MDMA-assisted therapy for post-traumatic stress disorder is one of the most-discussed developments in psychiatry, but its evidence is an adult Phase 3 programme[14]Nature Medicine (2021), and the single registered trial of MDMA-assisted psychotherapy for adolescent PTSD was withdrawn before enrolling anyone. So there is no completed therapeutic study of MDMA in minors. What the adolescent literature does contain is a different and more cautionary picture: trauma-exposed teenagers with PTSD and substance-use disorders use MDMA more than their peers[15]Eur. J. Psychotraumatology (2021), which is a self-medication signal, and infants exposed to MDMA in pregnancy show dose-dependent motor delays[16]Human Psychopharmacology (2015).

Where young people, parents and clinicians have actually been asked about adolescent MDMA therapy, they tend to move from scepticism to cautious openness once the model is explained, but they consistently say that research has to come first[17]J. Psychopharmacology / Drug Sci. (2023). That instinct matches the evidence. The adult results are a reason to design careful adolescent trials, not a licence to treat young people now.

What the population data actually says

Because controlled trials are scarce, much of the adolescent conversation leans on population data, which has to be handled carefully. Adolescent use of classic psychedelics is uncommon and, for several drugs, flat or falling: one analysis found hallucinogen use among US high-school students fell from 13.3 per cent in 2001 to 7.0 per cent in 2019[18]Children (2022), and the same study found that the adolescents who did use had higher odds of hopelessness, suicidal thoughts and suicide planning. That is the opposite of the reassuring narrative, and it is a useful corrective.

The most genetically rigorous datapoint comes from a Swedish study of 16,255 twins[19]JAMA Psychiatry (2024), which found that, after adjusting for other drug use, naturalistic psychedelic use was associated with fewer psychotic symptoms at age 15 (a beta of -0.39, 95% CI -0.50 to -0.27), yet interacted with genetic vulnerability to schizophrenia and bipolar disorder to increase manic symptoms. The crucial word in all of this is associated. These are observational findings, self-selected and confounded, in a group where almost everyone who used a psychedelic also used other drugs. They generate hypotheses; they do not establish that psychedelics help or harm adolescent minds, and the YRBSS data point the other way. Direction of effect remains genuinely unresolved.

Safety and the developing brain

Safety, not efficacy, is the centre of gravity for this population. A systematic review of psychedelic-induced psychosis found 93 documented cases with an average age of 23.7, of whom about a third went on to develop a schizophrenia-spectrum disorder[20]Asian J. Psychiatry (2025), a reminder that the people most exposed to these drugs are young and that a minority experience lasting harm. Persisting visual disturbances, known as hallucinogen persisting perception disorder, and acutely distressing experiences are real, if uncommon, outcomes. Poison-centre data show that reported exposures to LSD and psilocybin mushrooms are concentrated in 13 to 29-year-olds[21]J. Psychopharmacology (2018), although serious effects in those reports were infrequent.

None of this means psychedelics are uniquely dangerous, but it does mean that the developing brain raises questions adult data cannot answer, and that the people most likely to use these substances recreationally are precisely the age group with the least evidence and the most at stake. A serious adolescent research programme has to treat psychosis risk, especially in those with genetic vulnerability, persisting perceptual effects, and long-term developmental outcomes as primary questions, not footnotes.

The trial pipeline

The forward signal is the pipeline, and it is lopsided. The active and recently completed adolescent trials are overwhelmingly ketamine and esketamine for depression and acute suicidality, including studies of ketamine for youth suicide attempters, subcutaneous ketamine for suicidal depressive episodes, and intravenous ketamine for suicidal adolescents in the emergency department. For the classic psychedelics there is essentially one early-phase psilocybin self-harm study and little else. A notable share of the tagged adolescent trials are withdrawn, terminated or of unknown status, including the lone adolescent MDMA trial, which is a realistic feature of an early and cautious field rather than a footnote to gloss over.

Reading this honestly

So where does that leave a careful reader? The need is real: a large, under-served population of young people, and treatments that do not work for everyone. The mature evidence is narrow: small ketamine and esketamine trials for acute crises, with modest, often placebo-matched benefits. The classic-psychedelic evidence in minors is close to absent, resting on decades-old observational ayahuasca data and on adult results that cannot simply be read across to a developing brain. And the safety questions are serious enough that excluding minors from trials has been the right default. The promise is worth taking seriously precisely by refusing to overstate it. That is the honest position, and it is the one this page tries to model.