In a large online survey of over 12,000 participants followed for two months, people who used psychedelics outside of medical supervision reported increases in psychotic and manic symptoms. These increases occurred only among those who used psychedelics in an illegal context. The severity of psychotic symptoms rose with more frequent use and more intense challenging experiences, while manic symptoms increased more in individuals with a history of schizophrenia or bipolar I disorder and those who reported a strong sense of insight during their psychedelic experience. The findings suggest that naturalistic psychedelic use in illegal settings may pose risks for certain individuals.
In a large observational study of US adults aged 18–50, naturalistic psychedelic use was modestly linked to increased depressive symptoms over time. Among 12,345 participants followed longitudinally, 505 reported psychedelic use. Those who used psychedelics in a 'risk context'—such as a negative mindset or lack of psychological support—showed a moderate increase in depressive symptoms compared to non-users and to users without such risks. This association was explained by more challenging psychedelic experiences in that context. The findings indicate that psychedelic use outside controlled therapeutic settings may not be generally beneficial and could worsen depressive symptoms under certain conditions.
Ecological momentary assessment (EMA) measures of rumination are only modestly correlated with conventional self-report measures, especially for change over time, partly due to lower reliability of EMA. Changes in rumination were larger for conventional self-report than EMA. Both types of measures accounted for unique variance in depressive symptom improvement, showing incremental predictive validity. The findings suggest that EMA and conventional self-report provide distinct, clinically meaningful information. Researchers using EMA should consider psychometric properties and the precise construct they intend to capture.