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Psychedelic experiences elicited by serotonergic psychedelics: Molecular mechanisms and functional connectivity changes in the brain

Rivka Vollebregt, A. J. Storm, Paul J. Lucassen, Metten Somers

Neuroscience & Biobehavioral Reviews December 16, 2025 DOI: 10.1016/j.neubiorev.2025.106529 (opens in new tab)

Study at a glance

AI-extracted from the abstract
Characteristics Systematic review Peer reviewed
Topics Default mode network LSD Psilocybin Serotonin
Keywords Functional connectivity Hallucinogen Glutamate receptor Nerve net
Citations 3
Key findings Classical psychedelics primarily act as serotonin 5-HT2A receptor agonists, disrupt default mode network connectivity, and enhance global brain integration, which may underlie their therapeutic effects.

Abstract

Classical psychedelics, like lysergic acid diethylamide (LSD), N,N-dimethyltryptamine (DMT), and psilocybin, can alter perception, emotion, and cognition, and have shown promise as 're-purposed' treatments for some psychiatric disorders. Recent trials have, e.g., demonstrated rapid and sustained symptom relief in treatment-resistant depression. While promising as a treatment, the neurobiological mechanisms underlying both the subjective and clinical effects remain incompletely understood. Also, their broader influence on (intra) cellular processes, neural circuits, and brain-wide connectivity is less well documented. Here, we review the molecular and network-level alterations induced by classical serotonergic psychedelics through a systematic review of experimental and (pre)clinical studies from 1990 onward. We focus on the short-term impact on receptor activity, intracellular signaling, and functional brain connectivity underlying the psychedelic experience. Most psychedelics primarily act as serotonin 5‑HT₂A receptor agonists, initiating intracellular signaling pathways that modulate neuroplasticity, glutamate release, and cortical excitability. Psychedelics disrupt functional network connectivity, particularly within the default mode network, while enhancing global integration across brain regions. These effects are associated with subjective experiences of 'ego dissolution' and altered perception, which may contribute to their therapeutic effects. This review synthesizes findings at the molecular and systems level and their interaction during the psychedelic state. While no single model explains all effects, several overlapping theories begin to bridge receptor-level activity with large-scale brain connectivity changes. Improving our understanding of their neurobiological basis may help clarify how psychedelics act and allows for more tailored opportunities to enhance their therapeutic effects and clinical application in a stratified manner.

Comparable studies

Other systematic reviews and meta-analyses on serotonin, most cited first.

Study Year Design Participants
Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern‐era clinical studies Patients with cancer- or illness-related anxiety and depression, major depressive... 2020 Systematic review n = 188
Efficacy, tolerability, and safety of serotonergic psychedelics for the management of mood, anxiety, and substance-use disorders: a systematic review of systematic reviews Patients with mood, anxiety, or substance-use disorders, including cancer patients and... 2018 Systematic review of systematic reviews
Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review Patients in clinical trials with MDMA or serotonergic psychedelics 2022 Systematic review n = 598
Classic serotonergic psychedelics for mood and depressive symptoms: a meta-analysis of mood disorder patients and healthy participants Healthy volunteers and patients with mood disorders 2021 Meta-analysis n = 257
Serotonergic psychedelics and personality: A systematic review of contemporary research 2018 Systematic review

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