Psilocybin

Psilocybin is used recreationally, spiritually (as an entheogen), and medically. It is also under development for the treatment of depression and for various other indications elsewhere, such as the United States and Europe, but has not yet been approved in other countries (see below). This will potentially allow for approval by summer 2026. Dosing Psilocybin is used as a psychedelic at doses of 5 to 40mg orally. Low doses are 5 to 10mg, an intermediate or "good effect" dose is 20mg, and high or ego-dissolution doses are 30 to 40mg. Microdosing involves the use of subthreshold psilocybin doses of less than 2.5mg. Psilocin is about 1.4 times as potent as psilocybin because of the two compounds' difference in molecular weight. "Lemon tek" or "lemon tekking" is a method sometimes used by recreational psilocybin users. It involves soaking psilocybin-containing mushrooms in citric acid-containing lemon juice to supposedly convert their psilocybin content into psilocin before administration. Another form of psilocybin (as well as of related psychedelics like 4-AcO-DMT) is mushroom edibles such as chocolate bars and gummies, which may be purchased at psychedelic mushroom stores. ==Effects==

figure Timothy Leary conducted early experiments into the effects of psychedelic drugs, including psilocybin (1989 photo). Psilocybin produces a variety of psychological, perceptual, interpersonal, and physical effects. Low doses can induce hallucinatory effects. Closed-eye hallucinations may occur, where the affected person sees multicolored geometric shapes and vivid imaginative sequences. At higher doses, psilocybin can lead to "intensification of affective responses, enhanced ability for introspection, regression to primitive and childlike thinking, and activation of vivid memory traces with pronounced emotional undertones". Set and setting and moderating factors The effects of psilocybin are highly variable and depend on the mindset and environment in which the user has the experience, factors commonly called set and setting. In the early 1960s, Timothy Leary and his Harvard colleagues investigated the role of set and setting in psilocybin's effects. They administered the drug to 175 volunteers (from various backgrounds) in an environment intended to be similar to a comfortable living room. 98 of the subjects were given questionnaires to assess their experiences and the contribution of background and situational factors. Those who had prior experience with psilocybin reported more pleasant experiences than those for whom the drug was novel. Group size, dose, preparation, and expectancy were important determinants of the drug response. In general, those in groups of more than eight felt that the groups were less supportive and their experiences less pleasant. Conversely, smaller groups (fewer than six) were seen as more supportive and reported more positive reactions to the drug in those groups. Leary and colleagues proposed that psilocybin heightens suggestibility, making a user more receptive to interpersonal interactions and environmental stimuli. Theory of mind network and default mode network Psychedelics, including psilocybin, have been shown to affect different clusters of brain regions known as the "theory of mind network" (ToMN) and the default mode network (DMN). The ToMN involves making inferences and understanding social situations based on patterns, whereas the DMN relates more to introspection and one's sense of self. In studies done with single use psilocybin, areas of the DMN showed decreased functional connectivity (communication between areas of the brain). This provides functional insight into the work of psilocybin in increasing one's sense of connection to one's surroundings, as the areas of the brain involved in introspection decrease in functionality under the effects of the drug. Conversely, areas of the brain involved in the ToMN showed increased activity and functional activation in response to psychedelics. These results were not unique to psilocybin and there was no significant difference in brain activation found in similar trials of mescaline and LSD. Information and studies into the DMN and ToMN are relatively sparse and their connections to other psychiatric illnesses and the use of psychedelics is still largely unknown. and the psychosocial effects of psilocybin, it can be seen in many traditional societies that powerful mind-active substances such as psilocybin are regularly "consumed ritually for therapeutic purposes or for transcending normal, everyday reality". Positive effects that psilocybin has on individuals can be observed by taking on an anthropological approach and moving away from the Western biomedical view; this is aided by the studies done by Leary. Within certain traditional societies, where the use of psilocybin is frequent for shamanic healing rituals, group collectives praise their guide, healer and shaman for helping alleviate their pains, aches and hurt. They do this through a group ritual practice where the group, or just the guide, ingests psilocybin to help extract any "toxic psychic residues or sorcerous implants" This is speculated to grow, provided the evidence remains indicative of their safety and efficacy. In social sense, the group is shaped by their experiences surrounding psilocybin and how they view the fungus collectively. As mentioned in the anthropology article, Psychedelic researcher Rick Doblin considered the study partially flawed due to incorrect implementation of the double-blind procedure and several imprecise questions in the mystical experience questionnaire. Nevertheless, he said that the study cast "considerable doubt on the assertion that mystical experiences catalyzed by drugs are in any way inferior to non-drug mystical experiences in both their immediate content and long-term effects". A 2005 magazine survey of clubgoers in the UK found that over a quarter of those who had used psilocybin mushrooms in the preceding year experienced nausea or vomiting, although this was caused by the mushroom rather than psilocybin itself. A small dose of 1mg by intravenous injection had a duration of 15 to 30minutes. ==Contraindications==

Contraindications of psilocybin are mostly psychiatric conditions that increase the risk of psychological distress, including the rare adverse effect of psychosis during or after the psychedelic experience. These conditions may include history of psychosis, schizophrenia, bipolar disorder, or borderline personality disorder. Further research may provide more safety information about the use of psilocybin in people with such conditions. In the case of bipolar disorder, there are concerns that psychedelics may trigger a switch into mania. Psilocybin is considered to be contraindicated in women who are pregnant or breastfeeding due to insufficient research in this population. There are transient increases in heart rate and blood pressure with psilocybin, and hence uncontrolled cardiovascular conditions are a relative contraindication for psilocybin. Serotonin 5-HT2A receptor antagonists such as atypical antipsychotics and certain antidepressants may block psilocybin's hallucinogenic effects and hence may be considered contraindicated in this sense. Monoamine oxidase inhibitors (MAOIs) may potentiate psilocybin's effects and augment its risks. ==Adverse effects==

Most of the comparatively few fatal incidents associated with psychedelic mushroom usage involve the simultaneous use of other drugs, especially alcohol. A common adverse effect resulting from psilocybin mushroom use involves "bad trips" or panic reactions, in which people become anxious, confused, agitated, or disoriented. Accidents, self-injury, or suicide attempts can result from serious cases of acute psychotic episodes. The similarity of psilocybin-induced symptoms to those of schizophrenia has made the drug a useful research tool in behavioral and neuroimaging studies of schizophrenia. In both cases, psychotic symptoms are thought to arise from a "deficient gating of sensory and cognitive information" in the brain that leads to "cognitive fragmentation and psychosis". Flashbacks (spontaneous recurrences of a previous psilocybin experience) can occur long after psilocybin use. Hallucinogen persisting perception disorder (HPPD) is characterized by a continual presence of visual disturbances similar to those generated by psychedelic substances. Neither flashbacks nor HPPD are commonly associated with psilocybin usage, and correlations between HPPD and psychedelics are further obscured by polydrug use and other variables. Tolerance and dependence s. Tolerance to psilocybin builds and dissipates quickly; ingesting it more than about once a week can lead to diminished effects. Tolerance dissipates after a few days, so doses can be spaced several days apart to avoid the effect. A cross-tolerance can develop between psilocybin and LSD, and between psilocybin and phenethylamines such as mescaline and DOM. Repeated use of psilocybin does not lead to physical dependence. A 2008 study concluded that, based on U.S. data from 2000 to 2002, adolescent-onset (defined here as ages 11–17) usage of hallucinogenic drugs (including psilocybin) did not increase the risk of drug dependence in adulthood; this was in contrast to adolescent usage of cannabis, cocaine, inhalants, anxiolytic medicines, and stimulants, all of which were associated with "an excess risk of developing clinical features associated with drug dependence". Likewise, a 2010 Dutch study ranked the relative harm of psilocybin mushrooms compared to a selection of 19 recreational drugs, including alcohol, cannabis, cocaine, ecstasy, heroin, and tobacco. Psilocybin mushrooms were ranked as the illicit drug with the lowest harm, corroborating conclusions reached earlier by expert groups in the United Kingdom. Long-term effects A potential risk of frequent repeated use of psilocybin and other psychedelics is cardiac fibrosis and valvulopathy caused by serotonin 5-HT2B receptor activation. But single high doses or widely spaced doses (e.g., months apart) are thought to be safe, and concerns about cardiac toxicity apply more to chronic psychedelic microdosing or very frequent intermittent use (e.g., weekly). ==Overdose==

Psilocybin has low toxicity, meaning that it has a low risk of inducing life-threatening events like breathing or heart problems. This is thought to be because they act as partial agonists of serotonin receptors like the serotonin 5-HT2A receptor, in contrast to serotonin itself, which is a full agonist. In rats, the median lethal dose (LD50) of psilocybin when administered orally is 280mg/kg, approximately 1.5times that of caffeine. The lethal dose of psilocybin when administered intravenously in mice is 285mg/kg, in rats is 280mg/kg, and in rabbits is 12.5mg/kg. Psilocybin comprises approximately 1% of the weight of Psilocybe cubensis mushrooms, and so nearly of dried mushrooms, or of fresh mushrooms, would be required for a person to reach the 280mg/kg LD50 value of rats. Based on the results of animal studies and limited human case reports, the human lethal dose of psilocybin has been extrapolated to be 2,000 to 6,000mg, which is around 1,000 times greater than its effective dose of 6mg and 200times the typical recreational dose of 10 to 30mg. The Registry of Toxic Effects of Chemical Substances assigns psilocybin a relatively high therapeutic index of 641 (higher values correspond to a better safety profile); for comparison, the therapeutic indices of aspirin and nicotine are 199 and 21, respectively. The lethal dose from psilocybin toxicity alone is unknown, and has rarely been documented—, only two cases attributed to overdosing on hallucinogenic mushrooms (without concurrent use of other drugs) have been reported in the scientific literature, and those may involve factors other than psilocybin. ==Interactions==

Serotonin 5-HT2A receptor antagonists can block the hallucinogenic effects of serotonergic psychedelics like psilocybin in humans. Numerous drugs act as serotonin 5-HT2A receptor antagonists, including antidepressants like trazodone and mirtazapine, antipsychotics like quetiapine, olanzapine, and risperidone, and other agents like ketanserin, pimavanserin, cyproheptadine, and pizotifen. Such drugs are sometimes called "trip killers" because they can prevent or abort psychedelics' hallucinogenic effects. Serotonin 5-HT2A receptor antagonists that have been specifically shown in clinical studies to diminish or abolish psilocybin's effects include ketanserin, risperidone, and chlorpromazine. Benzodiazepines such as diazepam, alprazolam, clonazepam, and lorazepam, as well as alcohol, which act as GABAA receptor positive allosteric modulators, have been limitedly studied in combination with psilocybin and other psychedelics and are not known to directly interact with them. Because of this, recreational users often use benzodiazepines and alcohol as "trip killers" to manage difficult hallucinogenic experiences with psychedelics, such as experiences with prominent anxiety. A clinical trial of psilocybin and midazolam coadministration found that midazolam clouded psilocybin's effects and impaired memory of the experience. Benzodiazepines might interfere with the therapeutic effects of psychedelics like psilocybin, such as sustained antidepressant effects. Psilocin, the active form of psilocybin, is a substrate of the monoamine oxidase (MAO) enzyme MAO-A. An early clinical study of psilocybin in combination with short-term tranylcypromine pretreatment found that tranylcypromine marginally potentiated psilocybin's peripheral effects, including pressor effects and mydriasis, but overall did not significantly modify its psychoactive and hallucinogenic effects, although some of its emotional effects were said to be reduced and some of its perceptual effects were said to be amplified. Psilocin may be metabolized to a minor extent by the cytochrome P450 (CYP450) enzymes CYP2D6 and/or CYP3A4 and appears unlikely to be metabolized by other CYP450 enzymes. The role of CYP450 enzymes in psilocin's metabolism seems to be small, and so considerable drug interactions with CYP450 inhibitors and/or inducers may not be expected. Psilocin's major metabolic pathway is glucuronidation by UDP-glucuronosyltransferase enzymes including UGT1A10 and UGT1A9. Diclofenac and probenecid are inhibitors of these enzymes that theoretically might inhibit the metabolism of and thereby potentiate psilocybin's effects, but no clinical research or evidence on this possible interaction exists. Few other drugs are known to influence UGT1A10 or UGT1A9 function. ==Pharmacology==

Pharmacodynamics Psilocybin is a serotonergic psychedelic that acts as a prodrug of psilocin, the active form of the drug. Psilocin is a close analogue of the monoamine neurotransmitter serotonin and, like serotonin, acts as a non-selective agonist of the serotonin receptors, including behaving as a partial agonist of the serotonin 5-HT2A receptor. In addition to interacting with the serotonin receptors, psilocin is a partial serotonin releasing agent with lower potency. There is a significant relationship between psilocybin's hallucinogenic effects and serotonin 5-HT2A receptor occupancy in humans. Psilocybin's psychedelic effects can be blocked by serotonin 5-HT2A receptor antagonists like ketanserin and risperidone in humans. In addition, region-dependent alterations in brain glutamate levels may be related to the experience of ego dissolution. The cryo-EM structures of the serotonin 5-HT2A receptor with psilocin, as well as with various other psychedelics and serotonin 5-HT2A receptor agonists, have been solved and published by Bryan L. Roth and colleagues. Although serotonin 5-HT2A receptor agonism mediates the hallucinogenic effects of psilocybin and psilocin, activation of other serotonin receptors also appears to contribute to these compounds' psychoactive and behavioral effects. Serotonin 5-HT1A receptor activation seems to inhibit the hallucinogenic effects of psilocybin and other psychedelics. Some of psilocybin's non-hallucinogenic behavioral effects in animals can be reversed by antagonists of the serotonin 5-HT1A, 5-HT2B, and 5-HT2C receptors. In addition, the serotonin 5-HT1B receptor has been found to be required for psilocybin's persisting antidepressant- and anxiolytic-like effects as well as acute hypolocomotion in animals. In humans, ketanserin blocked psilocybin's hallucinogenic effects but not all of its cognitive and behavioral effects. The drug shows pronounced biased agonism at the serotonin 5-HT2C receptor. In addition to its psychedelic effects, psilocin has been found to produce psychoplastogenic effects in animals, including dendritogenesis, spinogenesis, and synaptogenesis. It has been found to promote neuroplasticity in the brain in a rapid, robust, and sustained manner with a single dose. Psilocin was also reported to act as a highly potent positive allosteric modulator of the tropomyosin receptor kinase B (TrkB), one of the receptors of brain-derived neurotrophic factor (BDNF), but subsequent studies failed to reproduce these findings and instead found no interaction of psilocin with TrkB. Relatedly, psilocybin has been found not to enhance but rather to inhibit hippocampal neurogenesis in rodents. Psilocybin produces profound anti-inflammatory effects mediated by serotonin 5-HT2A receptor activation in preclinical studies. These effects have a potency similar to that of (R)-DOI, and its anti-inflammatory effects occur at far lower doses than those that produce hallucinogen-like effects in animals. Psilocybin's anti-inflammatory effects might be involved in its potential antidepressant benefits and might also have other therapeutic applications, such as treatment of asthma and neuroinflammation. They may also be involved in microdosing effects. Psilocybin has been found to have a large, long-lasting impact on the intestinal microbiome and to influence the gut–brain axis in animals. These effects are partially but not fully dependent on its activation of the serotonin 5-HT2A and/or 5-HT2C receptors. Long-term repeated use of psilocybin may result in risk of cardiac valvulopathy and other complications by activating serotonin 5-HT2B receptors. Maximal concentrations of psilocin were 11ng/mL, 17ng/mL, and 21ng/mL with oral psilocybin doses of 15, 25, and 30mg psilocybin, respectively. But psilocin appears to form a tricyclic pseudo-ring system wherein its hydroxyl group and amine interact through hydrogen bonding. This in turn makes psilocin much less polar, more lipophilic, and more able to cross the blood–brain barrier and exert central actions than it would be otherwise. Metabolism of psilocybin and psilocin in humans and mice. There is significant first-pass metabolism of psilocybin and psilocin with oral administration. The competitive phosphatase inhibitor β-glycerolphosphate, which inhibits psilocybin dephosphorylation, greatly attenuates the behavioral effects of psilocybin in rodents. Psilocybin undergoes dephosphorylation into psilocin via the acidic environment of the stomach or the actions of alkaline phosphatase (ALP) and non-specific esterases in tissues and fluids. 4-HIAL is then further oxidated into 4-hydroxyindole-3-acetic acid (4-HIAA) by aldehyde dehydrogenase (ALDH) or into 4-hydroxytryptophol (4-HTOL or 4-HTP) by alcohol dehydrogenase (ALD). Findings also conflict on whether psilocybin can be detected in urine, with either no psilocybin excreted or 3% to 10% excreted as unchanged psilocybin. Psilocybin's psychoactive effects and duration are strongly correlated with psilocin levels. Single doses of psilocybin of 3 to 30mg have been found to dose-dependently occupy the serotonin 5-HT2A receptor in humans as assessed by imaging studies. The for occupancy of the serotonin 5-HT2A receptor by psilocin in terms of circulating levels has been found to be 1.97ng/mL. Body weight and body mass index do not appear to affect psilocybin's pharmacokinetics. This suggests that body weight-adjusted dosing of psilocybin is unnecessary and may actually be counterproductive, and that fixed-dosing should be preferred. Similarly, age does not affect psilocybin's pharmacokinetics. The influence of sex on psilocybin's pharmacokinetics has not been tested. ==Chemistry==

Physical properties is structurally similar to psilocybin. Psilocybin is a naturally occurring substituted tryptamine that features an indole ring linked to an aminoethyl substituent. It is structurally related to serotonin, a monoamine neurotransmitter that is a derivative of the amino acid tryptophan. Psilocybin is a member of the general class of tryptophan-based compounds that originally functioned as antioxidants in earlier life forms before assuming more complex functions in multicellular organisms, including humans. Psilocybin rapidly oxidizes upon exposure to light—an important consideration when using it as an analytical standard. Albert Hofmann and colleagues first synthesized psilocybin in 1958. Since then, various chemists have improved the methods for laboratory synthesis and purification of psilocybin. Fricke and colleagues described an enzymatic pathway for the synthesis of psilocybin and psilocin, publishing their results in 2017. Sherwood and colleagues significantly improved upon Shirota's method (producing at the kilogram scale while employing less expensive reagents), publishing their results in 2020. Analytical methods Several relatively simple chemical tests—commercially available as reagent testing kits—can be used to assess the presence of psilocybin in extracts prepared from mushrooms. The drug produces a yellow color in the Marquis test and a green color in the Mandelin reagent. ==Natural occurrence==

Psilocybin is present in varying concentrations in over 200 species of Basidiomycota mushrooms. In a 2000 review on the worldwide distribution of hallucinogenic mushrooms, Gastón Guzmán and colleagues considered these to be distributed amongst the following genera: Psilocybe (116 species), Gymnopilus (14), Panaeolus (13), Copelandia (12), Hypholoma (6), Pluteus (6), Inocybe (6), Conocybe (4), Panaeolina (4), Gerronema (2), and Galerina (1 species). Both the caps and the stems contain psychoactive compounds, although the caps consistently contain more. The spores of these mushrooms do not contain psilocybin or psilocin. Psilocybin can be produced de novo in GM yeast. ==History==

Early "mushroom stones" of Guatemala. The use of psilocybin mushrooms in religious ceremonies dating back thousands of years is contested. Despite popular narratives portraying psychedelics as ancient, widespread, and primarily used by shamans for therapeutic healing, anthropological and historical research shows their traditional use was limited, recent, and culturally specific, with modern Western interpretations largely shaped by idealization, tourism, and ideological agendas. 6,000-year-old pictographs discovered near Villar del Humo, Spain, illustrate several mushrooms that have been argued to be Psilocybe hispanica, a hallucinogenic species native to the area. After Spanish conquistadors of the New World arrived in the 16th century, chroniclers reported mushroom use by the natives for ceremonial and religious purposes. According to the Dominican friar Diego Durán in The History of the Indies of New Spain (published c. 1581), mushrooms were eaten in festivities conducted on the occasion of Aztec emperor Moctezuma II's accession to the throne in 1502. The Franciscan friar Bernardino de Sahagún wrote of witnessing mushroom use in the Florentine Codex (published 1545–1590), The few existing accounts that mention psilocybin mushrooms typically lack sufficient information to allow species identification, focusing on their effects. For example, Flemish botanist Carolus Clusius (1526–1609) described the bolond gomba ("crazy mushroom"), used in rural Hungary to prepare love potions. English botanist John Parkinson included details about a "foolish mushroom" in his 1640 herbal Theatricum Botanicum. The first reliably documented report of intoxication with Psilocybe semilanceata—Europe's most common and widespread psychedelic mushroom—involved a British family in 1799, who prepared a meal with mushrooms they had picked in London's Green Park. United States politicians' agenda against LSD usage had swept psilocybin along with it into the Schedule I category of illicit drugs. Such restrictions on the use of these drugs in human research made funding for such projects difficult to obtain, and scientists who worked with psychedelic drugs faced being "professionally marginalized". This was due in large part to wide dissemination of information on the topic, which included works such as those by Carlos Castaneda and several books that taught the technique of growing psilocybin mushrooms. One of the most popular of the latter group, ''Psilocybin: Magic Mushroom Grower's Guide'', was published in 1976 under the pseudonyms O. T. Oss and O. N. Oeric by Jeremy Bigwood, Dennis J. McKenna, K. Harrison McKenna, and Terence McKenna. Over 100,000 copies were sold by 1981. Because of lack of clarity about laws concerning psilocybin mushrooms, specifically in the form of sclerotia (also known as "truffles"), in the late 1990s and early 2000s European retailers commercialized and marketed them in smartshops in the Netherlands, the UK, and online. Several websites emerged that contributed to the accessibility of information on the mushrooms' description, use, and effects, and users exchanged mushroom experiences. Since 2001, six EU countries have tightened their legislation on psilocybin mushrooms in response to concerns about their prevalence and increasing usage. In the 1990s, hallucinogens and their effects on human consciousness were again the subject of scientific study, particularly in Europe. Advances in neuropharmacology and neuropsychology and the availability of brain imaging techniques have provided impetus for using drugs like psilocybin to probe the "neural underpinnings of psychotic symptom formation including ego disorders and hallucinations". Recent studies in the U.S. have attracted attention from the popular press and brought psilocybin back into the limelight. ==Society and culture==

Usage A 2009 national survey of drug use by the US Department of Health and Human Services concluded that the number of first-time psilocybin mushroom users in the United States was roughly equivalent to the number of first-time users of cannabis. The RAND Corporation report suggests psilocybin mushrooms may be the most prevalent psychedelic drug among U.S. adults. Similarly, religious groups like America's Uniao do Vegetal (UDV) use psychedelics in traditional ceremonies. A report from the U.S. Government Accountability Office (GAO) notes that people may petition the DEA for exemptions to use psilocybin for religious purposes. From 1 July 2023, the Australian medicines regulator has permitted psychiatrists to prescribe psilocybin for the therapeutic treatment of treatment-resistant depression. Advocates of legalization argue there is a lack of evidence of harm, and potential use in treating certain mental health conditions. Research is difficult to conduct because of the legal status of psychoactive substances. Advocates of legalization also promote the utility of "ego dissolution" In 2024, after calls for regulatory and legal change to expand terminally ill populations' access to controlled substances, two legal cases related to expanded access began moving through the federal courts under right-to-try law. The Advanced Integrative Medicine Science (AIMS) Institute in concert with the NPA filed a series of lawsuits seeking both the rescheduling of and expanded right-to-try access to psilocybin. ==Research==

Psychiatric and other disorders Psilocybin has been a subject of clinical research since the early 1960s, when the Harvard Psilocybin Project evaluated the potential value of psilocybin as a treatment for certain personality disorders. In 2018, the United States Food and Drug Administration (FDA) granted breakthrough therapy designation for psilocybin-assisted therapy for treatment-resistant depression. Depression Clinical trials, including both open-label trials and double-blind randomized controlled trials (RCTs), have found that single doses of psilocybin produce rapid and long-lasting antidepressant effects outperforming placebo in people with major depressive disorder and treatment-resistant depression. The antidepressant effects of psilocybin with psychological support have been found to last at least 6weeks following a single dose. Only "high-dose" psilocybin (≥20mg) outperforms escitalopram in improving depressive symptoms. Psychedelic-assisted therapy in general (with the vast majority of RCTs studying psilocybin) may be no more effective than open-label traditional antidepressants for major depression; blinding affects antidepressant outcomes but not psychedelics. Functional unblinding by their psychoactive effects and positive psychological expectancy effects (i.e., the placebo effect) are major limitations and sources of bias of clinical trials of psilocybin and other psychedelics for treatment of depression. Relatedly, most of the therapeutic benefit of conventional antidepressants like the SSRIs for depression appears to be attributable to the placebo response. It has been proposed that psychedelics like psilocybin may in fact act as active "super placebos" when used for therapeutic purposes. On the other hand, the inverse placebo effect (or "knowcebo" effect) caused by blinding failure may create an illusion of large effect sizes with psychedelics. Psilocybin has not received regulatory approval for medical use in the United States. A 2024 network meta-analysis of RCTs of therapies for treatment-resistant depression, with effectiveness measures being response and remission rates, likewise found that psilocybin was more effective than placebo and, considering both effectiveness and tolerability or safety, recommended it as a first-line therapy, along with ketamine, esketamine, and electroconvulsive therapy (ECT). However, the quality of evidence was generally rated as low or very low. Preliminary meta-analyses suggest that improvements in depressive symptoms with psilocybin are dose-dependent and that higher doses may result in greater improvements than lower doses. One meta-analysis found that the highest assessed dose in clinical trials, 30 to 35mg per 70kg body weight, was the most effective, with an effect size (Hedges' g) of 3.1 (relative to 1.3 overall), but based on only one study for that dosing subgroup. In the previously described dose-ranging Phase II trial of psilocybin for depression, the time to median depressive event after administration of psilocybin was 92 to 189days for 25mg, 43 to 83days for 10mg, and 21 to 62days for 1mg, depending on the analysis. Repeated dosing of psilocybin is being explored for maximization and maintenance of depressive symptom improvement, with preliminary effectiveness observed. In June 2025, Compass Pathways, which is developing psilocybin for treatment-resistant depression, announced the results of a Phase III clinical trial of single-dose 25mg psilocybin (COMP360) versus placebo. Psilocybin met the primary endpoint of a significant reduction in depressive scores on the Montgomery-Asberg Depression Rating Scale (MADRS) relative to placebo. Questions remain concerning the durability of psilocybin's antidepressant effects, the scalability of its treatment delivery, and regulatory uncertainty. Small sample sizes were common in the trials. Obsessive–compulsive disorder Psilocybin has been studied for the treatment of obsessive–compulsive disorder. It is formally under development for treatment of OCD by multiple pharmaceutical companies. These include candidates with the developmental code names SYNP-101 (Ceruvia Lifesciences) and MLS-101 (MycoMedica Life Sciences). ==See also==