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Review
. 2024 Nov 20;54(15):1-13.
doi: 10.1017/S0033291724002496. Online ahead of print.

Adverse psychiatric effects of psychedelic drugs: a systematic review of case reports

B Yildirim  1 , S S Sahin  2 , A Gee  3 , S Jauhar  3 , J Rucker  3   4 , P Salgado-Pineda  1 , E Pomarol-Clotet  1 , P McKenna  1
Affiliations
Review

Adverse psychiatric effects of psychedelic drugs: a systematic review of case reports

B Yildirim et al. Psychol Med. .

Abstract

Background: Psychedelic drugs are a focus of interest in the treatment of depression and other disorders but there are longstanding concerns about possible adverse psychiatric consequences. Because the relevant literature is largely informal, the seriousness of these risks is difficult to evaluate.

Methods: Searches were made for case reports of schizophrenia-spectrum, affective or other psychiatric disorders after use of psychedelic drugs. Case reports of flashbacks were also searched for. Individuals with recent use of other drugs (apart from cannabis and alcohol) and/or a previous history of major psychiatric disorder were excluded. Symptoms were tabulated using the Syndrome Check List of the Present State Examination (PSE-9).

Results: We found 17 case reports of schizophrenia spectrum disorder, 17 of affective disorder (depression, mania, or both), 3 cases of anxiety, 1 of depersonalization, and 1 of unclassifiable illness. The states could develop after a single use of the drug (5/17 schizophrenia; 6/17 affective disorder), and duration was highly variable. Recovery was the rule in cases of affective disorder but not in schizophrenia spectrum disorder. Twelve of 29 cases of flashbacks showed psychiatric symptomatology definitely outlasting the attacks, mainly anxiety (5 cases) and depression (8 cases). Flashback symptoms resolved within twelve months in approximately half of the cases but in a few persisted for years.

Conclusions: Reliable descriptions of schizophrenia spectrum disorder and major affective disorder after psychedelic drug use disorder exist but are relatively uncommon. Flashbacks are sometimes but not always associated with psychiatric symptomatology, mainly anxiety or depression.

Keywords: adverse effects; affective disorder; case reports; flashbacks; hallucinogen persisting perception disorder; hallucinogens; psychedelic drugs; psychosis; systematic review.

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Conflict of interest statement

J. R. has undertaken paid advisory boards for Clerkenwell Health (Past), Beckley PsyTech (Past), Delica Therapeutics (Past), paid articles for Janssen, received assistance for attendance at conferences from Compass Pathways (past) and Janssen, and received grant funding (managed by King's College London) from Compass Pathfinder, Beckley PsyTech, Multidisciplinary Association for Psychedelic Studies, National Institute for Health Research, Wellcome Trust, Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust. J. R. is co-director for the Centre for Mental Health Research & Innovation, a research collaboration between King's College London, the South London & Maudsley NHS Foundation Trust and Compass Pathways investigating the safety and efficacy of psilocybin treatment. J. R. has no shareholdings in pharmaceutical companies and no shareholdings in companies developing psychedelics. The views expressed are those of this author and not necessarily those of the NHS, the NIHR, or the Department of Health. No award/grant number is applicable. For the purposes of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Accepted Author Manuscript version arising from this submission. S. J. has received honoraria for educational talks given for Lundbeck, Sunovian, Boehringer-Ingelheim, and Janssen. He is a Council Member (unpaid) of the British Association for Psychopharmacology. He has sat as an advisor on panels for the Wellcome Trust and NICE. He has consulted for LB Pharmaceuticals. The remaining authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the results of the search process.
See this image and copyright information in PMC

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