Psychiatric risks for worsened mental health after psychedelic use
Carhart-Harris, R. L., Erritzoe, D., Kettner, H., Marrocu, A., Weiss, B., Zeifman, R. J.
This prospective observational study (n=807) analysed negative psychological responses to psychedelics, defining it as a clinically meaningful decline in mental health four weeks post-use. They found that 16% of participants experienced negative responses, with a notably higher prevalence (31%) among those with a prior diagnosis of personality disorder. The study implies that individuals with a history of personality disorder might face elevated risks with psychedelic use, emphasizing the need for enhanced psychological support and therapeutic alliance in this population.
Abstract
Background: Resurgent psychedelic research has largely supported the safety and efficacy of psychedelic therapy for the treatment of various psychiatric disorders. As psychedelic use and therapy increases in prevalence, so does the importance of understanding associated risks. Cases of prolonged negative psychological responses to psychedelic therapy seem rare; however, studies are limited by biases and small sample sizes. The current analytical approach was motivated by the question of whether rare but significant adverse effects have been under-sampled in psychedelic research studies.Methods: A ‘bottom margin analysis’ approach was taken to focus on negative responders to psychedelic use in a pool of naturalistic, observational prospective studies (N=807). We define ‘negative response’ by a clinically meaningful decline in a generic index of mental health, i.e., a one standard error from the mean decrease in psychological well-being 4 weeks post psychedelic use (vs pre-use baseline). We then assessed whether a history of diagnosed mental illness can predict negative responses.Results: We find that 16% of the cohort fall into the ‘negative responder’ subset. Parsing the sample by self-reported history of psychiatric diagnoses, results revealed a disproportionate prevalence of negative responses among those reporting a prior personality disorder diagnosis (31%). One multivariate regression model indicated a greater than four-fold elevated risk of adverse psychological responses to psychedelics in the personality-disorder sub-sample (b = 1.425, p < 0.05).Conclusion: We infer that the presence of a personality disorder may represent an elevated risk for psychedelic use, and hypothesize that the importance of psychological support and good therapeutic alliance may be increased in this population.