Everyone's Taking Psychedelics — Should You?

Every few weeks a new patient tells me a friend of theirs is microdosing mushrooms to "work on themselves," or that a cousin just got back from an ayahuasca retreat in Costa Rica, or that some executive at their company swears by a quarterly ketamine clinic day. The psychedelic boom is real. Whether any of it is right for you is a different question, and the answer depends more on your clinical picture than on what is trending in your social feed.

Here is what I tell patients when they ask.

What's real about the resurgence

Research suppression that held for fifty years has largely lifted. Johns Hopkins, NYU, UCSF, Yale, Imperial College London, and a long list of others now run psychedelic research programs. Psilocybin has breakthrough-therapy designation from the FDA for treatment-resistant depression. MDMA-assisted therapy for PTSD has gone through Phase 3 trials. Oregon and Colorado have legalized supervised psilocybin therapy. Several cities have decriminalized possession.

The science is progressing. The headlines are sometimes ahead of it, but the underlying work is serious, and for certain diagnoses — TRD, treatment-resistant PTSD, some addictions — the effect sizes from supervised trials are larger than anything in conventional psychiatry.

What I'm skeptical of

Microdosing. The body of evidence for sub-perceptual psilocybin or LSD as a routine wellness practice is mostly anecdotal. Randomized trials that control for expectancy (the placebo effect of thinking you are microdosing) have generally failed to find a meaningful signal. I am not saying it does nothing. I am saying I would not make clinical decisions on the basis of it yet, and I would not pay hundreds of dollars a month for mushroom capsules shipped from overseas.

Ayahuasca retreats. These range from genuinely therapeutic, well-screened programs run by experienced facilitators to effectively unregulated weekend trips that will hand you a cup of DMT brew regardless of what is on your medication list or your cardiac history. The dangerous version is more common than the retreat websites make it sound. Ayahuasca contains MAOIs that interact with SSRIs, SNRIs, some blood pressure medications, and a long list of other drugs in ways that are occasionally fatal. People have died on retreats. If you are considering one, get a cardiac workup and a medication review from a physician who is familiar with MAOI interactions, and do not assume the facilitators have done it for you.

The "quarterly clinic day" for optimization. Using psychedelics as a productivity tool without a therapeutic frame tends not to produce what people are hoping for. You can have a profound dissociative or psychedelic experience and then go back to your normal life on Monday morning and find that nothing has changed. Integration — the work you do in the weeks after — is where the actual change happens.

Where ketamine fits

Ketamine is grouped with classical psychedelics in the popular press, but clinically it sits somewhere adjacent. It is a dissociative, not a serotonergic psychedelic. It works through NMDA-receptor modulation and downstream BDNF release rather than through 5-HT2A activation. The subjective experience is typically shorter and less overtly "visionary" than psilocybin or ayahuasca. And it has one substantial clinical advantage over the classical psychedelics: it is already legal and prescribable, via both FDA-approved (Spravato nasal spray) and off-label (compounded sublingual, IV infusion) pathways.

For patients who have treatment-resistant depression, anxiety, or PTSD and want to pursue a dissociative or psychedelic-adjacent treatment under medical supervision, ketamine is almost always the right first call. The infrastructure exists, the dosing is well-characterized, and the safety profile in medical use is strong. Psilocybin may be a better fit clinically in two to five years once the FDA approves it for specific indications. Right now, in 2026, it is not generally the first option I reach for.

Who I refer out

I have referred patients to psilocybin clinical trials when they met entry criteria for a study I knew and trusted, when ketamine had not produced a durable response, and when the trial design included proper medical screening and integration support. These are rare situations, and I make the referral by name — to the specific investigator running the specific protocol — not to a retreat in the Amazon.

I have also referred patients away from psychedelics entirely. Personal or family history of schizophrenia or psychotic-spectrum illness is a hard stop. Active mania or bipolar I with recent episodes is a hard stop. Uncontrolled cardiovascular disease is a hard stop for substances that raise blood pressure acutely (which is most of them, including ketamine). Pregnancy. A current substance-use pattern that has not been addressed. If any of these apply, conventional psychiatric care is the right next step, not a retreat.

The question to ask yourself

If the thing pulling you toward psychedelics is curiosity about consciousness or a sense that you are "behind" culturally, I would pause. Those are reasons to read about it, not to put a Schedule I compound in your body without medical supervision.

If the thing pulling you toward psychedelics is years of depression, anxiety, or PTSD that conventional treatment has not touched — that is a different conversation. Supervised ketamine is available right now. Supervised psilocybin is available in two states and in clinical trials. MDMA-assisted therapy for PTSD is close to approval. The options are real. The right one for you depends on your diagnosis, your medication list, and your medical history.

That is the question worth asking. Not is everyone doing it. What does my specific picture call for.

Next step

If you have been cycling through antidepressants without adequate response and want to know whether ketamine therapy is a reasonable next move, the five-minute eligibility check will tell you quickly. If the answer is no, I will refer you somewhere it is yes.

Disclaimer: Compounded ketamine for anxiety, depression, PTSD, and chronic pain is not FDA approved. Discreet Ketamine provides at-home ketamine therapy to residents of Florida and New Jersey. All treatments are supervised by Dr. Ben Soffer, a board-certified physician.