Treatment approaches and efficacy in psychedelic-induced psychosis: A systematic review.
Asian journal of psychiatry – June 26, 2025
Source: PubMed
Summary
When hallucinogens like LSD or psilocybin induce psychosis, prompt treatment is crucial. A review of cases found second-generation antipsychotics, such as Risperidone, highly effective in resolving psychosis. These performed significantly better than first-generation antipsychotics like Haloperidol, offering positive outcomes for patients experiencing this challenging condition.
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.