Psilocybin and Mental Health Outcomes: Scoping Review with ☸SAIMSARA

This scoping review aims to comprehensively map and synthesize the breadth of evidence from original research on the relationship between psilocybin and health, spanning clinical trials, epidemiological surveys, mechanistic experiments, and cross-sectional attitudinal studies. The review uses 145 references and builds its evidence map from 216 original studies with 271241797 total participants/sample observations (topic-deduplicated ΣN). This review indicates that the most consistent and replicated signal for psilocybin and health is rapid, large, and sustained reduction of depressive symptoms in clinical populations, with a randomized, waiting-list-controlled major depressive disorder (MDD) trial reporting Cohen's d=2.5 at week 5 and benefits in treatment-resistant depression persisting up to 6 months. Converging evidence suggests broader therapeutic potential for anxiety, Post-Traumatic Stress Disorder (PTSD), and existential distress, alongside preliminary signals for substance use disorders, though risks such as manic or psychotic episodes in vulnerable individuals warrant rigorous screening. A recurring caveat is that real-world benefits and access are moderated by race and ethnicity, with protective associations and program participation concentrated among White participants. These findings support a cautiously optimistic but equity-conscious role for psilocybin-assisted therapy in psychiatric and palliative care. Future work should prioritize controlled, prospective trials that test mechanisms and confirm durability while embedding culturally adapted, equitable access strategies.