The short answer
Psychedelics are neither drugs with no medical value nor the next-generation antidepressants promised by press releases. In 2026, only one product in this constellation is authorized as a medicine in Europe: esketamine, a ketamine derivative, for treatment-resistant depression, in hospitals. Psilocybin shows a short-term signal in tightly controlled trials, with one recent trial inconclusive on its primary outcome. MDMA was rejected by the US Food and Drug Administration (FDA) in 2024. Ibogaine remains at the open-label study stage, with a documented risk of fatal cardiac complications.
In France, all these substances are classified as narcotics. My confidence is high regarding the legal framework and main risks, moderate regarding a specific effect of psilocybin and MDMA, and low regarding how long that effect lasts. This page is a starting point: it summarizes the evidence and links to the site’s detailed guides. It provides no doses, instructions for use or sources of supply.
What do we mean by psychedelics?
The term covers molecules that profoundly alter perception, emotions and the sense of self. Research distinguishes two broad groups, which do not share the same mechanism, risks or level of evidence.
| Class | Substances | Main mechanism | Status in France |
|---|---|---|---|
| Classic psychedelics | Psilocybin, LSD, DMT and ayahuasca, mescaline | Agonism at the serotonin 5-HT2A receptor | Classified as narcotics, no marketing authorization |
| Entactogen | MDMA | Massive release of serotonin, norepinephrine and dopamine | Classified as a narcotic, use prohibited |
| Dissociatives | Ketamine, esketamine | Blockade of glutamate NMDA receptors | Classified as narcotics, esketamine authorized in hospitals |
| Atypical alkaloid | Ibogaine | Multiple targets: NMDA, opioids, serotonin | Classified as a narcotic since 2007 |
The classic psychedelics are more alike than you might think. In a double-blind trial in Basel, equivalent doses of LSD, psilocybin and mescaline did not produce qualitatively different experiences. The real difference was duration, around 8 h for LSD versus 5 h for psilocybin, as detailed in the LSD and psilocybin comparison · FR. DMT has its own guide, DMT: effects, duration and risks · FR, and 5-MeO-DMT, a distinct molecule, has its own: 5-MeO-DMT, trials and status in France · FR.
The mechanism: a receptor, not a revelation
The most direct human evidence dates back to 1998. Franz Vollenweider’s team in Zurich gave psilocybin to healthy volunteers after pretreatment with ketanserin, a 5-HT2A receptor blocker. The psychological effects were blocked in a dose-dependent manner. A conventional antipsychotic, haloperidol, did not block them and instead intensified them. The driver of the experience is therefore activation of the 5-HT2A receptor, which is abundant in the cortex, rather than a simple dopamine surge.
What happens next in brain networks, imaging and neural plasticity is explored in magic mushrooms: effects on the brain · FR. Remember one rule: plasticity observed in animals or on imaging provides a biological hypothesis. It does not prove a clinical benefit. This is exactly where Mitochondria Marketing comes in: the art of using a real mechanism to sell an unproven benefit. The stack combining psilocybin, Lion’s Mane and niacin is a textbook example, taken apart in the Stamets Stack versus the evidence.
MDMA, ketamine and ibogaine do not act primarily through this receptor. Grouping them under the same label is convenient for headlines and misleading for risk assessment.
What clinical trials really show
Treatment-resistant depression: psilocybin and esketamine
The benchmark psilocybin trial remains Goodwin’s, published in 2022 in the New England Journal of Medicine: 233 adults with treatment-resistant depression, a single dose with psychological support. At three weeks, 25 mg reduced the MADRS score by 6.6 points more than a 1 mg dose, on a scale that goes up to 60. The 10 mg dose did not differ significantly, a sustained response at twelve weeks was not demonstrated, and 77% of participants experienced an adverse event. Suicidal thoughts or behaviors occurred in all groups.
The German EPISODE trial, published in 2026 in JAMA Psychiatry, dampened the enthusiasm. Among 144 adults, the response rate at six weeks was 17.0% after 25 mg versus 10.6% after nicotinamide, a nonsignificant difference. The authors describe an inconclusive trial, with one case of persistent perceptual disturbance. On the industry side, Compass Pathways secured a rolling submission of its application to the FDA in April 2026 and announced in August that it was targeting a complete submission in the fourth quarter. The press release reports that the primary endpoint was met. Peer-reviewed publication, however, is still pending. The trial-by-trial details are in psilocybin and depression: where the trials stand · FR.
Esketamine has cleared the hurdle psilocybin is aiming for. The European Medicines Agency authorized it on December 18, 2019 for adults with treatment-resistant depression, in combination with an SSRI or SNRI antidepressant, after at least two treatments had failed. In the United States, the FDA authorized it as a standalone treatment in January 2025. In France, in July 2024, the Haute Autorité de santé rated its actual clinical benefit as low, with no improvement over existing options, and reimbursement limited to people under 65 experiencing a severe episode resistant to two antidepressants, when electroconvulsive therapy is contraindicated, ineffective, inaccessible or refused. The product is classified as a narcotic, restricted to hospitals and prescribed by a psychiatrist. Blood pressure is monitored at every session.
Post-traumatic stress disorder: MDMA’s rejection
The two phase 3 trials in the submission were positive on paper. In 2021, among 90 adults with severe post-traumatic stress disorder, CAPS-5 scores fell by 24.4 points with MDMA versus 13.9 with placebo, alongside the same psychotherapy. In 2023, among 104 adults, the reductions were 23.7 versus 14.8 points.
Yet on June 4, 2024, the FDA advisory committee voted 9 to 2 that the data did not demonstrate efficacy, and 10 to 1 that the benefits did not outweigh the risks. On August 9, 2024, Lykos Therapeutics announced the agency’s rejection and its request for a new phase 3 trial. The objections had been laid out at the meeting. In the second trial, 94% of participants receiving MDMA believed they had received the active drug. The FDA also considered the assessment of cardiovascular, liver and abuse risks inadequate, noting that abuse-related effects were not recorded when considered positive or neutral. A molecule can have two positive trials and still have an inadequate submission: the FDA judges the quality of the evidence, not the enthusiasm it generates.
Addictions: alcohol, tobacco, ibogaine
For alcohol, Bogenschutz’s trial, published in 2022 in JAMA Psychiatry, randomized 95 adults to two sessions of psilocybin or an antihistamine, alongside twelve weeks of psychotherapy. Over 32 weeks, the proportion of heavy drinking days was 9.7% versus 23.6%. This is a meaningful signal from a single trial involving patients without another major psychiatric disorder. For tobacco, Johnson’s 2014 pilot study reported 12 out of 15 participants abstinent at six months, with no control group: a lead, not proof.
Ibogaine attracts attention through accounts of dramatic withdrawal relief. The Stanford study published in 2024 in Nature Medicine, involving 30 former special forces personnel, shows substantial improvements, but it is an open-label observational study without a comparator, which the authors themselves say needs confirmation. A 2016 toxicology review identified 27 deaths following ibogaine ingestion, linked in part to QT interval prolongation and ventricular arrhythmias, including in people with no known heart disease.
The underlying problem: impossible blinding
A double-blind trial requires patients not to know what they are receiving. After six hours of a psychedelic experience, they know. The care team often guesses too. Yet the expectation of getting better is part of the effect measured in psychiatry, and participants in these trials are often highly motivated volunteers.
A meta-analysis published in May 2026 in JAMA Psychiatry tackled the question head-on. Rather than comparing psychedelic therapy with placebo, it compared it with conventional antidepressants given open-label, meaning patients also knew what they were taking. Across 8 trials and 249 patients on one side, and 16 trials and 7,921 patients on the other, psychedelic therapy did no better. This work has its own limitations, notably the comparison across different trials. It is a reminder that the reported advantage over placebo probably overestimates the contribution of the molecule itself.
Then there is the Toll of these protocols, meaning a solution’s hidden cost in time, money and attention: sessions lasting 6 to 8 h, two therapists, preparation and integration appointments. What is being tested is the whole package. Nobody tested the mushroom alone in a living room.
Who authorizes what in 2026
In France, psilocybin is on the list of narcotics, and on May 27, 2025, the Ministry of Health reiterated that it has no authorization for depression or addictions outside trials authorized by the French National Agency for Medicines and Health Products Safety (ANSM). According to the OFDT, all hallucinogenic mushrooms and LSD are classified as narcotics, as are most active compounds in hallucinogenic plants. Iboga and ibogaine have been classified as such since the order of March 12, 2007. Ketamine is too, and its use without a prescription is a criminal offense. French law also penalizes presenting these products in a favorable light.
Elsewhere, access remains narrowly restricted:
- in Australia, since July 1, 2023, only authorized psychiatrists may prescribe psilocybin for treatment-resistant depression and MDMA for post-traumatic stress disorder, in a supervised healthcare setting, with no registered product
- in Czechia, a law in force since January 1, 2026 authorizes therapeutic psilocybin in specialized facilities, but the National Institute of Mental Health stated in March 2026 that treatment was not yet available because no reimbursement agreement had been reached
- in the United States, neither any classic psychedelic nor MDMA is FDA-approved to date
A retreat abroad or an online shop does not turn any of these frameworks into authorization for you.
The risks, substance by substance
Psychological risks
The bad trip is the best-known adverse effect: intense anxiety, confusion and a feeling of losing control, with a risk of accidents or dangerous actions. The OFDT also describes delusional episodes and effects that can last several days. Hallucinogen persisting perception disorder, known as HPPD, involves visual distortions that persist long after use. A 2022 review considers it uncommon but serious, with its frequency still poorly quantified.
People with a personal or family history of psychosis or bipolar disorder are excluded from almost all trials. This is not an administrative detail. In a cohort of more than 9 million Ontario residents aged 14 to 65, published in 2025, a hallucinogen-related emergency department visit or hospitalization was associated with an approximately sixfold higher risk of mania after adjustment. This is an association in people already experiencing difficulties, not proof that taking a substance causes the disorder, but the signal supports those exclusions.
Physical risks
Classic psychedelics moderately increase heart rate and blood pressure, as measured in the Basel trial comparing LSD, psilocybin and mescaline. MDMA carries a risk of hyperthermia with dehydration, rarely fatal, and serious heart rhythm disturbances. Ibogaine combines the risk of arrhythmia with substantial variability in metabolism involving the liver enzyme CYP2D6. Repeated ketamine use damages the bladder, sometimes irreversibly, and carries a risk of dependence.
Drug interactions
Three combinations warrant a clear warning:
- lithium: an analysis of 62 accounts of psychedelic use while taking lithium reported seizures in 47% of cases, using a weak methodology but showing a signal strong enough to take seriously
- monoamine oxidase inhibitors (MAOIs), present in the ayahuasca vine and related to certain antidepressants: they create a risk of serotonin toxicity with antidepressants, detailed in the DMT and ayahuasca comparison · FR
- SSRIs: in healthy volunteers, two weeks of escitalopram reduced psilocybin’s negative effects without reducing its positive effects, which does not justify stopping your treatment or combining it with a psychedelic on your own
Driving
Drogues Info Service considers ketamine completely incompatible with driving. The esketamine patient leaflet, even though it is administered in hospital, prohibits driving until the following day after a restful night’s sleep. The same reasoning applies to any substance that alters perception for several hours.
Harm reduction and support
This site does not encourage any use. If you are considering a psychedelic to feel better, the useful question is not “which one?” but “for what problem, with what follow-up care?” Treatment-resistant depression, post-traumatic stress disorder and addiction require medical care, with treatments already available, including esketamine for eligible patients. Enrollment in an authorized trial goes through a trial doctor, not a forum.
If you feel unwell, have persistent confusion or seizures, or display dangerous behavior after taking a substance, call 15 or 112. Warning signs and what to tell emergency services are detailed in magic mushrooms: dangers and emergency warning signs. If you are having suicidal thoughts, 3114 is available day and night. Drogues Info Service, on 0 800 23 13 13, supports people who use drugs and those around them, without judgment.
