On the Relationship between Classic Psychedelics and Suicidality: A Systematic Review

Abstract

Use of classic psychedelics (e.g., psilocybin, ayahuasca, and lysergic acid diethylamide) is increasing, and psychedelic therapy is receiving growing attention as a novel mental health intervention. Suicidality remains a potential safety concern associated with classic psychedelics and is, concurrently, a mental health concern that psychedelic therapy may show promise in targeting. Accordingly, further understanding of the relationship between classic psychedelics and suicidality is needed. Therefore, we conducted a systematic review of the relationship between classic psychedelics (both non-clinical psychedelic use and psychedelic therapy) and suicidality. We identified a total of 64 articles, including 41 articles on the association between non-clinical classic psychedelic use and suicidality and 23 articles on the effects of psychedelic therapy on suicidality. Findings on the association between lifetime classic psychedelic use and suicidality were mixed, with studies finding positive, negative, and no significant association. A small number of reports of suicide and decreased suicidality following non-clinical classic psychedelic use were identified. Several cases of suicide in early psychedelic therapy were identified; however, it was unclear whether this was due to psychedelic therapy itself. In recent psychedelic therapy clinical trials, we found no reports of increased suicidality and preliminary evidence for acute and sustained decreases in suicidality following treatment. We identify some remaining questions and provide suggestions for future research on the association between classic psychedelics and suicidality.

Suicidal cut‐throat wound during LSD intoxication

“…A hallucinogen persisting perception disorder (HPPD) was reported after 10 years of taking LSD with severe psychopathology, war exposer, and previous suicidal behavior. 14 However, a recent systematic review assessing the relationship between psychedelics and suicidality found positive, negative, and mixed findings 15 …”

“…14 However, a recent systematic review assessing the relationship between psychedelics and suicidality found positive, negative, and mixed findings. 15 Therefore, further evidence is needed to find out the cause and effect association (if any).…”

Adverse effects of psychedelics: From anecdotes and misinformation to systematic science

“…In their systematic review, Zeifmann et al (2021) examined the relationship between classic psychedelics and suicidality. Results suggest that psychedelic therapy can reduce suicidality in certain clinical psychiatric populations, and that classic psychedelic use may buffer against, and be associated with reductions in suicidality.…”

“…Results suggest that psychedelic therapy can reduce suicidality in certain clinical psychiatric populations, and that classic psychedelic use may buffer against, and be associated with reductions in suicidality. However, in unsafe and unmonitored settings, psychedelic use can, on rare occasions, also lead to fatal consequences, including suicide, but Zeifmann et al (2021) stress the highly limited nature of their source literature, with the majority of the included studies being case studies or small case reports using retrospective data.…”

Psychedelic replications in virtual reality and their potential as a therapeutic instrument: an open-label feasibility study

“…The last two decades have seen a massive resurgence of research into psychedelics largely due to their wide range of therapeutic benefits (e.g., addiction [2][3][4][5] , depression [6][7][8][9][10] , end-of-life distress [11][12][13][14][15] , suicidality [16][17][18] , obsessive-compulsive disorder 19 , migraine 20,21 , phantom-limb pain 22 , for reviews see [23][24][25][26][27][28] ). This has elevated interest in substance-assisted therapies, where conventional therapy is combined with psychedelic sessions.…”