How to talk to patients about psychedelic therapy amid media buzz
Industry Buzz
Hope is important. But in medicine, hope has to be disciplined by data. Psychedelic medicine may have a future, but it needs to enter medicine through careful science, not hype, politics, or commercial pressure.
—Manpreet Kaur Singh, MD, MS, Robert H. Putnam Endowed Chair in Bipolar Research and Treatment at University of California
Physicians should respond with clear, evidence-based talking points that emphasize medicalization. Treatment requires proper set, setting, and integration with trained therapists, never self-administration. Benefits include rapid relief and neuroplasticity.
— Tyler Kjorvestad, MD, psychiatrist
Use of psychedelic medications for treating mental health conditions is gaining momentum, with the Trump administration pledging to accelerate research into and access to the drugs.[]
But experts say there needs to be careful consideration before physicians prescribe the drugs to their patients.
“Psychedelics, including psilocybin and ibogaine, are generating understandable enthusiasm, particularly among patients who have been difficult to treat," Manpreet Kaur Singh, MD, MS, the Robert H. Putnam Endowed Chair in Bipolar Research and Treatment at the University of California, Davis, tells MDLinx.
"However, we need to be clear that most of these compounds are not approved by the Food and Drug Administration, and evidence for their efficacy and safety is mixed and not particularly robust," she adds. “There is scientific merit to psychedelic medications, but also risk of overinterpretation of their merit. We need to separate promise from practice.”
“Psilocybin is not FDA-approved. MDMA-assisted therapy for PTSD was rejected by [the] FDA in 2024, and esketamine/Spravato is already available in certified clinics under REMS monitoring. That gap matters. The field is exciting, but it needs the same evidentiary, safety, and regulatory standards we require of any psychiatric treatment,” Dr. Singh says.
Related: Docs react: Psychedelic therapy moves closer to clinical realityThe biggest challenges
Research into psychedelics for treating mental health conditions is ongoing. Experts say that while the findings are interesting, studying the drugs effectively in humans also poses challenges.
“Some researchers, in animal studies, have suggested that the biochemical action of these drugs in the brain might be beneficial independent of these same drugs’ ability to cause profound subjective effects—in essence, the ‘drug’ might not need ‘the trip’ to work," Boris Heifets, MD, PhD, an associate professor of anesthesiology, perioperative and pain medicine and, by courtesy, psychiatry and behavioral sciences at the Stanford University School of Medicine, tells MDLinx.
According to Dr. Heifets, human studies are complicated by three primary factors: 1) patients can often tell they received the drug, 2) expectations may bias reported outcomes, and 3) results may depend as much on the subjective experience as the drug itself. "Cultural enthusiasm around psychedelics raises expectations and creates pressure to report improvement," he says.
How to counsel in the exam room
When working with patients who may express interest in psychedelic medications for treating mental health problems, experts say physicians should focus on the evidence.
According to Tyler Kjorvestad, MD, a psychiatrist at the University of Kansas Health System, physicians should use clear, evidence-based guidance that frames psychedelics as medical treatments—highlighting supervised, therapy-integrated use for select conditions, while emphasizing proper setting, screening, and risks such as cardiovascular effects and psychological distress. He also notes that physicians should consider referring interested patients to specialized clinics or ongoing trials, and discourage off-label experimentation.
Key Clinical Takeaways
Rapid symptom relief (hours to days) in MDD, treatment-resistant depression, PTSD, and substance use disorders
Increased neuroplasticity
Preserved emotional responsiveness vs SSRI-associated emotional blunting
Lower rates of sexual dysfunction compared with traditional SSRIs
Single- or limited-dose regimens (ie, not daily meds)
Fewer chronic side effects reported in early trials
Facilitates psychological insight and behavioral change when combined with psychotherapy
Potential to interrupt acute suicidal crises and reduce long-term risk
While there may be some benefits of psychedelic medications to some patients, the drugs are not without risk.
“Framing these treatments as a ‘magic bullet’ is particularly concerning given the risks and toxicity profiles. The risks are not theoretical: Patients can experience panic, agitation, impaired judgment, dangerous behavior, worsening psychosis or mania, blood pressure changes, drug interactions, and serotonin-related toxicity concerns,” Dr. Singh says.
Related: Play Second Opinion: Psychedelic hype, exam room reality—how do you respond?“Ibogaine deserves particular caution because of QT prolongation and potentially fatal arrhythmias. Purity and misidentification are major risks outside clinical settings, stemming from wrong mushroom species, adulterated chocolates, or unknown compounds,” she adds.
While some psychedelic medications show promise, Dr. Singh argues that they must be grounded by appropriate research.
“Hope is important. But in medicine, hope has to be disciplined by data. Psychedelic medicine may have a future, but it needs to enter medicine through careful science, not hype, politics, or commercial pressure,” she says.
Patient talking points from Dr. Singh
“I understand why you’re interested, as there is promising research. Most psychedelic treatments are still investigational and not FDA-approved. Some, [such as] ibogaine, carry serious medical risks, including heart complications. If this field progresses, it will likely be in highly supervised medical settings, but not self-treatment. Let’s also make sure we’re optimizing the treatments that are available now.”
“Self-treatment can be risky. The safest path is for us to discuss your diagnosis, medications, bipolar/psychosis risk, cardiovascular risk, substance use history, and current evidence-based options such as psychotherapy, medications, TMS, and FDA-approved esketamine where appropriate.”