Psychedelics in Psychiatry: Is the ‘Trip’ Essential?
- Tammy Johnson, PMHNP-BC
- Sep 23
- 5 min read
When people think of psychedelics, the first images that come to mind are colorful visions, mystical moments, or even cosmic journeys. The trip refers to the hallucinogenic experience—intense shifts in perception, emotion, and self-awareness. But here’s a question that researchers have been pondering: do you need to have that “trip” for the medicine to work?
Why It Matters for Some
Classic psychedelics like psilocybin (magic mushrooms) and LSD activate serotonin receptors in the brain, especially the 5-HT2A receptor. This can create vivid changes in perception, time, and emotion. People often report experiences like feeling deeply connected to the universe, dissolution of the ego, or intense emotional release—sometimes bliss, sometimes fear or confusion.
For many patients, these subjective experiences are part of the healing. They describe insights, shifts in perspective, and new meaning in life that last well beyond the trip itself. In fact, some studies link the mystical intensity of the trip to better outcomes.
But it’s not always easy. Trips can also be overwhelming, destabilizing, or even traumatic with or without proper support. That’s why psychedelic therapy requires trained guides, calm environments, and hours of supervision.
The Brain Without the Trip: Neuroplasticity in Action
On the flip side, psychedelics don’t just change the mind—they change the brain.
Research shows these medicines promote neuroplasticity: the brain’s ability to grow, rewire, and form new connections. Some scientists argue that the healing may come from these brain changes alone, not the trip itself.
That’s where the exciting idea of non-hallucinogenic psychedelics comes in. Scientists are developing “neuroplastogens”—drugs that spark brain rewiring without causing hallucinations. These could make psychedelic-inspired treatments more accessible, more predictable, and less resource-intensive.
Barriers and Challenges
Even though psychedelic therapy shows promise, there are hurdles:
Cost & access: Sessions require hours of professional supervision, often in specialized clinics.
Insurance coverage: Still uncertain, leaving patients to pay out-of-pocket.
Risks of misuse: Without trained support, trips can be destabilizing.
Not for everyone: Some people are curious about psychedelic therapy but want to avoid hallucinations entirely.
So… Do You Need the Trip?
The truth is, we don’t fully know yet. For some, the mystical journey is deeply therapeutic. Instead of on either/or debate it may be more helpful to view the exploration of non-hallucinogenic compounds as just an expansion to our therapeutic toolkit for treating depression, PTSD, and other mental health conditions. Research is opening doors to new hope, new healing, and maybe even a broader definition of what treatment can look like.
Psychedelics and Psychiatry: A Closer Look into Psilocybin
The idea of using psychedelics in mental health care isn’t new. In the 1950s, psychiatrist Humphrey Osmond—who coined the term psychedelic (meaning “mind manifesting”)—studied LSD in people with alcohol use disorder. Unfortunately, research into psychedelics was halted in 1968 when these substances were classified as Schedule I drugs.
Fast forward to today, and psychedelics are back in the spotlight. From psilocybin and MDMA to ketamine, researchers and states are exploring how these compounds might treat mood disorders, PTSD, anxiety, and addiction. Let’s take a closer look at the categories of psychedelics and their effects:
Classic Psychedelics (Psilocybin, LSD, Ayahuasca/DMT)
Boost serotonin via 5HT2A and 5HT2C receptors.
Effects on cognition: increased flexibility, insight, creativity—but may cause distractibility or disorganized thought.
Effects on perception: visual changes, mystical experiences, occasional paranoia, or feelings of disconnection.
Entactogens (MDMA)
Influence serotonin, dopamine, and norepinephrine.
Effects on cognition: enhanced emotional connection and empathy, with potential attention or memory challenges.
Effects on perception: altered body awareness and mild sensory shifts, but no full hallucinations.
Dissociatives (Ketamine)
Act on NMDA receptors. Esketamine (Spravato) is FDA-approved for treatment-resistant depression.
Effects on cognition: temporary issues with focus, memory, or verbal fluency.
Effects on perception: altered sense of self or environment; may cause dissociation
Oregon’s Psilocybin Program
Oregon has led the way with regulated psilocybin services:
Over 1,500 clients accessed services in early 2025.
High costs have driven demand for group sessions, a more affordable option.
As of May 2025, medical professionals can administer psilocybin, not just licensed facilitators.
Studies show group therapy is cost-effective, especially for low-income patients with depression.
Interaction with SSRIs appears safe; clinical studies have not reported serotonin syndrome.
New administrative rules are expected to take effect January 1, 2026.
Access and Challenges
High cost: Sessions often range from $500–$3,000.Insurance coverage: Currently, psilocybin therapy is not covered by insurance. Affordability options: Group sessions and nonprofit sliding scale fees help make therapy more accessible.
Expanding State Access
New Mexico: Therapeutic psilocybin program approved April 2025.
Colorado: First licenses issued March 2025.
Tacoma, WA: Decriminalized natural psychedelics January 2025.
Not universal: Massachusetts rejected a 2024 ballot initiative; California vetoed decriminalization in 2023.
FDA & Clinical Trials
CYB003: Psilocybin analog with Breakthrough Therapy designation; Phase 3 trials underway.
Compass Pathways: Synthetic psilocybin (COMP360) in Phase 3 for treatment-resistant depression.
Usona Institute: Phase 3 uAspire trial for major depressive disorder.
Multiple universities, including Johns Hopkins, UCSF, and Yale, are conducting psilocybin studies.
Conditions under investigation: PTSD, alcohol/tobacco use disorders, anorexia, chronic pain, end-of-life anxiety, mild cognitive impairment, and early Alzheimer’s disease.
FAQs
How do I access psilocybin in Oregon?
Must be 21+ years old.
Therapy takes place at licensed psilocybin service centers with trained facilitators.
Patients can self-refer; no physician referral required, though centers collaborate with mental health providers.
How much does psilocybin treatment cost?
Individual sessions: $500–$3,000.
Group sessions are more affordable.
Insurance does not cover services.
Will psilocybin become more accessible?
Eventually… but it will likely take time. The cost of psilocybin in Oregon should decrease over time due to factors like increased competition. Also if psilocybin is federally rescheduling, this will pave the way for insurance coverage and may reduce expensive overhead. A psilocybin center in Bend has already partnered with a health insurance provider, potentially creating a model for future coverage. However, while access is improving through lower-cost options and financial assistance programs, a significant portion of the population will continue to find it cost-prohibitive for now.
Do I have to “trip” for psychedelics to work?
Some find the psychedelic experience essential; others benefit from biological brain changes post-treatment. Research continues.
Is psilocybin safe?
Supervised use can be safe but has risks including psychological distress (“bad trips”), Hallucinogen-persisting perception disorder (HPPD), paranoia, psychosis, elevated heart rate and blood pressure, among others.
The risk of harm is higher for those with pre-existing conditions and when used in unmonitored settings. Recreational use lacks safety controls, significantly increasing all the risks.
Psychedelics are at a fascinating crossroads—filled with hype and hope for its healing potential. Ongoing research, regulation, and clinical guidance will help ensure these treatments are used safely and effectively for those who may benefit most. But laws, safety questions, and gaps in research make the landscape complex.
Tammy Johnson, PMHNP has a passion for working with immigrant and underserved communities stemming from her personal background and years spent volunteering with Hispanic, Asian, and rural populations. She is an active supporter of the ACLU. In her free time she is a devoted animal lover and proud mom of two dogs and a cat.
References:
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Holze F, Becker AM, Kolaczynska KE, Duthaler U, Liechti ME. Pharmacokinetics and pharmacodynamics of oral psilocybin administration in healthy participants. Clin Pharmacol Ther. 2023;113(4):822-831. doi:10.1002/cpt.2821
Johnson M, Richards W, Griffiths R. Human hallucinogen research: guidelines for safety. J Psychopharmacol. 2008;22(6):603-620. doi:10.1177/0269881108093587
Oregon Health Authority. Oregon Psilocybin Services – Administrative Rules; 2023. Available from: https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/Psilocybin-Administrative-Rules.aspx.
Siegel JS, Subramanian S, Perry D, et al. Psilocybin desynchronizes the human
brain. Nature. 2024;632;131-138.
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