Long COVID lacks effective pharmaceutical treatment options. Psychedelic treatment for long COVID has received attention given anecdotal reports of neuropsychiatric symptom improvement. This study investigates the use of psilocybin for neuropsychiatric long COVID symptoms, examining online accounts of individuals with reported long COVID using psilocybin. We searched the Reddit communities, “r/LongCovid,” and “r/covidlonghaulers” for terms, “psilocybin,” “shrooms,” and “magic mushrooms.” Posts were included if they self-reported (1) neuropsychiatric symptoms of long COVID, (2) use of psilocybin, and (3) descriptions of the perceived effect or lack thereof on long COVID symptoms. Posts were manually coded to identify the nature of psilocybin ingestion, long COVID symptoms, and post’s author’s perceived effect on symptoms. The most common symptoms identified were fatigue (47.3%, N = 52), cognitive impairment (46.4%, N = 51), and depression (30.0%, N = 33). Of 110 posts meeting criteria, 78.2% (N = 86) reported any improvement in long COVID symptoms, while 11.8% (N = 13) reported worsening. For those with improvement, 77.9% (N = 67) reported improvement lasting beyond their acute psychedelic experience, while 5.8% (N = 5) reported improvement only during the experience. Given these findings, studies employing comparison social media data for other long COVID self-treatments and/or prospective observational studies of individuals self-treating neuropsychiatric long COVID symptoms with psychedelics may be warranted.

Psychedelic compounds such as lysergic acid diethylamide (LSD), 3,4-methylene-dioxymethamphetamine (MDMA, or Ecstasy), and psilocybin are drawing interest amid evidence that they may effectively treat psychiatric disorders and substance use disorders.1 This interest is further fueled by evidence that psychedelics used in a psychotherapeutic setting may improve treatment-resistant conditions and provide benefits that last for months or longer after just 1 treatment session.Because of the experime...

Olfactory dysfunction (OD) has become increasingly prevalent since the COVID-19 pandemic, yet effective treatments remain limited. In recent years, anecdotal reports have emerged on the potential benefits of serotonergic psychedelics (lysergic acid diethylamide [LSD], psilocybin, etc.) in improving OD. To date, only one case series in the medical literature has documented this phenomenon. This study aimed to explore the potential therapeutic effects of psychedelics on OD by conducting a thematic analysis of online posts from people with self-reported OD discussing whether psychedelic use affected their OD. We analyzed 125 online posts, extracting key demographic data, anosmia cause, psychedelic type, psychedelic dosage, and reported impact on olfactory function. 108 posts (86.4%) reported improvements in smell following psychedelic use. Among those reporting improvement, 55 (50.1%) first noticed smell enhancement during their psychedelic experience, and 42 (38.8%) reported olfactory improvements persisting at least one day post-psychedelic use. No statistical relationship was identified between duration of benefit and dose for either psilocybin or LSD. These exploratory findings highlight the need for further research to determine whether serotonergic psychedelics could serve as a viable clinical treatment for OD or facilitate the development of new therapies, if the mechanisms behind these reported improvements can be elucidated.

The author surveyed researchers about United States federal grant applications for therapeutic psychedelic research and their funding success. An anonymous survey was sent to corresponding authors of the 50 most-cited psychedelic research articles published after 2000 and also disseminated on Twitter. Ten researchers responded, reporting on 24 National Institutes of Health (NIH) grant applications for psilocybin, ibogaine, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA), and other psychedelics, dating back to the early 1990s. Grant applications increased noticeably after 2006. Of the applications assessed, 16.7% were funded, below the NIH’s 23.4% average funding rate for R01-equivalent grants from 1998 to 2023. While no applications submitted before 2006–2010 were funded, the funding rate since then (19.05–22.2%) aligns with the NIH’s 20.6 ± 1.9% annual average for R01-equivalent grants from 2006 to 2023. Respondents generally perceived funding for psychedelic research as more difficult to obtain than for other areas, though recent improvements were noted. If the analyzed applications represent only a small subset of total submissions of applications proposing to study therapeutic applications of psychedelics, the findings may have limited generalizability and larger-scale validation studies would be required. However, this is difficult to determine since detailed data on unfunded NIH applications are not publicly available.

Amid steadily growing interest in the therapeutic potential of psychedelics, as well as increasing industry (Aday et al. 2023), state (Acquisto and Six 2023), and federal (Volkow et al. 2023) financial support for this area of research, many academic medical centers throughout the United States have recently begun conducting studies of psychedelics or are planning to do so in the near future (Basen 2021). However, the intense psychoactive effects of these compounds, their Schedule I designation...

On June 30, 2023, the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel took a major step forward in facilitating equitable access to a promising and emerging category of treatments for diagnosed mental illnesses by1 creating Category III CPT codes for ‘‘Continuous In-Person Monitoring and Intervention During Psychedelic Medication Therapy’’ (0820T, 0821T, and 0822T). These codes describe the psychological support provided by qualified health care professionals (e.g., physician, psychologist, nurse practitioner, or clinical social worker depending on state laws and payer guidelines) and other clinical staff (e.g., medical assistant, licensed practical nurse, or registered nurse) who accompanies patient self-administration of a psychedelic drug in a monitored medical setting.

MethodsData descriptionThe U.S. National Survey on Drug Use and Health (NSDUH) is conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), in all 50 states and the District of Columbia (Substance Abuse and Mental Health Services Administration, 2020b). NSDUH personnel administer the survey in-person to randomly selected, noninstitutionalized civilians (important excluded populations include people who are imprisoned, hospitalized, or living in nursing homes)...

Importance: The ELEKT-D: Electroconvulsive Therapy (ECT) vs Ketamine in Patients With Treatment Resistant Depression (TRD) (ELEKT-D) trial demonstrated noninferiority of intravenous ketamine vs ECT for nonpsychotic TRD. Clinical features that can guide selection of ketamine vs ECT may inform shared decision-making for patients with TRD. Objective: To evaluate whether selected clinical features were associated with differential improvement with ketamine vs ECT. Design, setting, and participants: This secondary analysis of an open-label noninferiority randomized clinical trial was a multicenter study conducted at 5 US academic medical centers from April 7, 2017, to November 11, 2022. Analyses for this study, which were not prespecified in the trial protocol, were conducted from May 10 to Oct 31, 2023. The study cohort included patients with TRD, aged 21 to 75 years, who were in a current nonpsychotic depressive episode of at least moderate severity and were referred for ECT by their clinicians. Exposures: Eligible participants were randomized 1:1 to receive either 6 infusions of ketamine or 9 treatments with ECT over 3 weeks. Main outcomes and measures: Association between baseline factors (including 16-item Quick Inventory of Depressive Symptomatology Self-Report [QIDS-SR16], Montgomery-Asberg Depression Rating Scale [MADRS], premorbid intelligence, cognitive function, history of attempted suicide, and inpatient vs outpatient status) and treatment response were assessed with repeated measures mixed-effects model analyses. Results: Among the 365 participants included in this study (mean [SD] age, 46.0 [14.5] years; 191 [52.3%] female), 195 were randomized to the ketamine group and 170 to the ECT group. In repeated measures mixed-effects models using depression levels over 3 weeks and after false discovery rate adjustment, participants with a baseline QIDS-SR16 score of 20 or less (-7.7 vs -5.6 points) and those starting treatment as outpatients (-8.4 vs -6.2 points) reported greater reduction in the QIDS-SR16 with ketamine vs ECT. Conversely, those with a baseline QIDS-SR16 score of more than 20 (ie, very severe depression) and starting treatment as inpatients reported greater reduction in the QIDS-SR16 earlier in course of treatment (-8.4 vs -6.7 points) with ECT, but scores were similar in both groups at the end-of-treatment visit (-9.0 vs -9.9 points). In the ECT group only, participants with higher scores on measures of premorbid intelligence (-14.0 vs -11.2 points) and with a comorbid posttraumatic stress disorder diagnosis (-16.6 vs -12.0 points) reported greater reduction in the MADRS score. Those with impaired memory recall had greater reduction in MADRS during the second week of treatment (-13.4 vs -9.6 points), but the levels of MADRS were similar to those with unimpaired recall at the end-of-treatment visit (-14.3 vs -12.2 points). Other results were not significant after false discovery rate adjustment. Conclusions and relevance: In this secondary analysis of the ELEKT-D randomized clinical trial of ECT vs ketamine, greater improvement in depression was observed with intravenous ketamine among outpatients with nonpsychotic TRD who had moderately severe or severe depression, suggesting that these patients may consider ketamine over ECT for TRD.

Data on medication interactions with psychedelics are limited. Here we present what may be the first published report of a hypertensive emergency following the combination of psilocybin mushrooms with a monoamine oxidase inhibitor (MAOI). A 42-year-old man with treatment-resistant major depressive disorder took 1 g of Psilocybe cubensis mushrooms, while prescribed tranylcypromine, extended-release dextroamphetamine-amphetamine, and other medications. Approximately half an hour later, he developed severe hypertension with chest pain, palpitations, and headache. Upon hospital presentation, the electrocardiogram demonstrated ST-elevation. The patient was diagnosed with a myocardial infarction and treated with lorazepam, nitroglycerin, and aspirin. He subsequently underwent emergency cardiac catheterization, which revealed no significant cardiac abnormalities. Following overnight hospitalization, he was discharged home with no lasting physical sequelae. Though data are few, past studies suggest that classic serotonergic psychedelics (5HT-2A receptor agonists) such as dimethyltryptamine (DMT), lysergic acid (LSD), and synthetic psilocybin should not produce hypertensive emergency when combined with MAOIs. We suspect phenylethylamine, found in Psilocybe cubensis and other species of psilocybin mushrooms, interacted with tranylcypromine and dextroamphetamine-amphetamine to produce this hypertensive emergency. Patients prescribed MAOIs should be warned of the potential for hypertensive emergency when consuming psilocybin mushrooms, particularly when also prescribed norepinephrine releasers such as dextroamphetamine-amphetamine.

This study aimed to investigate the frequency of long COVID diagnosis among patients infected with severe acute respiratory syndrome coronavirus 2 with preexisting psychiatric conditions versus those without preexisting psychiatric conditions. The TriNetX Analytics platform, an aggregated electronic health record research network containing the deidentified electronic health record data of more than 90 million patients, was queried for patients who were diagnosed with COVID-19 infecti...

BARNETT: Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH Dr. B.S.B. holds stock options in CB Therapeutics. He also serves on advisory boards for CB Therapeutics and Compass Pathways. He has received monetary compensation from DynaMed Plus (EBSCO Industries Inc.) for editorial work and from Cerebral and Janssen Pharmaceuticals f...

Later this year the Food and Drug Administration (FDA) will decide whether MDMA, the drug commonly known as "ecstasy," is a medicine. Last month, Lykos Therapeutics, which has sponsored multiple positive clinical trials of MDMA-assisted psychotherapy for posttraumatic stress disorder, submitted a New Drug Application for the psychedelic to the FDA. Posttraumatic stress disorder affects 7% of Americans and about a third of patients with this frequently debilitating condition are not helped by ex

Background: Though lysergic acid diethylamide (LSD) use is rising in the United States amid expanding research into the therapeutic potential of psychedelics, little scholarly work exists on whether perceived risk of trying LSD (prLSD) is changing or factors influencing prLSD among the general public. Therefore, we sought to investigate changes in prLSD from 2015 to 2019 and identify characteristics associated with prLSD among respondents to the National Survey on Drug Use and Health (NSDUH). M

From the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland (B.S.B.); and the Departments of Emergency Medicine (P.R.C.) and Psychiatry (J.S.), Brigham and Women’s Hospital, the Department of Psychosocial Oncology and Palliative Care, Dana–Farber Cancer Institute (P.R.C.), and the Fenway Institute (P.R.C.), Boston, and the Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge (J.S.)

Mental health problems including depression, anxiety, suicide, and burnout are common among health care providers. Resilience and well-being are factors thought to protect against these incidents. Clinical trials and naturalistic studies of psychedelic compounds have shown decreases in depression, anxiety, and suicidality while suggesting improvements in well-being. This secondary analysis of a large cross-sectional online survey consisting of participants with at least one lifetime psychedelic