Prolonged Psychological Distress Following Recreational LSD Use in a Young Adult with Multiple Vulnerability Factors: A Case Report
Giacomo D’andrea, Antonio Inserra, Andrea Miuli, Maria Rosaria Balestra, Monica Santangelo, Mauro Pettorruso
Clinical Neuropsychopharmacology and Addiction September 24, 2026 DOI: 10.53941/cna.2026.100015 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 19-year-old Caucasian male who used LSD alone and presented to the emergency room with suicidal thoughts |
| Interventions | Trazodone Brexpiprazole Citalopram |
| Duration | 12-day hospitalization, followed by a second ER visit 5 days later and a third ER visit one month later with a 1-week hospitalization |
| Topics | LSD |
| Key findings | The authors describe a 19-year-old man whose LSD use was followed by recurrent suicidal thoughts, panic, and later pervasive doubt and confusion, requiring three emergency visits and two psychiatric admissions. They suggest he may have an underlying obsessive functioning pattern that became clinically apparent after LSD use, though other vulnerability factors could not be excluded. They argue the case highlights set and setting, harm reduction, and a potentially negative interaction between serotonergic psychedelics and alcohol. |
Abstract
While psychedelic experiences are often reported as positive, adverse psychological reactions can occur. We present the case of a 19-year-old Caucasian male who presented to the ER with suicidal thoughts after taking lysergic acid diethylamide (LSD) alone. He was diagnosed with anxious state associated with panic attacks, and suicidal thoughts without ideation or behaviors. He was admitted to the psychiatric ward and treated with trazodone, a serotonin antagonist and reuptake inhibitor antidepressant, and brexpiprazole, an atypical antipsychotic. He responded well and was discharged after 12 days with recommendations to continue therapy with brexpiprazole and attend follow-up at the territorial mental health services. Five days later, he engaged in alcohol consumption with a roommate met during the psychiatric admission, and suicidal thoughts re-emerged. He presented again to the ER but was not admitted to the inpatient unit, since he improved with supportive conversation and medication. One month later, he returned to the ER a third time due to pervasive doubt and confusion that distressed him to the point of triggering unstructured suicidal thoughts. After one week of hospitalization, he was discharged and citalopram (a selective serotonin reuptake inhibitor [SSRI]) was added to the therapy. Following the third admission, the clinical suspicion strengthened that he may have an underlying obsessive functioning pattern that became clinically apparent following LSD use, although the contribution of other vulnerability factors could not be excluded. This case highlights the importance of set and setting, underscores the relevance of harm reduction strategies for both recreational and clinical users, and highlights a potentially negative interaction between serotonergic psychedelics and alcohol.
Comparable studies
Other case reports and case series on LSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lasting Neuropsychiatric Sequelae of (??)Methylenedioxymethamphetamine (???Ecstasy???) in Recreational Users Persons who ingested large doses of MDMA | 1991 | Case study | n = 2 |
| Further Studies in the Therapeutic Value of Lysergic Acid Diethylamide in Mental Illness Patients with mental illness | 1957 | Case series | |
| Coma, Hyperthermia, and Bleeding Associated with Massive LSD Overdose a Report of Eight Cases People who self-administered large amounts of pure LSD powder intranasally | 1975 | Case series | n = 8 |
| Using a MDMA- and LSD-Group Therapy Model in Clinical Practice in Switzerland and Highlighting the Treatment of Trauma-Related Disorders Patients with chronic complex post-traumatic stress disorder (c-PTSD), dissociative,... | 2022 | Case series | |
| Persistent Palinopsia Following Ingestion of Lysergic Acid Diethylamide (LSD) Patients who developed persistent palinopsia after LSD ingestion | 1996 | Case series | n = 3 |