People with spinal cord injury (SCI) who use classical serotonergic psychedelics such as psilocybin and LSD often experience intense muscle spasms, sweating, and tremors, a phenomenon not previously described in academic literature. These symptoms resemble a peripherally dominant serotonin syndrome-like clinical picture and can interfere with any beneficial effects. The authors propose a theoretical framework for this hypersensitivity and call for awareness to guide harm reduction, informed consent, and development of protocols that allow safe use of psychedelic-assisted therapy in this population.
Adolescent treatment-resistant mental health disorders are increasing worldwide, and standard medications and therapy often fail. Classic psychedelics like psilocybin, LSD-25, and DMT, given within psychedelic-assisted therapy, have shown strong effectiveness in adults with refractory conditions, but adolescents have been excluded from trials. Safety concerns in adolescents are justified but must be weighed against limitations in current evidence, which is observational and underpowered for long-term outcomes. Adult studies indicate low physiological toxicity, minimal dependence risk, and a wide therapeutic index, but these findings cannot be directly applied to developing adolescents. This commentary advocates for cautious, ethically grounded research with these compounds in adolescents who have not responded to other treatments.