Everything You Need to Know About Psychedelic Treatments

Psychedelic substances are gaining traction beyond their traditional circles. Researchers highlight their potential to address a variety of mental health conditions, while prominent figures in technology and entertainment openly endorse microdosing. Even political personalities once considered unlikely advocates have begun supporting these compounds.

Recently, we invited readers to submit their questions about psychedelics — their therapeutic uses, associated risks, and availability. This article compiles expert responses to those inquiries, providing informed perspectives on this rapidly evolving field.

Andrew Jacobs, a specialist covering psychedelic medicine, offers detailed answers below.

Which psychedelics are commonly used in therapy, and what distinguishes them? — Laura Wilcox, Arlington, Massachusetts

Several psychoactive substances have shown promise in treating disorders such as depression, anorexia, and post-traumatic stress disorder. While ketamine is not a classic psychedelic, it is often grouped with these compounds due to its effects on perception. Here is a brief overview of the main agents currently explored in clinical settings.

Are psychedelics being explored as treatments for dementia or cognitive decline? — Ginger Gillison Schlather, Washington, D.C.

Research on this front remains preliminary. Scientists are particularly focused on how psychedelics influence neuroplasticity, mood regulation, and neuroinflammation—a major factor in Alzheimer’s disease progression. For example, studies are underway to determine if psilocybin can alleviate depression and enhance quality of life in individuals with early-stage Alzheimer’s.

What conditions can psychedelics treat, and do their effects differ for those with mental health disorders? — Vee Crichton-Hill, St. Paul, Minnesota

Numerous clinical trials are investigating psychedelics for anxiety related to end-of-life, depression, traumatic brain injury, and obsessive-compulsive disorder among others. Currently, ketamine is the only drug legally prescribed off-label for treatment-resistant depression. MDMA is close to approval for PTSD treatment, and psilocybin analogs are advancing toward approval for severe depression. Individuals with personality disorders are often excluded from trials due to concerns about adverse reactions.

What risks are associated with psychedelic use? — Jay Cantwell, Providence, Utah

When taken in controlled doses under professional supervision, psychedelics generally present a low risk profile. However, short-term psychological effects such as anxiety, paranoia, and confusion can occur, especially during intense experiences. Long-term data is limited, though rare instances of persistent paranoia, mood disturbances, and hallucinations resembling schizophrenia have been reported.

How involved are major pharmaceutical companies in developing psychedelic treatments? — Emily Miller, Traverse City, Michigan

Currently, most psychedelic compounds are produced by startups and independent firms. As regulatory approvals expand, larger pharmaceutical companies are expected to enter this growing market, which is projected to increase from $3 billion to $8 billion by 2032. Challenges include the natural origin of many substances, like psilocybin mushrooms, which limits patentability. To navigate this, companies may modify molecular structures or delivery methods to secure intellectual property rights.

Ernesto Londoño, who has researched drug policy extensively, provides additional insights.

How widespread is psychedelic use in the U.S., and which age groups are most involved? — Helen Young, Massachusetts

Use of psychedelics is increasing, particularly among young adults. Recent surveys show that nearly 10 percent of individuals aged 19 to 30 reported using psychedelics within the past year—a record high. Among older adults, over 5 percent reported usage, representing a fivefold rise since 2019.

Is it true that some users become "stuck" in psychedelic experiences, sometimes leading to institutionalization? How common is this? — Jeff Feiler, Florence, New Jersey

"Bad trips" can vary greatly in intensity. Rarely, individuals experience prolonged perceptual distortions and difficulty functioning for days or months, a condition known as hallucinogen persisting perception disorder, whose causes are not yet understood. For example, a 2023 incident involved an off-duty pilot experiencing a breakdown after mushroom use. More frequently, challenging trips involve confronting traumatic memories or intense fear akin to nightmares.

How can one minimize the risk of a bad trip? — Laura Knispel, Des Moines

Certain precautions can improve safety and reduce panic during psychedelic experiences. Having an experienced, trustworthy guide present is highly beneficial, although caution is advised as unqualified individuals sometimes offer guidance. Starting with a low dose is recommended, particularly for those prone to anxiety. Testing kits are available online to verify substance purity. Nonetheless, no method guarantees complete avoidance of adverse reactions.

Where are psychedelics legally permitted for mental health treatment, and how do state regulations differ? — Jane Tippet, Manhattan, Kansas

Ketamine-assisted psychotherapy is widely accessible across the United States but carries risks such as potential addiction and bladder complications. Oregon and Colorado have legalized psilocybin use in supervised therapeutic settings, with New Mexico preparing to implement similar programs. Other states are closely monitoring these developments. However, under federal law, the manufacture, sale, or possession of substances like psilocybin mushrooms, ayahuasca, LSD, and peyote remains illegal.

How can individuals access these treatments without legal repercussions or traveling abroad? — Alex Carswell, Pasadena, California

Certain religious organizations have received exemptions from the Drug Enforcement Administration allowing the importation and ceremonial use of psychedelics under religious freedom protections. The Native American Church was granted such dispensation for peyote in the 1980s, and more recently, churches in Oregon, Arizona, and Washington have been allowed to use ayahuasca as a sacrament. Additionally, some psychedelic practitioners have begun operating retreats under the guise of religious institutions, though the legal status of these groups is often unclear.