Yes, I think there is a component of that, which is why studies need proper design for the question and validated measurement tools that eliminate that kind of bias.

Problem is, when people have a manic episode, their judgment is severely compromised and they can ruin their lives in days (gambling, risky behaviors, medical effects). Some people will spend all of their money during an episode and ruin themselves financially. So even if the absolute risk of having a manic episode is low, the consequences of having one can be catastrophic. Theres no insurance for unintentionally ruining your life (non-medically) while having a manic episode.

Physiatry / Neurorehabilitation

Agree. Evidence is lacking for cannabis in most of what people say it is helpful for. If people find it helpful, that’s great! It’s still an exogenous psychoactive compound with its own set of risks.

I am a physician and would NOT recommend anyone with bipolar take shrooms. The risk of an adverse event is too high in people with psychiatric illness with psychotic features including bipolar disorder. Also, many people with bipolar/depression are on psychiatric meds and there isn’t much data on risks of things like serotonin sydrome and other complications like prolonged psychosis, precipitating a manic episode, etc. That being said, we need more objective data (with VALIDATED measures). I recently presented a Grand Rounds lecture on Psilocybin, its mechanisms, and current applications.

Edit: some highlights from the study design and results

• Subjects were recruited via online advertisements on the CREST.BD website and social media.

• “self-reported bipolar disorder diagnosis”

Sample bias and very likely including misdiagnoses and people with something not actually bipolar (personality disorder, mild schizophrenia, depression, thyroid disorder). There are a lot of people with “bipolar” self-diagnosed. And there are a lot of people who are older that have bipolar diagnoses that are not truly bipolar but were misdiagnosed in the past.

• “On a five-point scale from “Not at all” to “Extremely harmful,” the participants rated the harmfulness of their psilocybin experience “.

Having a wide range of time from last use can affect the results. Recency/time bias, inaccurate recall of events and symptoms the further out they get. Also, not a validated measure.

• “The most commonly cited reason for using psilocybin was to aid personal development, followed by to have fun.”

That’s cool, but I think that says something about the population under study. Patient recruitment methods likely influenced this.

• “32.2% of participants reported experiencing negative or unwanted outcomes during or in the 14 days after a psilocybin trip. New or increasing manic symptoms were the most common side effect. Eighteen people reported the use of emergency services during or in the 14 days after a psilocybin trip.”

Well that doesn’t sound great.

• “While our study shows that some people with bipolar disorder reported positive experiences of psilocybin use, others experienced significant bad outcomes, so using this substance can be risky.”

I don’t like this study and think it’s bad because of flawed methodology. But if it helps to get a clinical trial (which they say is underway), then I guess this weak and biased survey data is helpful. I expect that they would use validated symptom severity scales such as the Young Mania Rating Scale (YMRS) or Bech-Rafaelsen Mania Rating Scale (MAS) for future and ongoing clinical research.

For more info on bipolar diagnosis and symptom monitoring for those who are interested: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847794/