Psilocybin: Insights From A Psychiatrist For Depression

As a psychiatrist for depression and other mental illnesses, I see firsthand the struggles of my patients. While there are many FDA-approved pharmaceutical drugs and approved therapies for these conditions, I believe psilocybin also has potential as a therapeutic tool, especially for patients who may not have responded well to traditional treatments. Let’s take a look at this often-controversial subject.

What Is Psilocybin?

Psilocybin, often known as “magic mushrooms,” is a naturally occurring psychedelic compound found in some types of mushroom species. It is classified as a hallucinogen and has been used for centuries in spiritual and therapeutic practices.
When consumed, psilocybin is metabolized into psilocin in the body, which then binds to serotonin receptors in the brain. This interaction results in changes to perception, mood, and consciousness, often leading to visual and auditory hallucinations.​

A study at Washington University in St. Louis tracked changes in the brain before and after the use of psilocybin. The researchers found that a microdose of psilocybin had a profound effect on what is known as functional connectivity. This refers to how different regions in our brains communicate and work together to perform tasks or process information.
Essentially, it is postulated that small doses of psilocybin, given in controlled circumstances, might act as a sort of “reset” for our brains. Research suggests that psilocybin may boost our brain’s ability to reorganize and form new and healthier patterns of thought and behavior. It may help patients improve emotional processing as well as emotional regulation.

Is Psilocybin Legal?

Psilocybin remains illegal under federal law in the United States. Keep in mind, many states of legalized the use of marijuana, both for therapeutic and recreational use, yet this drug still remains illegal at the federal level.

Psilocybin is classified by the U.S. government as a Schedule I controlled substance under the Controlled Substances Act. In 2018, researchers at Johns Hopkins University, a world-renowned facility for medical research,  recommended that this drug be reclassified as a Schedule IV drug.

Schedule I drugs are those that the government has categorized as those with no currently acceptable medical uses and with a high potential for abuse. The schedule also includes drugs such as marijuana, LSD and heroin. Schedule IV drugs include drugs such as Xanax, Ambien, Valium and others that have accepted medical uses and a lower potential for abuse than drugs in Schedule I, II and III.

Keep in mind, these are categories developed by the government, and don’t necessarily reflect the opinions of all medical professionals, nor do they necessarily reflect the results of current scientific research.
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Despite the illegality at the federal level, several states and localities have enacted measures to decriminalize or legalize psilocybin for medical or therapeutic use, including:

• Oregon: Oregon was the first state to legalize psilocybin for therapeutic use. Adults aged 21 and older may access psilocybin in licensed service centers under the supervision of trained professionals.
• Colorado: In 2022, Colorado voters approved a measure to legalize psilocybin for therapeutic use in regulated settings.
• New Mexico: In April 2025, New Mexico passed the Medical Psilocybin Act, legalizing psilocybin for medical use under a regulated program. However, this will not be fully implemented until 2028. 

Additionally, several cities in the United States have decriminalized psilocybin, meaning that law enforcement may treat offenses related to psilocybin as a low priority:

• California: Cities including Oakland, Santa Cruz, San Francisco, Berkeley, and Eureka have decriminalized psilocybin, reducing penalties for possession. However, statewide laws still classify psilocybin as a controlled substance, and cultivation or distribution remains illegal. As a psychiatrist in Westlake Village, I am hopeful that Los Angeles and Ventura counties will eventually follow suit and decriminalize the psilocybin therapeutically.
• Washington, D.C.: In 2020, Initiative 81 was passed, making the enforcement of laws against psilocybin a low priority for law enforcement.

Potential Therapeutic Uses for Psilocybin

For many years, researchers were unable to legally study psychedelics, but in the last few decades, we’ve been able to begin studying the impact that these substance might have on healthy individuals as well as those who needed help with specific issues, ranging from depression to PTSD to anxiety and even with various substance use disorders, such as smoking and alcoholism.

Johns Hopkins, the facility that in 2018 recommended reclassifying psilocybin from Schedule I to IV, launched a center for psychedelic research in 2019, and in 2021, the university was awarded the first federal grant from the National Institutes of Health to explore the impact of using psilocybin for tobacco addiction.

While Johns Hopkins is not the only institution studying psychedelics, their results have been very promising so far. For instance, some of their studies have shown that psilocybin can be an effective treatment for depression, including major depressive disorder and treatment resistant depression.

In one study, participants were given two doses of psilocybin two weeks apart. The results were very promising, as the participants saw large decreases in severity and symptoms of depression and, for many, the results were long-term, lasting a year after the treatment. While larger studies and clinical trials are needed, this is an excellent result, and, as a medical doctor and mental health professional, I have high hopes that further research will yield similar outcomes.
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As a psychiatrist for depression, as well as a psychiatrist for anxiety and PTSD, I believe that psilocybin has great potential for treating many mental health conditions. In addition to treating depression, it may be useful for treating anxiety, PTSD, OCD, and it’s been found to be highly beneficial for helping in end-of-life care, helping terminally ill patients cope with the fear and depression related to dying.

Who Should Avoid Psilocybin Therapy?

Again, it is important to note that psilocybin is only legal in a few areas, and, even in these areas, it is restricted to therapeutic use in controlled settings. While I do believe psilocybin potentially can benefit some people, this therapy is not suitable for individuals with certain conditions or situations, including:

• Individuals with a history of psychosis or schizophrenia: Psilocybin can trigger or worsen psychotic episodes in those with a family or personal history of schizophrenia or related conditions. As a bipolar psychiatrist, I do not recommend this drug for patients with bipolar disorder, schizophrenia and other conditions that can cause psychosis.
• People with severe personality disorders: Conditions such as borderline personality disorder or antisocial personality disorder may make it more difficult to process the intense emotions and experiences psilocybin can provoke. As a borderline personality disorder doctor, I don’t recommend psilocybin for these conditions.
• Those with uncontrolled medical conditions: Individuals with unstable cardiovascular conditions (like heart disease) or severe epilepsy might be at higher risk due to the physiological effects of psychedelics.
• Pregnant or breastfeeding women: While there is limited research on psilocybin’s effects during pregnancy or breastfeeding, it’s generally advised to avoid it due to potential risks to fetal development or infant health.
• People currently taking certain medications: Psilocybin can interact with medications like antidepressants (especially SSRIs), antipsychotics, and blood pressure medications, possibly leading to adverse effects. For those on SSRIs, it is strongly recommended that you taper off these drugs before taking any type of psychedelic.
  
• People with unrealistic expectations or insufficient psychological support: Psilocybin therapy often involves intense emotional experiences that require proper guidance. Those who aren't prepared mentally or don’t have access to professional support may struggle with the process. 

What About Addiction?

As an addiction psychiatrist, I have concerns that some people with a history of substance abuse may be more likely to misuse psilocybin, even if it’s used in a therapeutic setting. However, while I have concerns, there have been four clinical trials that showed psilocybin seemed to benefit the subjects.

Keep in mind, these are very small, limited studies that only included individuals with alcohol and tobacco use disorders.  The psilocybin also was combined with some form of psychotherapy, such as talk therapy or cognitive behavioral therapy. With any type of medicine, adding a therapy component tends to increase the success of treatment significantly.
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If you are struggling with a substance use disorder, other types of treatments might be a better option than psilocybin for some people. If you are struggling with addiction, please contact me, and we will create a treatment plan that helps guide you into a successful recovery.

Potential Side Effects

While you likely have heard about the potential for hallucinations, in non-therapeutic doses and non-therapeutic settings, psilocybin may cause some uncomfortable or even dangerous side effects such as anxiety and paranoia, mood swings, confusion and difficulty concentrating or thinking rationally.
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Psilocybin also may cause nausea and vomiting, increased heart rate, increased blood pressure, muscle weakness and dizziness. When taken in non-therapeutic doses, it also can cause a “bad trip,” which might include high levels of fear and even panic attacks, and it can be difficult to process these emotions in an altered state. 

Final Thoughts

When we talk about the benefits of psilocybin, it’s important to remember that this drug was given in small doses in a safe, monitored setting. While I do believe that psilocybin has great potential to treat depression, PTSD and other illnesses, I also believe this drug needs to be given in a controlled setting with purpose and intent, just as we do when we provide ketamine treatments.
 
I am hopeful that more areas in the country will decriminalize its use and that larger studies will be done, as I believe the results will offer great hope to many people struggling with mental health disorders, especially for those who have not responded to traditional medications and therapies.
 
As a psychiatrist for depression, I can provide you with a myriad of treatment options, including more unique treatments such as using Auvelity, which I wrote about in my last blog post. This is a pharmaceutical drug that, in some ways, mimics what psilocybin can do, working as a type of reset for our brain. We also have options such as nasal esketamine and Transcranial Magnetic Stimulation, or TMS.  
 
If you are struggling with depression, anxiety, PTSD or other mental health issues, please contact me at any time to schedule a consultation. I work as a psychiatrist in Westlake Village, and serve clients in Thousand Oaks, Agoura Hills, Simi Valley and other nearby cities. We can work together to develop a treatment plan that addresses all of the issues you are facing and help you enjoy a healthier and happier life.