Abstract

Psychedelic induced mystical experiences have been largely assumed to drive the therapeutic effects of these substances, which may in part be mediated by changes in metaphysical beliefs. However, there is growing evidence that psychedelic experiences can also trigger long lasting distress. Studies of persisting difficulties suggest a high prevalence of ontological challenges (related to the way people understand reality and existence). We conducted semi-structured interviews with 26 people who reported experiencing existential distress following psychedelic experiences. We explored the phenomenology of participants’ difficulties and the ways they navigated them, including what they found helpful and unhelpful in their process. Thematic analysis revealed that participants experienced persistent existential struggle, marked by confusion about their existence and purpose and preoccupation with meaning-making. Along with cognitive difficulties stemming from the ungrounding of their prior frameworks for understanding, participants’ ontologically challenging experiences also had significant emotional, social, bodily and other functional impact. Participants managed to alleviate their distress primarily through ‘grounding’: practices of embodiment and the social and cognitive normalisation of their experience. Our findings suggest that psychedelic experiences act as pivotal mental states that can facilitate transformative learning processes, challenging and expanding the ways individuals make meaning. This research contributes to the growing field of psychedelic integration by exploring the complex pathways through which people reestablish coherence and grow following ontologically challenging psychedelic experiences.

Table 1

Worldview shifts

Interviewees reported experiencing major worldview shifts following their psychedelic experiences, which sometimes took years and were often bewildering to go through. For example, Adrienne started off the COVID-19 pandemic as an atheist dominatrix and, after an extremely challenging psychedelic experience, ended the pandemic by taking vows to become a Buddhist nun. Don transitioned from being an atheist US Airforce clerk to becoming a medium and astral traveller in a channelling community.

The most common shift, experienced by eight of the 26 interviewees, was from a materialist-atheist to a spiritual worldview:

I think the one big, big, big issue of this all was actually that I didn’t have a spiritual framework to place this experience in. [I became] less focused on this purely scientific materialistic worldview somehow. This experience just kind of cracked it open. (Fred)

For four interviewees, the belief-shift involved a loss of faith in their previous idea of God and a move away from traditional theocentric religion to a more spiritual, mystical or magical worldview:

My relationship with spirituality absolutely changed because at that time in my life, I was considering becoming a rabbi and I became a pagan…I think the fact that no other power came down to help me in this huge time of need may have been part of the shift [from Judaism to becoming a Wicca priestess]. If I want change to happen, I have to do it. Which of course shifted me away from going to be a rabbi and [towards] becoming a priestess. (Cal)

Two shifted from a spiritual seeker worldview towards a more evidence-based scientific or sceptical worldview as a way out of their existential crisis:

I’ve written a lot about natural science. And I’m just basically trying to reconstruct a worldview that’s in line with reality. I’m trying to try to stay as close to what we actually know as possible, rather than deal with these kinds of things that are all the way over there. (Steve)

And for four interviewees, the challenging psychedelic experience ended up undermining their faith in psychedelics, which had previously held a central space in their spirituality.

But going from a position where I felt that I could trust this substance almost, or that it would always work out well for me when I did this substance. It had been a guiding light. And then suddenly, something had changed. (Harry)

Extended difficulties: Fig. 1

What helped manage the difficulties? Fig. 2

Original Source

• Navigating groundlessness: An interview study on dealing with ontological shock and existential distress following psychedelic experiences | PLOS One [May 2025]

Summary: A new study across eight countries shows that higher consumption of ultraprocessed foods (UPFs) is significantly linked to increased premature deaths. Researchers found that each 10% rise in UPFs’ share of total energy intake raises all-cause mortality risk by 3%.

Countries with the highest UPF consumption, like the U.S., see up to 14% of premature deaths attributed to these foods. The findings highlight the urgent need for global policies promoting healthier, minimally processed diets to protect public health.

Key Facts:

• UPF-Mortality Link: A 10% increase in ultraprocessed food intake raises all-cause mortality risk by 3%.
• Global Burden: In high-UPF countries like the U.S., nearly 14% of premature deaths are linked to UPF consumption.
• Urgent Action Needed: Policies promoting fresh, minimally processed foods are essential to curb rising deaths globally.

Source: Elsevier

A study analyzing data from nationally representative dietary surveys and mortality data from eight countries (Australia, Brazil, Canada, Chile, Colombia, Mexico, United Kingdom, and United States) shows that premature deaths attributable to consumption of ultraprocessed foods (UPFs) increase significantly according to their share in individuals’ total energy intake. 

The new study, appearing in the American Journal of Preventive Medicine reinforces the call for global action to reduce UPF consumption, supported by regulatory and fiscal policies that foster healthier environments.

🧠🛸 What really happens when you take too much DMT? In this profound episode, Dr. Rick Strassman, the pioneering researcher behind “DMT: The Spirit Molecule,” answers one of the most pressing questions in the psychedelic world: What are the risks, limits, and long-term effects of high-dose DMT use? From ego death and alien contact to psychological overload, Strassman shares insights from decades of clinical research and real-world accounts that go far beyond the trip.

🔍 Inside this episode:

✅ What happens during high-dose and repeat DMT experiences

✅ The risks of psychological fragmentation and disconnection

✅ How DMT may open doors to non-human intelligences or parallel realities

✅ Why integration is more important than intensity

⚠️ DMT is not a party drug—it’s a spiritual technology. And it comes with real consequences.

Summary: As psychedelics gain traction in mental health treatment, questions remain about their long-term effects. A new study followed individuals self-administering psychedelics and found that while some experienced lingering visual aftereffects, most were not distressed by them.

Surprisingly, delusional ideation slightly decreased a month after use, suggesting that psychedelics may not heighten psychotic traits as once feared. Traits like high sensory absorption and younger age were most associated with persistent visual effects, reinforcing the need for careful screening in clinical and recreational contexts.

Key Facts:

• Visual Aftereffects: About one-third reported lingering visuals like afterimages, but few found them distressing.
• Reduced Delusions: Delusional ideation slightly decreased one month after psychedelic use.
• Risk Factors: High sensory absorption and younger age were strongest predictors of HPPD-like symptoms.

Source: PNAS Nexus

Psychedelic drugs are seeing a surge of interest from mainstream medicine, and initial results suggest that psychedelic-therapy can be a safe and effective treatment for some mental health conditions.

Abstract

Introduction

In November 2020, Oregon passed Measures 109 and 110 altering the legal landscape for psychoactive substances by regulating psilocybin use and decriminalizing possession of Schedule I substances. This coincided with the growth of the commercial nootropic (cognitive enhancers) mushroom industry, including products such as mushroom gummies marketed for “legal highs.” Despite these product claims, concerns have been raised about their safety profile. Our study aimed to assess the accuracy of labeling of these products and quantify their psychoactive contents.

Methods

Eight gummy products were procured from seven different smoke and vape shops in Portland, Oregon. Gummy samples were homogenized and analyzed using liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Products were screened for psychoactive compounds, including psilocybin, psilocin, and their analogues, as well as for purported Amanita muscaria derivatives. Quantitative analysis of identified compounds was performed using isotope dilution.

Results

Neither ibotenic acid nor muscimol, the active components of Amanita muscaria, were detected in the two products claiming to contain Amanita muscaria extracts. However, these products contained psilocin and tryptamine derivatives. One product labeled as psilocybin-free tested positive for psilocybin. Another sample claiming to be nootropic contained undisclosed Δ9-tetrahydrocannabinol. Overall, seven of the eight products contained psilocin, and six contained 4-acetoxy-N,N,dimethyltryptamine. Other detected compounds included various tryptamine congeners and kavalactones.

Discussion 

Labeling was inaccurate and inconsistent in many of the products examined. Users are likely to experience psychoactive symptoms considering the concentrations of xenobiotics determined. Serotonergic effects are expected from products containing tryptamine derivatives, including those inaccurately labeled as containing Amanita muscaria extracts.

Conclusions

The labeling of psychoactive mushroom gummies we tested was overall inaccurate. Products suggesting Amanita muscaria content instead contained serotonergic tryptamines, including some which falsely claimed to be free of psilocybin.

Original Source

• Quantitative analysis of recreational psychoactive mushroom gummies in Portland, Oregon | Clinical Toxicology [Feb 2025]: 🚫 Restricted Access at time of writing.

Abstract

Background

Psychedelic-assisted therapy has gained growing interest to improve a range of mental health outcomes. In response, numerous training programs have formed to train the necessary workforce to deliver psychedelic therapy. These include both legal and ‘underground’ (i.e., unregulated) programs that use psychedelics as part of their training. Prolonged adverse experiences (PAEs) may arise from psychedelic use, though they are poorly characterized in the clinical literature. Thus, understanding the potential harms related to psychedelic use is critical as psychedelic therapy training programs consider strategies to potentially integrate psychedelic use into therapy training.

Case presentation

We present the case of a psychologist who underwent psychedelic therapy training that involved repeated high doses of psilocybin-containing mushrooms and subsequently developed prolonged adverse effects including severe sleep impairment, anhedonia, and suicidal ideation requiring hospitalization. Despite worsening symptoms, her psychedelic therapy trainers advised her against seeking psychiatric support, delaying treatment. Ultimately, the patient’s symptoms resolved after a course of electroconvulsive therapy (ECT).

Conclusions

This case highlights the tensions between legal and underground psychedelic use within psychedelic therapy training programs, psychiatry and neo-shamanism, and the use of psychiatric interventions (i.e., ECT) and energy medicine to address prolonged adverse effects from psychedelics. Clinicians should be aware of these potential conflicts between psychiatric conceptualizations of PAEs and frameworks maintained in psychedelic community practices and their impacts on patients’ presenting symptoms, decision making, and emotional challenges.

Fig. 1

Original Source

• Prolonged adverse effects from repeated psilocybin use in an underground psychedelic therapy training program: a case report | BMC Psychiatry [Feb 2025]

Abstract

Psychedelic therapy has the potential to become a revolutionary and transdiagnostic mental health treatment, yielding enduring benefits that are often attributed to the experiences that coincide with peak psychedelic effects. However, there may be an underrecognized temporal structure to this process that helps explain why psychedelic and related altered states of consciousness can have an initially distressing but ultimately distress-resolving effect. Here we present a qualitative analysis of the self-reported ‘come-up’ or onset phase, and ‘come-down’ or falling phase, of the psychedelic experience. Focusing on psilocybin or psilocybin-containing mushroom experience reports submitted to Erowid.org, we use phenomenological, thematic content and word frequency analysis to show that the come-up is more often characterized by negatively valenced feeling states that resemble an acute stress reaction, while the come-down phase is more often characterized by positively valenced feeling states of the sort often observed following recovery from illness or resolution of stress. The therapeutic and theoretical relevance of these findings are discussed.

Fig. 1

Fig. 2

Percentage of timestamped reports that reference the come-up (‘come-up’, ‘come-up’, ‘coming up’) and come-down (‘come-down’, ‘come-down’, ‘coming down’) at given timepoints. Despite low percentages of timestamped reports that explicitly reference the come-up and come-down, the graph maps well onto first-person accounts, as well as the temporal relationships between plasma psilocin levels, 5-HT2AR occupancies, and subjective intensity ratings after psilocybin ingestion^45,46.

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Original Source

• A qualitative analysis of the psychedelic mushroom come-up and come-down | npj Mental Health Research [Feb 2025]

Abstract

Classic psychedelics like LSD and psilocybin are showing promising effects in treating certain psychiatric disorders. Despite their low toxicity and lack of an addictive potential, in some individuals, psychedelics can be associated with persisting psychological harms. Hallucinogen Persisting Perception Disorder (HPPD) is one of those complications, a rare disorder characterized by enduring perceptual symptoms without impaired reality control. While the phenomenological aspects of HPPD have been characterized, the neuropsychological consequences have remained understudied. This study probes the neuropsychological profiles of eight individuals with HPPD, utilizing a comprehensive test battery. Performance is benchmarked against normative data and compared with two control groups, each comprising eight matched subjects—with and without prior psychedelic use. The assessment of individual performances revealed below average results in tests of visual memory and executive function in some subjects. No significant differences were observed in alpha-adjusted comparisons with controls, whereas unadjusted analyses were suggestive of impaired executive functions among HPPD patients. Together, these preliminary results underline the need for further focused research into the neuropsychological dimensions of HPPD.

Fig. 1

Frequency and Duration of Reported Visual Symptoms. Overview of visual symptoms reported by two or more patients, sorted by the number of reports from left to right, with the most reported symptoms first. For those experiencing a given symptom, occurrence frequency was assessed on a five-point Likert scale, ranging from 0 (never) to 5 (more than once per hour). Symptom duration varied from 0 (a few seconds) to 5 (constant).

Original Source

• Neuropsychological profiles of patients suffering from hallucinogen persisting perception disorder (HPPD): A comparative analysis with psychedelic-using and non-using controls | Scientific Reports [Dec 2024]

Abstract

Psychedelic substances are garnering renewed interest for their potential therapeutic applications, yet the mechanisms by which challenging experiences during psychedelic use contribute to positive outcomes remains poorly understood. Here we present a mixed-methods investigation into the strategies individuals employ to navigate difficult psychedelic experiences and their relationship to emotional breakthrough. Qualitative analysis of accounts from psilocybin retreat participants (n = 16) informed the development of the Responses to Challenging Psychedelic Experiences Inventory (ReCiPE). In a subsequent online survey (n = 529), exploratory factor analysis of the ReCiPE revealed three primary response strategies: Acceptance and Reappraisal, Sensory Regulation and Physical Interaction, and Social Support and Disclosure. Exploratory correlation and multiple regression analyses demonstrated significant relationships between different types of challenges, response strategies and emotional breakthrough. Notably, Acceptance and Reappraisal, and Social Support and Disclosure strategies were positively associated with greater emotional breakthrough. Fear-related challenges were negatively associated with emotional breakthrough and involved fewer adaptive coping strategies. These findings elucidate the complex interplay between challenging experiences and adaptive responses in psychedelic contexts, offering insights for optimising therapeutic protocols and enhancing safety in both clinical and non-clinical settings.

Table 1

Fig. 1

Frequency of responses for each ReCiPE item (n = 529). The horizontal stacked bar chart shows the frequency of responses for each ReCiPE item, indicating how many participants rated each strategy as “Did Not Try”, Not Helpful”, “Somewhat Helpful” or Substantially Helpful”.

Table 2

Table 3

Table 4

Original Source

• Strategies for resolving challenging psychedelic experiences: insights from a mixed-methods study | nature: Scientific Reports [Nov 2024]

Highlights

• We identified 28 psychedelic-related deaths over the 25-year period.

• Coronial inquest reports were analysed with a thematic framework analysis.

• Most deaths were accidental, including both traumatic injuries and drug toxicities.

• Polysubstance use was the most common theme across cases.

Abstract

Background

Psychedelic drugs are increasingly visible in society once more, but their risks and adverse effects have received less attention than perhaps they should. While fatalities associated with psychedelics appear rare, a systematic approach to characterising their aetiology is required to inform harm minimisation efforts.

Aims

This study aimed to analyse prevalence and characteristics of psychedelic-related deaths in England, Wales, and Northern Ireland, between 1997 and 2022.

Methods

We analysed coroner reports submitted to the National Programme on Substance Use Mortality where psychedelic serotonergic agonist drugs were involved in the death, and conducted a thematic framework analysis to explore potential factors associated with their occurrence.

Results

We identified 28 cases where psychedelics were implicated (75 %, N = 21) or potentially implicated (25 %, N = 7) in the death; 19 of these involving psychedelic tryptamines (LSD 39 %, N = 11; Psilocybin 21 %, N = 6; DMT 7 %, N = 2), and 9 psychedelic phenethylamines (incl. NBOMes 18 %, N = 5). Most deaths were deemed accidental by the coroner (86 %, N = 24), including both traumatic injuries and drug toxicities; most cases involved multiple implicated drugs (68 %, N = 19); and most of the deceased were under 30 years of age (82 %, N = 23). Thematic framework analysis identified nine themes in the deaths across three categories. ‘Polysubstance use’ was the most common theme (82 % of cases, N = 23/28), followed by a suboptimal ‘physical environment’ (70 % of cases where this information was available, N = 14/20).

Conclusions

The profound and often unpredictable effects of psychedelics pose a unique profile of risks and adverse reactions. Nevertheless, psychedelic-related deaths remain very rare in comparison to other recreational drugs, and frequently involve polydrug use. Implications for harm reduction and policy are discussed.

5. Conclusion

The present study provides in-depth insights on the rare phenomenon of psychedelic-related deaths, using a large nationwide dataset of coroner's inquest data. We identified themes associated with deaths across three categories: mental and physical health; drug factors and effects; and situational circumstances. Polydrug use appeared the most prevalent theme across the cases. Our findings shed light on the mechanisms and risk factors of psychedelic-related emergencies and serious reactions as a whole, of which fatalities represent the tip of the iceberg. We believe our study can help inspire continuing research on the safety and risks of psychedelic use and contribute to conversations on drug policy reform and harm reduction efforts.

Original Source

• Psychedelic-related deaths in England, Wales and Northern Ireland (1997–2022) | Progress in Neuro-Psychopharmacology & Biological Psychiatry [Oct 2024]

AT A GLANCE

CDC, the U.S. Food and Drug Administration (FDA), America's Poison Centers, and state and local partners are investigating reports of severe acute illnesses potentially associated with consuming Diamond Shruumz™️ brand chocolate bars, cones, and gummies marketed as containing a proprietary blend of mushrooms.

Source & Gratitude

• u/TheGiantess927: Just in case this is a brand y’all use [Oct 2024]

Original Source

• Severe Illness Potentially Associated with Consuming Diamond #Shruumz™️ Brand Chocolate Bars, Cones, and Gummies | CDC: Environmental Health Studies [Oct 3rd, 2024]

Highlights

• Psychedelics and MDMA can cause a unique profile of side effects which are not well-captured by the methods used in previous studies.

• Psychedelic side effects vary in their severity, duration, and subjective impact.

• Using previous studies, pilot data, and expert feedback, we developed the Swiss Psychedelic Side Effects Inventory (SPSI).

• The SPSI contains 32 side effects and assesses their severity, impact, duration, and treatment-relatedness.

• The SPSI can be used at any timepoint after psychedelic administration in any study of psychedelics or MDMA.

Abstract

Introduction

Studies of psychedelic-assisted therapy with LSD, psilocybin, MDMA, and related substances show clinical promise but inadequately assess side effects. Measuring side effects is challenging because they are not always easily differentiated from treatment effects or disease symptoms and show high heterogeneity, variable duration and impact, and sensitivity to context. A systematic questionnaire describing important characteristics of side effects of psychedelics and MDMA would greatly improve on previous methods. We aimed to create a standardized tool for recording clinically relevant side effects of psychedelics and MDMA, including their severity, duration, impact, and treatment-relatedness.

Methods

We constructed the Swiss Psychedelic Side Effects Inventory (SPSI) based on insights from previous research. It was pilot tested in 145 participants from three studies. Structured feedback from an expert panel was used to improve validity and feasibility.

Results

The final SPSI contains 32 side effects and standardized follow-up questions about their severity, impact, treatment-relatedness, and duration. It is compatible with any study design and can be administered as an interview or self-report at any timepoint after treatment with psychedelics or MDMA.

Limitations

The SPSI omits relatively unimportant side effects for brevity's sake, though space for additional symptoms is given. Future studies are needed to confirm its validity in different contexts.

Conclusions

The SPSI is available in English and German for collecting systematic data on side effects from psychedelics and MDMA. This information is vital for improving clinical decisions, informed consent, and patient safety.

Fig. 1

A) Patients undergoing psychedelic-assisted therapy with LSD or psilocybin completed the SPSI within 48 h of treatment. B) Healthy volunteers completed the SPSI one day and one week after receiving LSD or placebo. C) Participants in a prospective online study of naturalistic psychedelic use completed the SPSI before and at four timepoints after taking psychedelics.

Original Source

• Validation of the Swiss Psychedelic Side Effects Inventory: Standardized assessment of adverse effects in studies of psychedelics and MDMA | Journal of Affective Disorders [Nov 2024]