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Background:
Case Report

Psilocybin Use in an Intercollegiate Athlete with Persisting Symptoms After Concussion: A Case Report

by
David W. Lawrence
1,2,3,*,
Alex P. Di Battista
3,4 and
Michael G. Hutchison
3
1
Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5R 0A3, Canada
2
Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5, Canada
3
Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON M5R 0A3, Canada
4
Toronto Research Centre, Defence Research and Development Canada, Toronto, ON M3H 5Y8, Canada
*
Author to whom correspondence should be addressed.
Psychoactives 2025, 4(3), 22; https://doi.org/10.3390/psychoactives4030022
Submission received: 30 April 2025 / Revised: 7 June 2025 / Accepted: 13 June 2025 / Published: 1 July 2025
Browse Figure
Versions Notes

Abstract

Background: Persisting symptoms after concussion is a complex syndrome warranting exploration into further treatment options. Emerging research highlights the potential of classic psychedelics, such as psilocybin, in managing neuropsychiatric conditions and promoting neuroprotection. Case Report: A case is presented of a 22-year-old male intercollegiate athlete who sustained a concussion and developed persisting symptoms despite multidisciplinary standard care. The symptom burden remained relatively stable for the first month post-concussion. He independently administered three 250 milligram (mg) doses of the dried fruiting body of Psilocybe cubensis (2.5 mg of psilocybin) on days 42, 45, and 46 post-injury. He reported immediate symptom relief, including improvements in headache, noise sensitivity, and cognitive function. His symptom severity score decreased from 25 to 11 and his affective symptom burden resolved completely. Functional improvements allowed him to return to full activity. No adverse effects were reported. Conclusions: This case highlights the potential role of classic psychedelics as adjuvant agents in treating persisting symptoms after concussion. Clinicians should be aware that athletes may explore psychedelics as alternative treatments. Further research is needed to evaluate the efficacy and safety of psilocybin in concussion recovery.

1. Introduction

Concussion is a form of mild traumatic brain injury (TBI) that is typically self-limiting and follows a natural recovery trajectory [1]. The pathophysiology of concussion involves acute neuronal depolarization, triggering a neurometabolic cascade resulting in neuronal calcium influx and mitochondrial sequestration [2]. The subacute phase involves more global energy metabolic dysfunction and disruption to cerebral blood-flow dynamics [3,4]. Although animal models of concussion suggest spontaneous recovery can occur within hours to days, clinical studies have demonstrated that alterations in synaptic transmission, white matter integrity, and neuroinflammation can persist for weeks to months following concussion [5,6]. Estimated recovery times for concussion vary, typically ranging from weeks to months [7,8,9,10].
Current best practices for concussion management emphasize a brief period of relative rest lasting 24–72 h, followed by a graded return to activity alongside a multidisciplinary active rehabilitative approach that includes vestibular, cervical, and oculomotor rehabilitation alongside psychological support, where indicated [1,11]. Evaluating and monitoring concussion recovery primarily relies on symptom tracking and response to graded functional stressors, with ultimate clearance determined by symptom resolution following the successful integration of full functional activities [1].
While most individuals recover within expected timeframes, approximately 15–30% of individuals experience prolonged symptoms [6,12], referred to as persisting symptoms after concussion [13]. Recommendations suggest that symptoms lasting longer than one to three months post-injury should be defined as persisting [1,6,13]. Persisting symptoms after concussion are a heterogeneous syndrome characterized by symptoms across specific domains, including affective symptoms, cognitive complaints, headaches and migraines, cervicogenic dysfunction, sleep disorders, and vestibulo-ocular disturbances [5,14,15].
The management of persisting symptoms currently involves a targeted, multidisciplinary rehabilitative approach that integrates both pharmacological and non-pharmacological treatments while addressing comorbid conditions [16,17]. Given the significant burden and functional impact of concussion, there is a critical need to explore and develop novel treatment strategies for both acute and persistent symptoms.
Growing interest surrounds psychedelics and psychedelic-assisted therapy for the management of various neuropsychiatric conditions, including depression and anxiety [18,19,20,21,22,23,24,25,26,27]. Classic psychedelics, a class of psychoactive substances with predominant action via serotonin 2A (5-HT2A) receptor agonism, have been shown to rapidly alleviate symptom burden in depression [18,19,20,21,22,23,24,25,26,27]. Higher doses of classic psychedelics, such as psilocybin and N, N-dimethyltryptamine (DMT), have also been associated with profound alterations in consciousness, including perceptual and cognitive distortions, disruptions in self-referential processing, and mystical-type experiences, marked by a sense of unity, the transcendence of time and space, and deeply felt positive emotions [28,29].
The efficacy of psychedelics in managing symptoms of depression and anxiety, frequently experienced in individuals with persisting symptoms after concussion, underscores their potential as promising adjuvant therapies in concussion care. Moreover, early research is examining the role of classic psychedelics, including psilocybin and DMT, in models of acquired brain injury, with early findings showing promising neuroprotective effects [30,31,32,33,34,35]. In rodent models of stroke, both psilocybin and DMT have demonstrated neuroprotective properties hypothesized to be mediated through sigma-1 receptor (Sig-1R) agonism [32,36,37]. The Sig-1R is a membrane protein primarily located in the mitochondria-associated endoplasmic reticulum, where it regulates calcium homeostasis, reduces oxidative stress, and mitigates ER stress [38]. The cytoprotective and anti-inflammatory properties associated with Sig-1R modulation make it a promising target for neuroprotective therapies in acquired brain injury [32,33,34,35]. Given the established disruption of mitochondrial calcium homeostasis in concussion and the potential protective effects of Sig-1R agonism via psilocybin and DMT, these compounds represent promising therapeutic targets with both symptomatic and neuroprotective potential.
A case is presented of an intercollegiate athlete who sustained a concussion secondary to direct blunt impact and subsequently developed persisting symptoms. Despite an evidence-based, actively rehabilitative, multidisciplinary management approach at an academic sports medicine clinic, his symptom and functional recovery had plateaued. The individual independently engaged in naturalistic psilocybin use to manage his concussion, experiencing a temporally associated sustained reduction in symptom burden and improvement in functional tolerance. Clinicians managing athletes should be aware that athletes may have knowledge of psychedelics and may engage in self-directed use.

2. Case Report

2.1. Acute Injury

A case is presented of a 22-year-old male intercollegiate athlete who was diagnosed with a concussion following a blunt force trauma (head impact from teammate) to his right infra-orbital region during a contact practice. Written and verbal informed consent was obtained from the individual for the publication of this case. Furthermore, the individual described in the case had the opportunity to review, provide feedback, and approve the manuscript prior to submission. To note, the athlete’s specific sport has been intentionally omitted to preserve anonymity. When reporting psilocybin dosing, it is important to note that concentrations of the active compound psilocybin can vary across different strains of Psilocybe cubensis [39,40]. Nevertheless, a commonly accepted estimate is that the dried fruiting body of Psilocybe cubensis contains approximately 1% psilocybin by weight [40].
This athlete had three prior remote concussions at ages 11, 16, and 21 years old, all were sport-related with symptoms lasting 1–2 weeks. His past medical history was significant for a diagnosis of depression, anxiety, and attention deficit hyperactivity disorder (ADHD), none of which had been pharmacologically managed. He had no surgical history and was not taking medications or supplements. His substance-use history included regular inhaled cannabis use once weekly and prior remote experience with psilocybin: taking 2.5–3.0 g of the dried fruiting body of Psilocybe cubensis [25–30 mg of psilocybin], which is considered a macrodose, on 2 occasions, and a dose of 200 to 250 mg (2.0 to 2.5 mg of psilocybin) on 3–5 occasions. He denied alcohol and cigarette use. His cannabis use continued during his concussion recovery at a frequency of once per week with no change in dosing compared to baseline.
Immediately following the index head injury, the individual experienced facial pain, head pressure, and neck pain. He denied loss of consciousness, post-traumatic amnesia, emesis, radicular upper extremity pain, upper extremity neurological symptoms, and visual symptoms. He removed himself from play and avoided all physical activity until his first consultation with a sports medicine physician three days later.
At this initial consultation, conducted three days post-injury at an academic sports medicine clinic, his physical exam demonstrated periorbital ecchymosis and tenderness in the infra-orbital region, with no evidence of orbital deformity. His cervical spine exam demonstrated full active and passive range of motion. There was mild midline tenderness at C6. His neurological exam was normal, including the assessment of cranial nerves and upper-extremity neurological function. A Sideline Concussion Assessment Tool (SCAT) 6 symptom check list was administered. The SCAT6 is a standardized concussion assessment tool and includes a symptom inventory comprising 22 concussion symptoms, each rated on a 0 to 6 Likert scale [1]. The individual’s symptom severity score, calculated as the sum of the ratings across all symptoms, was 27 across eleven symptoms at initial presentation (see Figure 1). Notably, he reported a score of zero on all symptoms within the affective domain (more emotional, irritability, sadness, nervous or anxious, and trouble falling asleep). He also reported feeling “50% of normal,” with his top three symptoms being headache, pressure in the head, and neck pain.
He was diagnosed with a concussion and imaging studies, including a cervical spine X-ray and a computed tomography (CT) scan of the facial bones, were ordered. He was advised to follow a 24–48 h period of relative rest, after which he could introduce some light aerobic activity with minimal head movement in the form of a standardized stationary bike protocol [8]. He was provided academic accommodations for school and initiated on a return-to-learn protocol. He was referred to a sport physiotherapist for active rehabilitation.

2.2. Imaging Results

The cervical spine X-ray demonstrated straightening of the normal cervical curvature, but no fracture, paravertebral soft tissue swelling, or neuroforaminal stenosis was identified. The CT facial bones demonstrated comminuted fractures involving the anterior and posterolateral walls of the maxillary sinus in addition to a fracture of the superior orbital rim and lateral anterior orbital floor, with minimal depression. He was evaluated by an oral and maxillofacial surgeon, who recommended non-surgical management and advised avoiding contact sports for six months post-injury.

2.3. One Week Post-Concussion

At 6 days post-concussion, his symptom severity score increased to 31 across eight symptoms, with his affective symptom severity increasing to 7. He continued to report feeling “50% of normal”, and his top three symptoms at this visit were headache, light sensitivity, and difficulty concentrating. He attempted a light stationary bike session at a heart rate (HR) intensity of 100–120 beats per minute (bpm) for 15 min, which he tolerated initially with no worsening symptoms. He also attempted attending classes for 30–60 min, which aggravated his light and noise sensitivity.

2.4. One Month Post-Concussion

Up to 39 days post-concussion, his symptom severity score remained relatively stable. He successfully completed the prescribed stationary bike protocol [8] and began light, individual sport-specific drills, without symptom exacerbation. However, due to persistent symptoms, he reduced his course load from five to three classes and continued his academic accommodations.
His symptom severity score at 39 days post-concussion was 25 across eleven symptoms, and he reported feeling “70% of normal”. Given the refractory nature and moderate symptom burden, a brief computerized cognitive screening was conducted at 39 days post-concussion using C3 Logix [41]. His results were as follows: Trails A: 25.8 seconds (s), Trails B: 57.6 s, processing speed (number correct): 60, simple reaction time: 247 ms, and choice reaction time: 358 ms (see Table 1). His performance fell within normal limits when compared to established athletic norms.

2.5. Psilocybin Dosing

The individual independently administered psilocybin, without the knowledge of his physician or physiotherapist, by consuming 250 mg of the dried fruiting body of Psilocybe cubensis (2.5 mg of psilocybin) mushrooms on three occasions: days 42, 45, and 46 post-concussion. His reported intent was to enhance recovery, influenced by research suggesting that psilocybin might promote neuroplasticity. He selected a dose of 250 mg of the dried fruiting body of Psilocybe cubensis (2.5 mg of psilocybin) as this was the threshold dose where he typically experienced minimal subjective effects, including mild mood enhancement and increased color vividness. The subjective effects associated with the psilocybin doses administered during the post-concussion period were consistent with his prior subjective experiences with the same dosage, as described above, characterized by the presence of perceptual and affective changes that remained minimal in intensity. Following his first dose, he reported complete resolution of symptoms, specifically headache, noise sensitivity, and light sensitivity for 24 hours (h). Encouraged by this response, he returned to skills-based practice the following day, experiencing some mild symptom recurrence, but at 50% of the severity he had experienced prior to psilocybin use.
This led him to administer two additional doses on days 45 and 46 post-injury. Over the next 1–2 weeks, he reported near-complete symptom resolution, reaching an overall rating of 90% of normal. His symptom severity score decreased from 25 to 11, and his affective symptom score dropped from 7 to 0, where it remained for the rest of his recovery. Functionally, he noted improved tolerance for higher-intensity activity, with longer durations in sport-specific non-contact drills and strength and conditioning exercises. Academically, while he remained on a three-course load, he reported enhanced concentration, recall, and processing speed, ultimately no longer requiring accommodations for schoolwork. The individual did not identify any other factors or treatments that might have influenced his symptom and functional improvements.
Based on his symptom and functional improvement, he was referred for repeat brief cognitive testing at 100 days post-concussion, which revealed small improvements in all testing metrics: Trails A: 20.4 s (down from 25.8 s), Trails B: 47.8 s (down from 57.6 s), processing speed (number correct): 67 (up from 60), simple reaction time: 236 ms (down from 247 ms), and choice reaction time: 354 ms [down from 358 ms (see Table 1)].

2.6. Concussion Clearance

At 127 days post-concussion, he reported a symptom severity score of 0 across all symptoms and felt “100% of normal”. He was fully engaged in academic activities without accommodations. Despite medical recommendations to avoid contact for 6 months due to his facial fractures, he had returned to full-contact practice with no exacerbation of symptoms.

3. Discussion

A case is presented of a 22-year-old male intercollegiate athlete who independently administered three doses of psilocybin approximately one-month post-concussion, reporting an immediate and sustained reduction in symptoms along with improved functional tolerance. Although concussion symptoms may improve naturally improve over time, the typical trajectory of persisting after concussion symptoms in the absence of intervention is characterized by a slow, gradual reduction in symptom severity, often with fluctuations rather than rapid resolution [5].
Persisting symptoms after concussion is a complex multisystem syndrome involving symptoms across multiple domains [5,42]. This case highlights several established risk factors for the development of persisting symptoms, including a pre-injury history of depression, anxiety, and ADHD [42,43,44]. Prior mental health diagnoses have been shown to increase the risk of persisting symptoms after concussion by an estimated two- to three-fold [44]. Experiencing persisting symptoms after concussion is associated with a higher risk of depression, anxiety, and depressive symptoms, with up to 40–50% of individuals with persisting symptoms after concussion having affective symptoms [14,42,45]. In this case, the individual reported an affective symptom severity score of 7, which remained stable for the first month of recovery. Following psilocybin administration, the affective symptom burden resolved, as evidenced by a reduction in the affective symptom severity score to zero, where it remained for the duration of his recovery. This finding is noteworthy given the growing body of literature suggesting that psychedelics can improve mental health symptoms in other neuropsychiatric conditions [20,27]. Standard pharmacological treatments for mood disorders are often limited by their delayed therapeutic onset, lack of standardized concussion-specific guidelines, and treatment duration, which does not align well with the dynamic recovery timeline of concussion [46]. In contrast, psychedelics offer a unique therapeutic opportunity, given their rapid onset and potential for single-dose efficacy [18,20].
Beyond the therapeutic potential of psychedelics in reducing affective symptom burden in concussion, the overlapping neurophysiological and pharmacological actions of psilocybin and concussion may highlight a further therapeutic mechanism. For example, concussion disrupts autonomic nervous system (ANS) homeostasis, generating a physiological state of sustained sympathetic overdrive [47]. Emerging research suggests that psychedelics, including psilocybin and DMT, influence the ANS by first inducing acute sympathetic activation, which is immediately followed by parasympathetic activation or sympathetic–parasympathetic coactivation [48,49,50]. The ANS flexibility induced by psychedelics may facilitate a more adaptive autonomic state, potentially aiding recovery from concussion-related dysautonomia. To note, while psilocybin’s effects are primarily attributed to serotonergic mechanisms, preclinical evidence also suggests it may modulate dopaminergic pathways, specifically increasing extracellular dopamine in the nucleus accumbens, which could also contribute to observed behavioral improvements [51].
At a neurometabolic level, both concussion and psychedelics intersect in their effects on mitochondrial function and calcium homeostasis [2,32,33,34,37]. Acute concussion is known to increase mitochondrial calcium sequestration, leading to metabolic dysfunction and impaired cellular energy production [2]. Psychedelics, through their action on the Sig-1R, have been shown to promote neuroprotection by enhancing mitochondrial function and calcium homeostasis, which may potentially ameliorate the mitochondrial metabolic impairments induced by concussion [33,37].
The reported improvements following psilocybin use in this case could be attributed to the expectancy or placebo effect rather than the pharmacological action of psilocybin itself [52,53]. Given the growing cultural and scientific attention surrounding psychedelics as potential treatments for neurological and psychiatric conditions, individuals using psilocybin may anticipate symptom relief, thereby generating a powerful psychological response that modulates perception of improvement. The placebo effect is particularly relevant in conditions with subjective symptomatology, such as persisting symptoms after concussion, where mood, cognition, and pain are influenced by expectation and belief in treatment efficacy [54]. Further studies should attempt to differentiate true pharmacological benefits of psilocybin in concussion from expectancy-driven effects.
This case report has several limitations that must be considered when interpreting the observed improvements in persistent symptoms following psilocybin use. First, this report describes a single-subject case, which limits the generalizability of the findings and cannot establish causality between psilocybin and symptom improvement. The case report also lacks a control condition, limiting the ability to determine whether the effects were due to psilocybin’s pharmacological properties, the expectancy effect, or natural symptom fluctuation over time. Additionally, post-concussion symptoms can be highly variable, and spontaneous recovery or other lifestyle factors (e.g., sleep, diet, stress reduction, or concurrent therapies) may have contributed to the observed improvements. Another limitation is the potential for recall bias, as self-reported symptom changes may be influenced by the participant’s expectations or retrospective interpretation of their experience. The individual also continued using cannabis at his baseline frequency of once per week throughout the post-concussion period. The potential interaction between his symptoms, cannabis use, and psilocybin use is acknowledged. Future controlled studies are warranted to further investigate the effects of concurrent substance use in this context. No validated depression or anxiety tools, such as the Patient Health Questionnaire (PHQ)-9, Quick Inventory of Depressive Symptomatology (QIDS), or General Anxiety Disorder (GAD)-7 were used to quantify the affective symptom burden. Furthermore, objective physiological markers of autonomic function were not assessed and neural imaging was not available, limiting our ability to quantify the neurobiological effects of psilocybin in this case. Future studies, including randomized controlled trials with subjective validated psychological questionnaires, physiological outcomes (heart rate, heart-rate variability, etc.), and neuroimaging assessments (functional magnetic resonance imaging, diffusion tensor imaging, electroencephalogram, etc.) are needed to clarify the role of psilocybin in modulating persistent symptoms following concussion and to differentiate true therapeutic effects from placebo or expectancy-driven changes.

4. Conclusions

In conclusion, this case highlights the potential growing awareness of psilocybin among patients seeking relief from persisting symptoms after concussion. While this individual reported symptom improvement, the lack of a controlled study design prevents definitive conclusions regarding efficacy and safety. Physicians should be aware that patients may explore alternative therapies, including psychedelics, and be prepared to engage in informed, nonjudgmental discussions about their potential effects and risks. Lastly, this case underscores the need for continued research to systematically evaluate the role of psilocybin in the management of persistent symptoms after concussion.

Author Contributions

Conceptualization; methodology; data analysis; manuscript writing, review and editing: D.W.L., A.P.D.B. and M.G.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Written and verbal informed consent was obtained from the individual for the publication of this case. Furthermore, the individual described in the case had the opportunity to review, provide feedback, and approve the manuscript prior to submission.

Data Availability Statement

Due to the case-report nature of this methodology, the data presented in this study are available on request from the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

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Psychoactives 04 00022 g001
Figure 1. Trends in symptom burden {total symptom severity score (total symptom score), number of symptoms, and affective symptom severity score (affective symptom score) from the SCAT6 [1]} and percent (%) of normal post-concussion. Psilocybin was administered on days 42, 45, and 46 post-concussion.
Figure 1. Trends in symptom burden {total symptom severity score (total symptom score), number of symptoms, and affective symptom severity score (affective symptom score) from the SCAT6 [1]} and percent (%) of normal post-concussion. Psilocybin was administered on days 42, 45, and 46 post-concussion.
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Table 1. Brief computerized neurocognitive testing pre- and post-psilocybin administration.
Table 1. Brief computerized neurocognitive testing pre- and post-psilocybin administration.
Test ConditionTime Post-Concussion (Days)Time Relative to First Psilocybin Dose (Days)Trails A (s)Trails B (s)Processing Speed (Number Correct)Simple RT (ms)Choice RT (ms)
Pre-psilocybin39−325.857.660247358
Post-psilocybin110+6820.447.867236354
milliseconds, ms; RT, reaction time; s, seconds.
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MDPI and ACS Style

Lawrence, D.W.; Di Battista, A.P.; Hutchison, M.G. Psilocybin Use in an Intercollegiate Athlete with Persisting Symptoms After Concussion: A Case Report. Psychoactives 2025, 4, 22. https://doi.org/10.3390/psychoactives4030022

AMA Style

Lawrence DW, Di Battista AP, Hutchison MG. Psilocybin Use in an Intercollegiate Athlete with Persisting Symptoms After Concussion: A Case Report. Psychoactives. 2025; 4(3):22. https://doi.org/10.3390/psychoactives4030022

Chicago/Turabian Style

Lawrence, David W., Alex P. Di Battista, and Michael G. Hutchison. 2025. "Psilocybin Use in an Intercollegiate Athlete with Persisting Symptoms After Concussion: A Case Report" Psychoactives 4, no. 3: 22. https://doi.org/10.3390/psychoactives4030022

APA Style

Lawrence, D. W., Di Battista, A. P., & Hutchison, M. G. (2025). Psilocybin Use in an Intercollegiate Athlete with Persisting Symptoms After Concussion: A Case Report. Psychoactives, 4(3), 22. https://doi.org/10.3390/psychoactives4030022

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