Psychedelic Use Among Psychiatric Medication Prescribers: Effects on Well-Being, Depression, Anxiety, and Associations with Patterns of Use, Reported Harms, and Transformative Mental States

Herrmann and colleagues frame their study within a recognised mental health crisis among health care workers, noting high rates of depression, anxiety, burnout and suicide that have been exacerbated by the COVID-19 pandemic. Earlier research and recent clinical trials suggest that psychedelic-assisted therapies and naturalistic psychedelic use can reduce symptoms of depression and anxiety, lower suicidality, and improve aspects of well-being and resilience in general populations. The authors highlight that little is known about how naturalistic psychedelic use affects clinicians who prescribe psychiatric medications, partly because of concerns about professional and legal repercussions that discourage disclosure. This paper reports a secondary analysis of data from the larger Psychedelics and Wellness Study (PAWS). The specific aim was to examine retrospective self-reported changes in depression, anxiety, emotional well-being, resilience and suicidal ideation among prescribers of psychiatric medication who have used psychedelics at least once. Secondary aims included exploring associations with lifetime use patterns, preferred psychedelic agent, and harms attributed to use. The authors hypothesised that respondents would generally report improvements on the assessed measures and that harms would be less common.

This study is a secondary analysis of the PAWS dataset, an anonymous cross-sectional retrospective online survey registered on clinicaltrials.gov (NCT04040582). Recruitment was broad and non-probabilistic (online platforms, social media, in-person, flyers, e-mail, snowball sampling). Eligibility for PAWS required age ≥18 years and at least one lifetime psychedelic use; for the present analysis participants additionally had to indicate they were a "health care provider who treats psychiatric disorders with medications." No personal identifying data were collected, participation was voluntary and uncompensated, and Western Institutional Review Board deemed the survey exempt. Key measures used were validated and study-specific instruments. Depression and suicidality were assessed with the Patient Health Questionnaire-9 (PHQ-9), anxiety with the Generalized Anxiety Disorder-7 (GAD-7), and emotional well-being with the HERO Wellness Scale (happiness, enthusiasm, resilience, optimism). Participants retrospectively rated average scores both before any lifetime psychedelic use and after their psychedelic use. Two PAWS-designed instruments were also employed: the PCQ-26, which asks about persistent changes across 26 domains related to psychedelic experiences (used here to derive an 18-item subset linked to resilience), and the NCI-8, which queries eight potential harms (e.g., suicidal impulses, aggressive/criminal impulses, and substance misuse). Participants also reported demographics, estimated lifetime number of psychedelic uses, preferred psychedelic, and microdosing history. Statistical analyses began with frequency distributions and assessment of normality. Although initial normality tests for pre-post residualised scores indicated deviations, bootstrapping (1,000 samples) supported the use of parametric tests. Paired-sample t-tests compared pre and post scores for HERO, PHQ-9 and GAD-7, with Cohen's d reported for effect sizes. An exploratory principal components factor analysis, supported by Monte Carlo parallel analysis, examined the 18 PCQ-26 items; factor loadings were interpreted using standard thresholds and items with cross-loadings were handled per stated criteria. To evaluate predictors of change, the investigators computed residualised change scores (standardised residuals from regression-predicted post scores) and used multiple linear regression with predictors including total lifetime uses, number of negative responses, gender, age, preference for psilocybin or LSD, and the PCQ-derived factor score. Correlations between lifetime use and change scores were also reported. Statistical significance was set at alpha <0.05 and analyses were conducted in SPSS v28.

The analytic sample comprised 228 prescribers, aged 23–82 years. Mean estimated lifetime psychedelic uses was 25.24 (range 1–500). Preferred agents were most commonly psilocybin (45.6%) and LSD (26.8%); ketamine was secondarily preferred by 7.9%. Eighteen participants (7.9%) reported a single use and 41.2% (n = 94) reported a history of microdosing. Retrospective comparisons showed statistically significant improvements from pre-to post-lifetime psychedelic use on all primary measures. HERO total scores increased from a mean of 32.73 to 40.14 (p < 0.001), PHQ-9 decreased from 6.03 to 3.02 (p < 0.001), and GAD-7 decreased from 6.11 to 2.74 (p < 0.001). HERO item 3 (resilience) rose from 6.66 to 8.23 (p < 0.001). PHQ-9 item 9 (suicidality) decreased from 0.36 to 0.14 (p < 0.001). Effect sizes were large for HERO total (d = 0.84) and medium for PHQ-9 (d = 0.60), GAD-7 (d = 0.68) and HERO resilience item (d = 0.72); suicidality change was a small effect (d = 0.32). Exploratory factor analysis on the 18 PCQ-26 items identified a single dominant factor (Factor 1) after parallel analysis, with an eigenvalue = 10.86 accounting for 60.4% of variance; a secondary eigenvalue (1.10) was not retained by parallel analysis. Factor 1 comprised 11 items with loadings ≥0.32 and excellent internal consistency (Cronbach's α = 0.94). The items with the highest loadings pertained to mystical-type experiences (connection to the universe, connection to nature, sense of awe) alongside interpersonal and personal domains; overall, 84.5% of respondents reported improvements on items comprising Factor 1. Factor 1 correlated with improved outcomes: decreased PHQ-9 (r = 0.38, p < 0.001), decreased GAD-7 (r = 0.36, p < 0.001), decreased suicidality (r = 0.26, p < 0.001), and increased HERO (r = −0.57, p < 0.001) and resilience (r = −0.50, p < 0.001). In multiple regression models using residualised change scores, greater improvement in PHQ-9 was independently associated with Factor 1 (B = 0.36, p < 0.001), fewer negative responses on the NCI-8 (B = 0.33, p < 0.001), higher age (B = −0.20, p < 0.001), and preferring LSD (B = −0.14, p = 0.037). For GAD-7, reductions were associated with Factor 1 (B = 0.33, p < 0.001), fewer lifetime uses (B = 0.13, p = 0.020), fewer negatives (B = 0.42, p < 0.001), and higher age (B = −0.17, p = 0.004). For HERO total and HERO resilience item, Factor 1 was the sole significant predictor (HERO B = −0.57, p < 0.001; resilience B = −0.49, p < 0.001). Reduction in suicidality (PHQ-9 item 9) was associated with Factor 1 (B = 0.21, p = 0.002) and fewer negatives (B = 0.25, p < 0.001). No significant associations were found between total number of lifetime psychedelic uses and residualised change in PHQ-9 (r = 0.09), GAD-7 (r = −0.06), HERO (r = 0.06), resilience (r = 0.06), or suicidality (r = −0.05). When analyses were stratified by use-frequency groups (e.g., 1–5, 6–10, …, 50+), most groups showed significant pre-to-post decreases in PHQ-9 and GAD-7 and increases in HERO with medium to large effect sizes, though the 16–20 group did not show significant decreases for PHQ-9/GAD-7. Resilience increased in nearly all groups except 31–50, and suicidality scores decreased significantly in groups 6–10, 11–15, 21–30 and 50+ (with the 50+ group showing a medium effect size). Regarding harms, 30 participants (13.2%) endorsed at least one negative outcome attributed to psychedelic use, yielding a total of 50 negative item responses across the NCI-8 domains. The types of harms assessed included suicidal and aggressive impulses and misuse of substances (alcohol, cigarettes, cannabis, benzodiazepines, opiates). The overall harm rate matched that previously reported in PAWS.

Herrmann and colleagues interpret their findings as broadly consistent with clinical trials and prior naturalistic studies showing that psychedelic experiences are associated with reductions in depression, anxiety and suicidal ideation and with increases in well-being and resilience. They emphasise that this is, to their knowledge, the largest study focusing specifically on psychiatric prescribers and that improvements were seen across most frequency-of-use strata. The investigators highlight the identification of an 11-item Factor 1—combining mystical-type, interpersonal and personal items—which was strongly associated with improvements across depression, anxiety, well-being, resilience and suicidality. They suggest this cluster may represent mechanisms by which psychedelic experiences facilitate psychological change. The authors situate the Factor 1 composition within existing literature: while mindfulness and purpose have been linked to resilience, mystical-type experiences are less conventionally associated with resilience yet loaded highly on Factor 1. They propose two hypothetical pathways: one emphasising a "sense of the bigger picture" (awe and connectedness to nature/universe) and another emphasising renewed appreciation of ordinary life (purpose, gratitude, altruism) that could lead to re-engagement with clinical work. The discussion also notes that mystical-type experience intensity has been linked in other work to longer-term prosocial and wellbeing outcomes and that connectedness may reduce experiential avoidance, thereby improving mental health. In terms of safety, the authors acknowledge that although overall suicidality ratings decreased, a small number of respondents (n = 5; 2.2%) reported increased suicidal ideation after psychedelic use, underscoring the need for ongoing surveillance of adverse events as psychedelic therapies expand. They point to historical and recent reports of adverse events in psychedelic-assisted therapy and argue that potential harms warrant continued investigation. Finally, the study is positioned within debates about how psychedelics might play a role in clinician self-care, training and practice, noting that prescribers are divided about therapeutic potential and often feel unprepared to deliver psychedelic-assisted therapies.

The study concludes that, based on retrospective self-report in this sample of psychiatric prescribers, naturalistic psychedelic use was associated with multiple mental health benefits: lower self-reported depression, anxiety and suicidal ideation, and higher emotional well-being and resilience. The authors note that mystical-type, interpersonal and personal experience items (Factor 1) may mediate these effects. Reported harms were observed in a minority (13.2%) and were consistent with rates seen in the general PAWS population; a small subset reported worsening suicidal ideation. The investigators recommend further research into how psychedelics might affect burnout, mental health and overall wellness among psychiatric prescribers.