Psychedelic-assisted pharmacotherapy: clinical applications and regulatory considerations

INTRODUCTION: After decades of regulatory marginalization, psychedelic compounds have reemerged as promising therapeutic tools in psychiatry, driven by unmet clinical needs in treatment-resistant mental disorders and by growing evidence of rapid and sustained effects on mood, cognition, and behavior. AREAS COVERED: This narrative review critically examined the current clinical and regulatory landscape of psychedelic-assisted therapies in psychiatry. We synthesize evidence from phase II-III clinical trials, regulatory agency documents, and international drug policy frameworks, focusing on ketamine/esketamine, MDMA, psilocybin, LSD, DMT/5-MeO-DMT, and ibogaine across major depressive disorder, treatment-resistant depression, PTSD, anxiety disorders, and substance use disorders. Particular attention will be given to regulatory pathways, scheduling constraints, access mechanisms, and compound-specific approval trajectories in the United States, European Union, and selected international jurisdictions. EXPERT OPINION: Psychedelic-assisted therapies are unlikely to follow a conventional prescription model and instead require specialist-delivered, psychotherapy-integrated care under appropriate regulatory and ethical safeguards. While late-stage trials support their potential in high-need populations, unresolved challenges, including long-term safety, scalability, workforce training, equity of access, and medico-legal accountability, must be addressed before broader clinical implementation.