Treatment approaches and efficacy in psychedelic-induced psychosis: A systematic review.
Adi Sulstarova, Luise Scheuerlein, Silvia Monari, Federico Seragnoli, Thorens Gabriel, Katrin H. Preller, Kerem Böge, Othman Sentissi, Stefan Kaiser, Marco Solmi, Matthias Kirschner, Michel Sabé
Asian Journal of Psychiatry June 26, 2025 DOI: 10.1016/j.ajp.2025.104604 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Case report Peer reviewed |
|---|---|
| Sample size | 93 |
| Population | Patients with psychedelic-induced psychosis |
| Interventions | first-generation antipsychotics second-generation antipsychotics electroconvulsive therapy |
| Topics | LSD Psilocybin |
| Keywords | Hallucinogens Haloperidol Risperidone Hallucinogen-induced psychosis: psychosis Challenging condition Resolving psychosis Positive outcomes Second-generation antipsychotics First-generation antipsychotics Prompt treatment Highly effective Performed significantly better |
| Citations | 4 |
| Key findings | Second-generation antipsychotics had a significantly higher response rate (91.3%) than first-generation antipsychotics (27%) for treating psychedelic-induced psychosis. |
Abstract
Psychedelics are increasingly used in the general population, yet they are associated with increased risk of psychosis in a minority of users that can experience psychedelic-induced psychosis (<1 % in controlled trial settings). In contrast, the evidence regarding the treatment of psychedelics-induced psychosis remains to date scarce. We conducted a PRISMA 2020-compliant systematic review (CRD42023399591), searching electronic databases (inception-August 2024) for interventional, observational studies, case series, or case reports on the treatment of psychedelic-induced psychosis. Frequencies of population, treatment, and outcome characteristics were analyzed. We included 14 case series, 20 case reports, and one prospective study, reporting on 93 cases of psychedelic-induced psychosis, between 1955 and 2024. The primary substances implicated were LSD (47.3 %) and MDMA (38.7 %), and the average patient age of 23.7 ± 6.3 years, with a predominance of male subjects (88 %). Psychosis lasted an average of 1.8 weeks. We identified two main treatment categories: first-generation antipsychotics (n = 37) and second-generation antipsychotics (n = 57). Electroconvulsive therapy was used in a minor subset of cases (n = 9). The response rate for first-generation antipsychotics (27 %) was significantly lower than that for second-generation agents (91.3 %) and electroconvulsive therapy (91 %). Follow-up data indicated 34 % of patients later developed schizophrenia spectrum disorders, and 20.4 % were diagnosed with bipolar disorder. However, the lack of comprehensive follow-up limits the interpretation of findings In conclusion, the evidence supporting treatment options remains limited, primarily based on case reports. Our findings suggest that second-generation antipsychotics seem to be more beneficial in managing psychedelic-induced psychosis, warranting further investigation into optimized treatment protocols.
Comparable studies
Other systematic reviews and meta-analyses on LSD, most cited first.
Citations in the library
Cited by 3
- Psychedelic-Related Psychosis: From Model Psychosis to Psychotherapy. Current Topics in Behavioral Neurosciences 2026
- The intersection between psychedelics and schizophrenia spectrum disorders: Reevaluating risk and therapeutic potential. Journal of Psychopharmacology June 25, 2026
- Trip killers: Addressing a critical knowledge gap in psychedelic research. Journal of Psychopharmacology May 1, 2026
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- ADVERSE REACTIONS TO PSYCHEDELIC DRUGS. A REVIEW OF THE LITERATURE The Journal of Nervous and Mental Disease October 1, 1984
- Neuropharmacology of N,N-dimethyltryptamine Brain Research Bulletin April 30, 2016
and 41 more in the library