In the quest for new treatment options for depression, attention is being paid to the potential role of psychedelic drugs. Psilocybin is of particular interest given its mechanism of action, its benefits in early trials and its relatively low side effects burden. This viewpoint outlines a number of key issues that remain to be elucidated about its potential use in the clinical environment, including clarification of the profile of people most likely to benefit and those who might experience adverse effects, longer-term outcomes and the role of psychotherapeutic input alongside the drug itself. There are also opportunities to understand better, the neurobiology underpinning its effects.

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Recent high-profile findings supporting the possible efficacy of psychedelic-assisted psychotherapy (Psy-AP) for indications including treatment-resistant depression and post-traumatic stress disorder make it increasingly likely that these treatments will become more widely available. While social and popular media discussions have highlighted interpersonal risks associated with Psy-AP, within psychiatry there has been little focus on this issue. In this viewpoint, we argue that while abuse of power unarguably happens in psychotherapeutic relationships more broadly, there are factors rendering Psy-AP modalities particularly vulnerable to such issues, while also presenting obstacles to reporting. Mainstream psychiatric institutions have a key role to play in increasing awareness of interpersonal risks in Psy-AP and developing protocols consistent with accepted standards of clinical care to manage them.

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