Psilocybin is considered one of the most well-known psychedelics, and it’s one you hear a lot about in the field of psychedelic medicine. A growing body of research suggests that, when taken in controlled conditions, psilocybin may be useful for treating various mental health disorders such as depression. This has had some people exploring psilocybin’s effects on other chronic mental health conditions, including obsessive-compulsive disorder (OCD).
Before we go any further, it’s important to know that psilocybin is classified as a “Schedule I controlled substance” in the U.S.—which means there is no accepted medical use and it’s considered to have a high potential for abuse. The classification places psilocybin in the same category as other substances like heroin, ecstasy, and LSD. Only certain states like Oregon and Colorado, and certain cities like San Francisco, Denver, and Oakland have legalized it for therapeutic use. All other states specify that psilocybin is illegal under federal law in the United States.
That said, you may have heard about psilocybin for OCD, or even considered a clinical trial using the drug. Keep reading to learn what the research says about the risks as well as potential benefits, and understand your best options for treating OCD.
Psilocybin and OCD
Given how debilitating OCD can be when left untreated, it’s no wonder that many people are asking: What are all the options that can help me find relief?
A quick refresher: OCD is a chronic mental health condition; its two main symptoms are obsessions, or recurrent and intrusive thoughts, urges, feelings, sensations, or images that cause distress, and compulsions, or repetitive behaviors or mental acts done in an attempt to reduce anxiety or “neutralize” obsessive thoughts. Compulsions often work, but only temporarily, which is why a more lasting way of dealing with the disorder is needed.
But simply put, psilocybin has not gained status as an effective treatment for OCD. “Does psilocybin treat OCD? No,” says Dr. Patrick McGrath, PhD, the Chief Clinical Officer at NOCD. “It can potentially reduce symptoms, but there’s only anecdotal evidence. We don’t have enough studies to give us a good conclusive answer for that.”
Does psilocybin treat OCD? No. It can potentially reduce symptoms, but there’s only anecdotal evidence. We don’t have enough studies to give us a good conclusive answer for that.
It’s also important to remember that OCD is not an untreatable condition that demands experimental therapies; in fact, it’s highly treatable using a form of behavioral therapy known as exposure and response prevention (ERP) which is backed by ample clinical research.
What is psilocybin and how does it work?
Psilocybin is a naturally occurring psychoactive compound found in what are known as magic mushrooms, or shrooms. Classified as a hallucinogen, psilocybin activates receptors in the brain associated with mood regulation, perception, and cognition, particularly in areas of the brain linked to anxiety and fear. Psychedelics can help the brain develop new cellular connections—a process called neuroplasticity—and some researchers say that psilocybin may be beneficial for breaking out of rigid and restrictive patterns, providing a sort of “reset.”
How does this actually work in the brain? Well, hallucinogens like psilocybin cause mind flights, which are mental shifts that result in reality-altering effects, including vivid dreams, visual sensations, and derealization, or feelings that the world around you is distorted or not quite real. These experiences can cause people to reflect on their thoughts, behaviors, and relationships in new ways.
But there are large gaps in research as far as psilocybin for mental health conditions is concerned—partly due to years of stigma as well as policies that for decades prevented most researchers from investigating psychedelics. As those barriers are beginning to fall away, researchers have made some strides. In 2000, psilocybin was approved for psychedelic research; and in 2020, psilocybin was granted therapy status for the treatment of major depressive disorder.
Research into psilocybin’s possible role in helping people with OCD isn’t as far along, however—although it is getting more attention lately from the scientific community.
What the research says about psilocybin for OCD
As mentioned, there’s limited research on psilocybin to treat OCD symptoms, and it’s emphatically not considered a treatment for OCD, as McGrath says.
So what are the (limited) studies that give some people hope for future research? An older 1987 study by The American Journal of Psychiatry presented a case report of a 17-year-old person who experienced a relief of OCD symptoms after taking three different psychedelic drugs. Another study by J Clin Psychiatry conducted in 2006 administered 29 psilocybin doses to 9 individuals, finding that there was a decrease in OCD symptoms.
Once again, it’s important to note the small sample size of these studies. Further research is needed with larger participant groups.
The good news? As of 2024, there are five ongoing clinical trials investigating the impact of psilocybin in OCD.
“We are still figuring out various mechanisms of action of psilocybin including where in the brain it actually focuses on and targets, what it does, what are the short-term effects, and what are the long-term effects,” McGrath says. “Let’s do the research first before we jump to any conclusions.”
Things to think about before considering psilocybin therapy
Psilocybin is a psychoactive substance, and it’s important to be fully informed about the potential risks. For one thing, even if you see someone on TikTok or in an online forum praising its benefits, psilocybin doesn’t have the same effect on everyone. There will always be some people who react differently to it than others do. Again, it’s important to reiterate that psilocybin is still illegal under federal law in the United States.
Another critically important consideration: Even if you’re curious about alternative treatments, it’s important to not simply acquire psychedelics and self-medicate—the same way people with cancer shouldn’t purchase chemotherapy drugs to use without supervision or guidance. After all, “psilocybin therapy”—as it’s called—is not taking mushrooms recreationally or in an unsupervised setting. Instead, it is a structured, carefully controlled process that should be done under professional care to ensure safety and effectiveness.
Since everyone reacts differently to psychedelics, a “bad trip” can happen which may include feelings of panic, intense fear, and heightened anxiety. Physical symptoms are also common, including nausea, vomiting, increased heart rate, and dizziness.
While psychedelics have an extremely low chance of addiction or lethal overdoses, that doesn’t mean they are right for everyone. For instance, for people who have a personal or family history of schizophrenia or bipolar disorder, there may be an elevated risk of psychedelics triggering a psychotic or manic episode. Additionally, people who are already taking medication for mental health conditions may experience a surplus of serotonin in the brain, resulting in serotonin syndrome, a serious condition that can lead to life-threatening adverse drug reactions. Likewise, psilocybin can raise blood pressure and heart rate, so those with heart conditions are often told they aren’t good candidates for the drug.
The bottom line? Psilocybin therapy is still being studied for its impact on OCD symptoms, whereas other treatments—like ERP and FDA approved medication—have decades of clinical research backing their effectiveness.
The best treatment for OCD
Although the field of psilocybin therapy may be promising, ERP therapy remains the leading evidence-based approach for treating OCD.
This specialized therapy works to break the OCD cycle of obsessions and compulsions by exposing you to what triggers your intrusive thoughts, images, feelings, sensations, or urges. The second and perhaps most crucial part of ERP focuses on response prevention techniques that teach you how to resist engaging in the compulsions that make OCD worse over time.
A therapist specializing in ERP will guide you through various exercises that will help you stop doing compulsions and learn to accept the uncertainty and doubt that obsessions can bring. Over time, your brain learns that the fears prompted by your obsessions are not actual threats.
On average, it can take about two months of ERP treatment to see a change in your symptoms.
“You always want to start with ERP,” McGrath says. “Some people hear about certain treatments online and think, that must mean that’s the best, new option, but just because something is new doesn’t mean it’s better. We know that ERP works and that it’s good. So why not continue and go with that as you’re working on things?”