Psilocybin users with depression report higher unmet healthcare needs

In a nationally representative study on psilocybin use and mental health treatment, researchers at the University of California San Diego School of Medicine have found that among people with depression, those who use psilocybin pursue mental health care at similar rates to nonusers. However, they report higher unmet needs for mental health care services, suggesting that while people may seek out psilocybin as an alternative or adjunct to traditional therapy, they are not looking to replace it entirely. The results are published online in the journal Psychological Medicine.

Our main takeaway is that among people with depression, those using psilocybin aren't abandoning conventional mental health care, which is good news. But what is interesting is that even though they use mental health care at the same rate as nonusers, they still feel that their needs aren't being met, which gives us an opportunity to better understand those unmet needs so we can help these patients."

Avery Eun, first author of the study and second-year medical student, UC San Diego School of Medicine

As psilocybin decriminalization gains momentum across the U.S., concerns have grown among mental health care professionals that individuals may forgo supervised mental health care in favor of self-medicating with psilocybin. Until now, there were no nationally representative studies to determine if this trend was actually occurring among those with depression.

In the new study, the researchers analyzed data from the 2024 National Survey on Drug Use and Health (NSDUH), the first iteration of the survey to specifically track the recency of psilocybin use in addition to its prevalence.

"It is one thing to know if someone has used psilocybin at any point in their life, but knowing they used it within the past year allows us to see how that use actually relates to their current engagement with mental health care," added Eun.

The study analyzed data from 6,793 individuals aged 12 and older with a past-year major depressive episode.

Key findings include:

• An estimated 7.3% of individuals who experienced a major depressive episode in the past year reported using psilocybin during that same period.
• Psilocybin use was not associated with lower utilization of outpatient, inpatient or telehealth treatment, nor was it linked to a decrease in the use of prescription medications for depression.
• Psilocybin users reported a significantly higher perceived unmet need for mental health treatment (52.0%) compared to nonusers (33.9%).
• Psilocybin users were more likely to be younger, male, never married and employed full-time.

While randomized controlled trials have shown psilocybin-assisted therapy to be effective in highly monitored clinical settings - featuring structured dosing and psychological support - the researchers emphasize that "naturalistic" use occurs without these safeguards. Because users often obtain the substance from inconsistent sources without clinical monitoring, the safety and efficacy seen in trials may not generalize to those using it on their own.

The new study suggests that the gap between perceived need and actual treatment receipt may drive some individuals toward self-directed symptom management with psychedelics, but the researchers emphasize that it would take further research to prove this hypothesis.

The researchers also note that policy changes, such as decriminalization, may improve patient safety by reducing stigma and creating a safer environment for individuals to share their experiences with providers.

"It's really important for providers to interpret psilocybin use in their patients differently," said Eun. "Rather than assuming a patient is retreating from care, providers can use this as a way to start a conversation about the motivations for use. If psilocybin is being used for therapeutic reasons, it may be an opportunity to discuss whether the patient feels their needs are being met by conventional care and what can be done to help if not."