Can Psilocybin Treat PTSD? Reviewing the Clinical Evidence

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The unfortunate reality for many living with PTSD is that conventional treatment isn’t effective or is only partially effective. Post-traumatic stress disorder (PTSD) has baffled the medical world for pretty much... forever. There are only two therapies available for people with PTSD: medication and psychotherapy. The trouble for many is that these therapies are ineffective, even when combined.

And so, for most with PTSD, it becomes a chronic, lifelong condition.

But there is another, third option.

Yes, we're talking about psychedelics—namely Psilocybin mushrooms.

A brief history of healing with mushrooms.

Psilocybin mushrooms have a rich and ancient history of being used for healing and transformation. The Mazatec community have long used these psychedelic fungi for connection with the divine and to cure spiritual and emotional blockages which manifest as tensions believed to be the root of physical ailments.

Today, there are a couple of dozen mushroom healers in Huautla – and Sabina’s home survives as a shrine to the famed chjoón chjine (“wise woman”). Every week, hundreds of mostly Mexican tourists visit Huautla, a state-approved pueblo mágico. Some visit the museum after sacred pilgrimages up a hill overlooking Sabina’s former abode. Ceremonies (known as kuá tí na kuáñ), in which the local fungi that grow abundantly during the rainy season are consumed, can help identify the causes of diseases, give hints on how they can be treated and clear tensions, our guide tells me as we stand next to a mural depicting ancestral local use of psychedelic mushrooms.

In the 1500s, Spanish missionaries who sought to Christianise Indigenous people across Latin America were horrified by the mushroom ceremonies. The clergy attempted to prevent the use of psilocybin mushrooms and destroy evidence of their history of use – which may go back 4,000 years in the region. 

From 1968, as a draconian reaction to the anti-Vietnam war hippie movement and the “turn on, tune in, drop out” counterculture – fuelled by the awakening powers of psychedelics, then considered a threat to the US establishment – magic mushrooms were made illegal. “Psychedelics arrived like bombs into society,” says Terrance McKenna, one of the fathers of modern mycology. “They are transformative and disruptive, but the authoritarian powers that be do not want to hear that their kids are going to take strange drugs and become alienated from them.” 

But the recreational and spiritual use of magic mushrooms increased under the radar and in recent years has shed its politicised taboos. Justin Bieber was photographed this year wearing a shroomy pearl necklace. Harry Styles thinks they boosted his creativity. Jaden Smith has extolled how everything is beautiful on shrooms, and legitimate shops in Canada are now selling openly after police suggested they have more important things to do than shut them down. Coldplay frontman Chris Martin spoke about the drug provided the “confirmation I needed about how I feel about the universe”. 

Today, Psilocybin mushrooms have become mainstream enough to overcome this long-standing political stigma, joining the ranks of MDMA when it was granted “breakthrough therapy” designation for its potential to treat certain mental health issues, like anxiety, addiction, depression. This move enables the medical world to study Psilocybin in a clinical context, which is bound to help us better understand how, and why, Psilocybin mushrooms can accelerate healing from PTSD.

Now that you know how we got here, let's talk about what you're going to learn.

In this article, we’re talking about PTSD, why it occurs, current treatment options (and their limitations), and how treatment with Psilocybin mushrooms helps to accelerate recovery from PTSD. Lastly, we share an overview of past and ongoing research shining a light on its clinical potential.

What is PTSD?

PTSD (Post-Traumatic Stress Disorder) is a chronic stress disorder and mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. As a result, PTSD is most common among certain populations, like war veterans. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and good self-care, they usually get better. If the symptoms get worse, last for months or even years, and interfere with your day-to-day functioning, you may have PTSD.

However, PTSD can also occur after prolonged exposure to trauma, such as sexual abuse victims or domestic violence.

PTSD Symptoms

PTSD sometimes presents in a person immediately after the trauma, but can also be latent for years before manifesting clinically. A person with PTSD experiences repeated recollection of the event, typically avoids stimuli that arouse the memory, and has negative thoughts and moods. It’s very common for patients with PTSD to experience anxiety disorder and depressive disorder as comorbidities.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.

Intrusive memories

Symptoms of intrusive memories may include:

• Recurrent, unwanted distressing memories of the traumatic event
• Reliving the traumatic event as if it were happening again (flashbacks)
• Upsetting dreams or nightmares about the traumatic event
• Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Avoidance

Symptoms of avoidance may include:

• Trying to avoid thinking or talking about the traumatic event
• Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

• Negative thoughts about yourself, other people or the world
• Hopelessness about the future
• Memory problems, including not remembering important aspects of the traumatic event
• Difficulty maintaining close relationships
• Feeling detached from family and friends
• Lack of interest in activities you once enjoyed
• Difficulty experiencing positive emotions
• Feeling emotionally numb

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

• Being easily startled or frightened
• Always being on guard for danger
• Self-destructive behavior, such as drinking too much or driving too fast
• Trouble sleeping
• Trouble concentrating
• Irritability, angry outbursts, or aggressive behavior
• Overwhelming guilt or shame

Theories about why PTSD occurs.

Nobody quite understands why PTSD occurs in some people but not in others. It has been hypothesized that there is a genetic factor in PTSD risk, as those whose parents have a mental health disorder may be more likely to develop PTSD.

Aside from this, there are three main theories.

The first is the “survival mechanism” theory. The constantly recurring memories may be the person’s subconscious way of being “prepared” for the next time such an event occurs, making them better fit for survival.

The second is the “adrenaline” theory. In this theory, the traumatic event triggers a chronic dysregulation of the fight-or-flight response, causing constantly elevated levels of adrenaline, norepinephrine and dopamine. This causes hyperarousal, or an inability to switch off. Essentially, it puts a person in a constant mode of fight-or-flight.

Finally, the third is that constant stress causes changes to the hippocampus. In those with PTSD, ongoing stress is a major factor. In some studies, evidence shows that hippocampal size is reduced in those with PTSD, suggesting that stress has major consequences on brain function. This may explain the symptoms associated with PTSD and its resistance to treatment.

Conventional treatment options for PTSD.

There are two main approaches to treating PTSD: psychotherapy and pharmaceutical medicines.

Psychotherapy involves regular, one-on-one interactions with a mental healthcare professional to help individuals make desired changes. Cognitive processing therapy, a common form of psychotherapy, is often used for people with PTSD, with the goal of teaching individuals how to assess and change their distressing thoughts following a traumatic event.

Therapists believe that by altering thought patterns, a person can change how they feel. In the case of a traumatic event, psychotherapy can help individuals reevaluate and see the world differently, particularly if they tend to blame themselves.

The second way to treat PTSD is through antidepressant medication, which affect the hippocampus, the brain's memory center, to counteract the effects of stress.

More specifically, PTSD is treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), namely sertraline (Zoloft®), paroxetine (Paxil®), fluoxetine (Prozac®), all SSRIs and venlafaxine (Effexor®). In addition to antidepressants, three antipsychotic drugs – olanzapine, quetiapine, and risperidone – are used for treating PTSD.

Read: The Truth About Mushrooms & Meds: Are They Safe to Mix?

Read: Is It Safe to Mix Magic Mushrooms and Antidepressants?

The Problem with Conventional PTSD Treatments

While therapy, antidepressants, and antipsychotics do help many patients with addressing trauma-related symptoms, these methods often fall short.

To date, trauma-focused psychotherapy is the best-indicated treatment for PTSD. It works by allowing you to access a traumatic memory from a safe place, process it, and move on from it. The trouble is that trauma-focused psychotherapy is typically a long-term therapy that isn’t effective, or is only partially effective, for many.

Plus, the very nature of PTSD makes it difficult to commit to long-term psychotherapy, because avoidance is one of the primary psychological indicators of PTSD.

When it comes to medicating, studies suggest that medications do not work well for people who have chronic PTSD or have had multiple traumas over the years.

A 2011 clinical trial – randomized and placebo-controlled – found that the antipsychotic risperidone worked no better than a placebo in alleviating typical PTSD symptoms in patients with long-term PTSD. At the same time, adverse side effects, including weight gain and fatigue, were high compared to placebo.

However, for better or worse, drugs are typically only given when another issue arises as a result of PTSD. For example, many with PTSD and trauma-related stress receive medication for reducing blood pressure as high blood pressure is a common symptom.

At the same time, many of these drugs cause intolerable side effects, causing many patients to give up on their medications and leaving them with no sign of relief. Instead, many turn to substance abuse, develop anger management issues, or commit suicide. A 2015 study estimates that 14% of people with PTSD had at least one suicide attempt following their trauma.

Another 2004 clinical trial evaluating suicide risk in PTSD patients unearthed even more staggering statistics: over 56% of their participants reported some aspect of suicidality, with 38.3% reporting ideation, 8.5% reporting suicide plans, and 9.6% having made suicide attempts since the trauma.

Luckily, there is a growing body of evidence showing that Psilocybin may hold the answer to long-term relief from PTSD—maybe even complete recovery.

Can Psilocybin help treat PTSD?

Researchers have developed various models to explain why psychedelics may reduce psychological distress from trauma. But first, it’s important to understand what it does to the body.

Psilocybin works primarily on serotonin receptors, which play a significant role in our mood and emotional regulation. Its interaction with the 5-HT2A receptor is thought to be responsible for inducing the psychedelic experience.

In that altered state of consciousness, any sense of rigidity and hierarchy is relaxed. This allows users to change negative beliefs in favor of ones that are better serving.

Psilocybin also triggers other neurobiological changes in the brain.

For example, Psilocybin facilitates fear extinction, a process that is essential for trauma recovery, by promoting neurogenesis (new neurons) and neuroplasticity (new synapses, or connections) in the hippocampus, a brain region involved in memory formation. It also reverses the decline in BDNF, a protein associated with neuroplasticity and fear extinction.

Another concept is the “helioscope effect," a nod to the instrument used to look at the sun without burning your eyes. In a normal state of consciousness, thinking about past traumas can be triggering or emotionally intense. Researchers say that psychedelics offer a sort of helioscope effect by allowing people to confront traumatic experiences directly without the associated triggers upsetting them. This may help people reprocess their trauma and lessen the associated psychological distress.

There are also the more obvious emotional effects of using psychedelics, such as increased empathy, increased mindfulness and insightfulness, increased acceptance, and increased openness. 

However, a word of caution.

Having PTSD or a trauma-related stress disorder puts you at risk for a "bad trips" when using alone. Working with a psychedelic-assisted therapist is recommended for safety and efficacy.

Studies on Psilocybin for treating PTSD.

2013 study on psilocybin and fear in mice.

A 2013 study from the University of South Florida found that psilocybin stimulates neurogenesis—the growth and repair of brain cells in the hippocampus, which is the brain’s center for emotion and memory. In the study, mice that were given psilocybin overcame fear conditioning far better than mice that were given a placebo. The study supported the hypothesis that psilocybin can help break the traumatic cycle that occurs in patients with PTSD.

2016 clinical trial on psilocybin and relief of distress in cancer patients.

Stephen Ross, MD, a psychiatrist at NYU Langone, conducted a study on terminally ill cancer patients and found that one-time treatment with psilocybin very quickly brought relief from distress that had lasted more than 6 months in 80% of study subjects.

In Dr. Ross’s study, half of the participants were randomly assigned to receive psilocybin. The rest received a control drug of niacin, which is known to produce a “rush” similar to that associated with a hallucinogenic drug experience. Halfway through the seven-week study period, all of the participants switched treatments. Neither the researchers nor the patients knew which patients had first received psilocybin or which received the control. All of the patients, mostly women, had advanced gastrointestinal, blood, or breast cancers and had been diagnosed as having serious psychological distress related to their disease.

Patients noted that after being treated with psilocybin, they felt their quality of life improve. They noted that they wanted to engage more with external activities, had more energy, experienced improved relationships with their family members, and performed better at work. The researchers concluded that if psilocybin could reduce psychological distress in terminally ill cancer patients, it could apply to less extreme medical conditions related to psychological distress as well.

Dr. Ross says that the findings “…have the potential to transform the care of cancer patients with psychological and existential distress, but beyond that, it potentially provides a completely new model in psychiatry of a medication that works rapidly as both an antidepressant and anxiolytic and has sustained benefit for months.” Dr. Ross has hope that the drug will become legal in the next five years.

“If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients.”

2021 survey on psilocybin and PTSD.

Child maltreatment is significantly linked to post-traumatic stress symptoms and internalized shame. Specifically, emotional abuse and neglect are most strongly associated with complex trauma symptoms and internalized shame.

Interestingly, according to a survey involving 166 participants, individuals with a history of intentional therapeutic psychedelic use report lower complex trauma symptoms and internalized shame, despite having similar histories of maltreatment. Notably, these differences are most pronounced in those with a history of more than five instances of intentional therapeutic psychedelic use.

Furthermore, a history of more than five occasions of intentional therapeutic psychedelic use significantly changed the relationship between emotional abuse and neglect and complex trauma symptoms. However, there were no observed associations between maltreatment, psychedelic use, and the recognition of facial emotions.

In conclusion, these findings suggest that using psychedelic drugs for therapeutic purposes is linked to reduced levels of complex trauma symptoms and internalized shame in individuals who have experienced child maltreatment. Psychedelic use may hold promise as a therapeutic approach for addressing the aftermath of childhood maltreatment.

2022 open-label study on psilocybin and PTSD.

In an open-label study involving AIDS survivors who had experienced trauma, psilocybin-assisted psychotherapy (PAP, also known as PAT) was found to reduce PTSD symptoms, attachment anxiety, and feelings of demoralization.

Several PAP trials have also shown initial promise in helping individuals confront traumatic memories, reduce emotional avoidance, alleviate depression and anxiety, foster a more positive outlook, enhance interpersonal connections, and promote self-compassion and forgiveness, all of which are relevant to PTSD recovery.

2023 phase 2 clinical trial on psilocybin and PTSD.

Preliminary data from a phase 2 clinical trial of COMP360 psilocybin for the treatment of patients with posttraumatic stress disorder (PTSD) found the treatment was safe and well tolerated, according to a press release.

The phase 2 trial, performed in partnership with COMPASS Pathways, King's College London, Icahn School of Medicine at Mount Sinai, was an open-label study of 22 patients with PTSD; the PTSD was a result of trauma experienced as an adult.

Patients were monitored for 12 weeks after receiving a single 25 mg dose of the agent. The international study is being conducted in the United States and the United Kingdom, with study cites at The Institute of Psychiatry, Psychology and Neuroscience at King’s College in London, Icahn School of Medicine at Mount Sinai in New York City, and Sunstone Therapies in Rockville, Maryland.

The preliminary data included results of evaluating patients at 24 hours following the 25 mg dose administration. There were no treatment-emergent serious adverse effects, and the investigators noted psilocybin “was well-tolerated and the safety profile was as expected.” Full data is expected to be available in spring 2024.

Breakthrough therapy.

The potential of psilocybin for PTSD has already been discovered by many brave pioneers, but only on an anecdotal level. Nonetheless, the discovery of an effective, safe therapeutic for conditions as complex as depressive disorder, clinical anxiety, and PTSD is a breakthrough. For many with PTSD, there’s no clear light at the end of the tunnel, and for that, alternative therapies are welcomed.

Given that the FDA has approved psilocybin for breakthrough therapies, we can only assume that we will be seeing the results of clinical trials in the very near future. This should give the medical world a better idea of the place psilocybin has in the clinical context, how it should be administered, and the best dose for treating PTSD.

Read: Microdose Cycling: What It Is, and Why You Should Be Doing It

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