Psychedelic medicines used to facilitate psychotherapy have shown tremendous promise in treating depression and post-traumatic stress disorder. We are now to the point where MDMA is likely to be approved by the Food and Drug Administration in 2024 for treating PTSD. Studies have shown that these medicines can be very effective. However, researchers have not followed up for years after these patients were treated. What happens after people use psychedelic medicines and after the researchers quit paying attention?
Short Term Issues After Psychedelic Use
Pretty much everyone is aware that by using psychedelics one may experience hallucinations. Other short term side effects may include nausea and vomiting, high blood pressure and a rapid heartbeat, diarrhea, headaches, and trembling. People also report confusion and agitation. All of these are temporary side effects. In the case of people who go through Ayahuasca ceremonies these side effects are considered part of a “mystical” experience. Short term therapeutic effects include reduction of anxiety and the ability to open up and deal with troubling aspects of one’s life. This last part is how psychedelics work as adjunctive therapy for conditions like PTSD and depression.
Psychedelic Effects That Last After the Researchers Have Gone Home
Research studies focus on how well medicines like psilocybin or MDMA work to help treat depression and PTSD. Treatment and follow-up go on for months or ever a year or so. When the patient has gotten better and the researchers have the information they wanted, the patient is discharged and basically forgotten about. Here is where there may be a long term issue for some people. Recently published research looks at this issue.
Long Term Side Effects of Psychedelics
Psychedelics are likely to become an important part of the therapeutic picture in psychiatry. All of the positive press that psychedelics have received appears to encouraged a lot more people to try them. Thus it is appropriate to consider whether or not there are long term risks to psychedelic use along side of potential therapeutic benefits. In the study in question the researchers solicited individuals who had experienced long term issues after using psychedelics. They ended up with 608 English-speaking adults who said they had issues with psychedelics that lasted more than 24 hours.
Psychedelics that caused longer term issues included psilocybin at 27%, LSD at 25%, ayahuasca at 10%, cannabis at 10%, MDMA at 7%, DMT at 5%, ketamine at 4%, mescaline at 2%, and salvia divinorum at 1%. Longer term issues were such that one out of six respondents said that they had problems lasting more than three years. Long term problems included the following:
- 67%, emotional difficulties including anxiety, fear, and panic
- 42%, existential or ontological difficulties including derealization and existential struggle
- 27%, social difficulties including trouble with communication, fear of ostracism, and a sense of disconnection from society
- 23%, self-perception difficulties including a diminished sense of self and dissociation or depersonalization.
- 21%, perceptual difficulties including visual disturbances and hallucinations as well as flashbacks non-sensory disturbances or hallucinations
- 18%, cognitive difficulties including confusion and ruminative, obsessive or fixed thoughts
- 19%, somatic difficulties including trouble sleeping, fatigue, and nightmares
- 11%, behavioral difficulties including substance abuse and difficulty studying and paying attention at work
- 5%, recurring psychotic episodes
These numbers add up to more than 100%. Thus, may people had more than one of these problems on a long term basis after using psychedelics.
What Does This Study Tell Us About Long Term Psychedelic Aftereffects?
It is clear for this small sample that there are people who have taken psychedelics and have problems for years thereafter. What is not clear is the issue of cause and effect. When researchers study psychedelics for treating anxiety, substance abuse disorders, depression or PTSD they commonly exclude individuals with a history of conditions like schizophrenia because these folks are known to have a higher incidence of adverse reactions to psychedelics. In addition, nobody appears to have asked if any of these folks had problems and what kinds of problems before taking psychedelics.
What this tells us is that psychedelics may not be appropriate treatment for everyone. Patients should and will be screened before being treated with MDMA or psilocybin when these psychedelic medicines are made legal in the USA.