II. Definitions
-
Psilocybin
- Tryptamine alkaloid Hallucinogen extracted from Psilocybe mexicana (Teonanacatl, Magic Mushrooms)
III. Indications
- Psilocybin (and Magic Mushrooms) have a long history of ilicit recreational use as a Psychedelic (DEA Schedule I)
- Has been proposed for management of mental health conditions
IV. Mechanism
- After ingestion, Psilocybine is rapidly dephosphorylated into the active agent, psilocin
- Psilocin activates CNS Serotonin 2A (5-HT2A)
- Psilocin has Hallucinogenic, Anxiolytic, and psychoactive properties
V. Precautions
- Even micro-dosing has potential risks (see adverse effects)
- However, overall appears to be a safe agent in therapeutic doses
- Kopra (2022) J Psychopharmacol 36(8):965-73 +PMID: 35388724 [PubMed]
- Online or Vape shop products have unknown safety and are not recommended
- Psilocybin carries Substance Abuse potential
- Safety and efficacy in mental health studies have been in controlled settings
- Standardized dosing with reliable product source
- Medical or psychiatry supervision
- Adequate social support
VI. Adverse Effects
-
Mania
- Increased risk in personal or Family History of Bipolar Disorder
- Overdose or Death
VII. Drug Interactions
-
Serotonin Syndrome
- Increased risk with other serotonergic agents (e.g. SSRI, St Johns Wort)
VIII. Efficacy
-
Major Depression
- Major Depression Management has the best associated evidence for Psilocybin treatment
- Gukasyan (2022) J Psychopharmacol 36(2):151-8 +PMID: 35166158 [PubMed]
- Raison (2023) JAMA 330(9):843-53 +PMID: 37651119 [PubMed]
IX. References
- (2024) Presc Lett 31(11): 66
- Lowe (2021) Molecules 26(10):2948 +PMID: 34063505 [PubMed]