Psilocybin-induced neurocardiogenic syncope: a case report.
Mazen A Atiq, Eli Weisman, Rodrigo B Guerra, Luis Luna Martinez, David B. Yaden, Frederick S. Barrett, Sandeep M. Nayak, Ceyda Sayalı
Psychopharmacology May 28, 2026 DOI: 10.1007/s00213-026-07079-8 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Open-label Pilot study Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Healthy 35-year-old male enrolled in an open-label study of psilocybin with TMS-EEG |
| Intervention | Psilocybin |
| Dose | 25 mg |
| Topics | Psilocybin |
| Registration | NCT06835699 |
| Key findings | A healthy adult experienced neurocardiogenic syncope after psilocybin, a rare hypotensive adverse event that resolved with supportive care. |
Abstract
Psilocybin is among the serotonergic psychedelics closest to potential FDA approval, with growing evidence of therapeutic benefit across psychiatric conditions. As clinical trials expand, systematic characterization of adverse events (AEs) remains essential. While transient hypertensive responses are well documented, hypotensive events such as neurocardiogenic syncope (NCS) are rarely reported. We describe a healthy 35‑year‑old male enrolled in an open‑label study investigating psilocybin‑evoked changes in brain function during transcranial magnetic stimulation and electroencephalography (TMS‑EEG). Approximately 60 minutes after receiving 25 mg oral psilocybin, and shortly after initiation of an eye‑open resting‑state EEG, he experienced prodromal lightheadedness followed by a brief loss of consciousness and postural tone. Immediate blood pressure was 93/51 mmHg with tachycardia and diaphoresis. Supportive measures, including leg elevation and oral hydration, led to rapid stabilization, and no further cardiovascular abnormalities occurred. The participant reported an emotionally intense experience, and contextual factors - including upright seated posture, restrictive EEG equipment, and anticipatory anxiety surrounding TMS - may have contributed to heightened autonomic arousal and susceptibility to NCS. This case highlights a rare hypotensive AE during psilocybin administration and underscores the importance of vigilant cardiovascular monitoring, particularly during procedures that may amplify emotional arousal. Given that fewer than one‑quarter of contemporary psychedelic trials report systematic AE assessment, transparent documentation of both hypertensive and hypotensive events is critical for defining psilocybin's safety profile as clinical applications expand. Open Label Psilocybin Brain Stimulation and Imaging Pilot Study; ClinicalTrials.gov: NCT06835699. Date registered: 02/13/2025. The parent‑study consent form explicitly permits publication of de‑identified participant data, and separate institutional approval for this case report was obtained (IRB00543773).
Comparable studies
Other case reports and case series on psilocybin, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psilocybin Mushroom (Psilocybe semilanceata) Intoxication with Myocardial Infarction 18-year-old man | 1998 | Case study | n = 1 |
| Relief from intractable phantom pain by combining psilocybin and mirror visual-feedback (MVF) Person with leg amputation and phantom-limb pain | 2018 | Case study | n = 1 |
| Hallucinogen persisting perception disorder after psilocybin consumption: a case study 18-year-old man with HPPD after mixed psilocybin and cannabis intoxication | 2005 | Case study | n = 1 |
| Microdosing psilocybin for chronic pain: a case series Individuals with chronic neuropathic pain | 2022 | Case series | n = 3 |
| Psilocybin and Obsessive Compulsive Disorder Individual with Obsessive Compulsive Disorder | 2014 | Case study | n = 1 |
Citations in the library
Cites 6
- Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance Psychopharmacology July 7, 2006
- Adverse Events in Studies of Classic Psychedelics JAMA Psychiatry September 4, 2024
- Psilocybin-assisted therapy for depression: A systematic review and dose-response meta-analysis of human studies European Neuropsychopharmacology August 7, 2023
- Acute Adverse Effects of Therapeutic Doses of Psilocybin JAMA Network Open April 10, 2024
- Adverse experiences resulting in emergency medical treatment seeking following the use of magic mushrooms Journal of Psychopharmacology April 7, 2022
and 1 more in the library