Depressive DisordersSchizophreniaEquity and EthicsPersonality & Trait Factors

Predicting Reactions to Psychedelic Drugs: A Systematic Review of States and Traits Related to Acute Drug Effects

This review (14 studies) found that traits of absorption, openness, acceptance, and surrender correlated with more positive and mystical (MEQ30) experiences. Gender didn't predict drug effects, but possible biomarkers are serotonin receptor binding potential, executive network node diversity, and right anterior cingulate cortex volume.

Authors

  • Alan Davis
  • Jordan Aday
  • Emily Bloesch

Published

ACS Pharmacology and Translational Science
meta Study

Abstract

Psychedelic drugs are increasingly being incorporated into therapeutic contexts for the purposes of promoting mental health. However, they can also induce adverse reactions in some individuals, and it is difficult to predict before treatment who is likely to experience positive or adverse acute effects. Although consideration of setting and dosage as well as excluding individuals with psychotic predispositions has thus far led to a high degree of safety, it is imperative that researchers develop a more nuanced understanding of how to predict individual reactions. To this end, the current systematic review coalesced the results of 14 studies that included baseline states or traits predictive of the acute effects of psychedelics. Individuals high in the traits of absorption, openness, and acceptance as well as a state of surrender were more likely to have positive and mystical-type experiences, whereas those low in openness and surrender or in preoccupied, apprehensive, or confused psychological states were more likely to experience acute adverse reactions. Participant sex was not a robust predictor of drug effects, but 5-HT2AR binding potential, executive network node diversity, and rACC volume may be potential baseline biomarkers related to acute reactions. Finally, increased age and experience with psychedelics were individual differences related to generally less intense effects, indicating that users may become slightly less sensitive to the effects of the drugs after repeated usage. Although future well-powered, placebo-controlled trials directly comparing the relative importance of these predictors is needed, this review synthesizes the field’s current understanding of how to predict acute reactions to psychedelic drugs.

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Research Summary of 'Predicting Reactions to Psychedelic Drugs: A Systematic Review of States and Traits Related to Acute Drug Effects'

Introduction

Classic psychedelic substances such as psilocybin, LSD, ayahuasca/DMT, and mescaline can produce a wide range of cognitive, emotional and neurological effects. Interest in their therapeutic potential has re-emerged after decades of prohibition, driven by preliminary findings for conditions like depression and substance misuse. At the same time, psychedelic sessions can be psychologically challenging for some individuals, and current practices—careful attention to dosage and setting, plus excluding those with psychotic predispositions—have reduced but not eliminated adverse acute reactions. The introduction highlights that there remains limited understanding of which baseline states or traits predict whether an individual will have a positive, mystical-type response or a difficult, adverse reaction. Aday and colleagues framed the review to synthesise contemporary empirical work that tests predrug (baseline) variables as predictors of acute psychedelic effects. The stated aim was to identify replicable states, traits, and potential biomarkers that might inform screening or preparatory procedures in clinical and research contexts, thereby improving safety, optimising therapeutic benefit, and reducing ineffective treatments as psychedelics are integrated into medical settings.

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