Psychosis and LSD

Psychosis and lysergic acid diethylamide, more commonly known as LSD, are popular topics for urban legends. When people started using LSD as a recreational drug in the 1960s, some spoke of it in whispers as a gateway to spiritual enlightenment, while others warned of bad trips and permanent highs that fried people’s brains and turned them into “acid casualties.” Myths about LSD and psychosis persist to this day, causing people to worry that using the drug can trigger lifelong schizophrenia.

The truth about psychosis and LSD is much less lurid than these popular myths. Research shows that while using LSD can trigger the onset of schizophrenia in people who are predisposed to it, the drug can’t cause the disorder on its own. People who use LSD are no more likely than anyone else to have a psychotic disorder. Most people only experience its effects for a few hours or days and have only mild residual effects, if they have any at all.

However, this doesn’t mean that there isn’t a connection between LSD and psychosis. A range of short-term altered mental states induced by medical conditions, substances, sleep deprivation or extreme stress can be classified as psychosis, including LSD intoxication.

Many people who use LSD want to experience some form of short-term psychosis. The fact that they know they are under the drug’s influence makes the hallucinations much less disturbing than they otherwise would be. However, some people are overwhelmed by the drug’s effects and panic. Many go to the emergency room seeking help to stop the hallucinations. It is not uncommon for people to be admitted to inpatient psychiatric units for LSD-induced psychosis, especially when they do not tell treating professionals that they have taken the drug.

Someone who uses LSD and experiences psychotic symptoms may wonder, “Can LSD cause psychosis?” The answer depends on the definition of psychosis someone is using. Some of the myths and confusion linking LSD and schizophrenia are dependent on the different ways people use the word.

If psychosis is defined as any instance of hallucinations or other psychotic symptoms, LSD predictably causes psychosis. However, by definition, LSD-induced psychosis only lasts as long as LSD causes intoxication or withdrawal effects. It is not a chronic disorder.

The reason why people experience psychosis from LSD use is that the drug affects the same brain chemicals and regions of the brain as psychotic disorders. Both schizophrenia and LSD affect serotonin receptors and cause brain networks responsible for inward-focused and outward-focused attention to cross signals.

It is true that LSD can remain attached to serotonin receptors even after it has been flushed from the bloodstream. However, despite common myths, LSD doesn’t linger in the brain for years or even days. Brain cells usually dissolve and flush out LSD in 15 hours or less.

Some people do experience after-effects and flashbacks from LSD psychosis that qualify them for a diagnosis of hallucinogen-persisting perception disorder (HPPD). However, people with HPPD typically only experience minor visual disturbances like false movement, blurring or halo effects.

Not only are these persistent effects rare, but they are also not full hallucinations and do not cause people to mistake them for real events, meaning they do not meet the criteria for psychosis. In addition, even the most severe cases of HPPD can respond to treatment and go into remission.

Psychiatrists and other mental health professionals diagnose LSD-induced psychosis using the definition of substance-induced psychosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). To be diagnosed with a drug-induced psychotic disorder, a person must:

  • Experience delusions, hallucinations, or both
  • Develop these symptoms in response to substance intoxication or withdrawal
  • Not have symptoms better explained by a non-substance-induced psychotic disorder
  • Experience clinically significant distress or functional impairment from their symptoms

While LSD predictably causes hallucinations, it doesn’t consistently cause clinical distress. Most clinicians wouldn’t diagnose someone with an LSD-induced psychotic disorder just because they hallucinated while under the influence of LSD. A formal diagnosis is typically made on occasions when people show up for a mental health evaluation in a state of distress caused by LSD-induced hallucinations.

Most of the time, the hallucinations caused by LSD are relatively mild. In movies or television, people under the influence of LSD may travel to other dimensions or see talking dragons. In reality, people are more likely to experience subtler effects like seeing stationary objects move or “breathe.” People on an acid trip often see bright halos around objects or vivid colors. They sometimes experience synesthesia, or crossed sensory perceptions like seeing sounds. They may also make new mental connections and experience an altered sense of self.

The main factors that distinguish symptoms of LSD psychosis from symptoms of other psychotic disorders are the type and duration of the symptoms. Usually, LSD psychosis symptoms last for a few hours. People who experience LSD-induced psychosis symptoms may or may not be aware that the drug is causing the side effects, but there are usually revealing signs that the symptoms they experience are drug-induced.

Both people with schizophrenia and people under the influence of LSD experience hallucinations. However, people with schizophrenia are more likely to experience auditory hallucinations and people who use LSD are more likely to have visual hallucinations. People under the influence of LSD are more likely to experience heightened moods while people with schizophrenia are more likely to experience blunted emotions during psychotic episodes.

People who have a psychotic disorder usually experience other symptoms even when they are not hallucinating. These may include bizarre speech or movement, delusional thinking, social withdrawal or restricted emotional expression. The presence of any of these symptoms after acute LSD intoxication ends can indicate to a clinician that LSD psychosis triggered the onset of a psychotic disorder.

People who have schizophrenia or other psychotic disorders experience recurrent psychotic episodes throughout their lives that must be managed with medications. Most people who use hallucinogens only experience an altered sense of reality for a short period. For most people, after the effects of the drug wear off, no traces of LSD psychosis remain.

The effects of LSD psychosis can be frightening and lead to severe distress and impairment. Fortunately, LSD psychosis recovery is usually manageable, requiring only time spent under observation in a safe environment. When people experiencing LSD-induced hallucinations become agitated, sedative medications may be administered but usually, no other interventions are required.

It is important to note that LSD use, especially in large doses and over a long time, can cause problems that linger after the hallucinations stop. People who develop a hallucinogen use disorder may continue using LSD or other similar drugs frequently even after experiencing negative consequences like extreme anxiety, emergency room visits, inpatient psychiatric admissions or accidental injuries.

People with substance use disorders often start having problems at work or home because they use substances in greater amounts and over longer periods than intended. When isolated episodes of LSD-induced psychosis develop into a long-term LSD use disorder, more in-depth treatment, like inpatient or outpatient substance abuse treatment, may be required. People who have been using hallucinogens to escape or enhance reality often need help adjusting to life without them.

The good news is that any negative changes wrought by chronic LSD use, including HPPD, typically respond to treatment, and to the natural recovery that comes with abstinence from substance use. For people who used LSD to cope with schizophrenia or another underlying psychotic disorder, discontinuing substance use is often the first step toward recovery and remission of psychotic symptoms.

Some relevant facts to remember about LSD and psychosis include:

  • Using LSD can cause symptoms of psychosis, brief psychotic episodes or LSD-induced psychotic disorder.
  • The reason the effects of LSD and the symptoms of psychosis overlap is that both are linked to the same changes in brain function and activity.
  • While LSD can cause effects that resemble symptoms of schizophrenia, these effects are generally short-lived and last no longer than the drug remains in the brain.
  • While using LSD can’t cause schizophrenia or other long-term psychotic disorders, it can trigger their onset or mask their symptoms.
  • When symptoms of psychosis persist even after a person stops using LSD, it usually indicates that they have an underlying psychotic disorder.

If you are concerned that your substance use disorder and psychosis disorder, contact a representative at The Recovery Village today to learn about integrated treatment options for people with dually diagnosed disorders.

Cormier, Zoe. “No Link Found Between Psychedelics and Psychosis.” Nature News. Published March 4, 2015. Updated May 26, 2015. Retrieved December 8, 2018.

Tamminga, Carol. “Substance/Medication-Induced Psychotic Disorder.” Merck Manual: Professional Version. Updated October 2018. Retrieved December 8, 2018.

Beck, Taylor. “A Trip Inside the Schizophrenic Mind.” Scientific American Mind. Published March 1, 2017. Retrieved December 8, 2018.

National Institutes of Health. “Protein Structure Reveals How LSD Affects the Brain.” NIH Research Matters. Published February 14, 2017. Retrieved December 8, 2018.

UNC School of Medicine. “This Is LSD Attached to a Brain Cell Serotonin Receptor.” UNC Faculty News. Published January 27, 2017. Retrieved December 8, 2018.

Noushad, Fabida, Al Hillawi, Qutaiba, Siram, Vasantha, and Arif, Muhammad. “25 Years of Hallucinogen Persisting Perception Disorder: A Diagnostic Challenge.” British Journal of Medical Practitioners. Published March 2015. Retrieved December 8, 2018.

Hays, Peter, and Tilley, J. R. “The Differences Between LSD Psychosis and Schizophrenia.” The Canadian Journal of Psychiatry. Published August 1, 1973. Retrieved December 8, 2018.

Carhart-Harris, R. L., Kaelen, M., Bolstridge, M., et al. “The Paradoxical Psychological Effects of Lysergic Acid Diethylamide (LSD).” Psychological Medicine. Published February 5, 2016. Retrieved December 8, 2018.

Psychosis and LSD
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