Psychedelics and Suicide-Related Outcomes: A Systematic Review
Shakila Meshkat, Taha Malik, Jennifer Swainson, Yanbo Zhang, Lisa Burback, Olga Winkler, Eric Vermetten, Walter Dunn, Rakesh Jetly, Muhammad Ishrat Husain, Venkat Bhat, Richard J. Zeifman, Andrew J. Greenshaw, Amy C. Reichelt, David Erritzøe, Manish K. Jha
Journal of Clinical Medicine February 20, 2025 DOI: 10.3390/jcm14051416 via OpenAlex
Summary
AI-generated from the abstractA systematic review examined whether psychedelic therapies can rapidly reduce suicide risk. Four randomized controlled trials reported significant reductions in suicidal ideation with psilocybin (three studies) and MDMA-assisted therapy (one study), with effect sizes (Cohen's d) ranging from 0.52 to 1.25 and no safety issues. Five additional randomized trials also showed reductions. Among 24 non-randomized and cross-sectional studies, results were mixed: psilocybin reduced suicidal ideation (odds ratios 0.40–0.75), MDMA-assisted therapy for PTSD showed a pooled effect of d = 0.61, while LSD was associated with increased odds of suicidality (odds ratios 1.15–2.08). DMT studies showed no significant effects. The evidence remains inconclusive, underscoring the need for further trials.
Study at a glance
| Characteristics | Systematic review Randomized Cross-sectional Peer reviewed |
|---|---|
| Interventions | Psilocybin MDMA-assisted therapy LSD DMT multiple psychedelics |
| Topics | MDMA Psilocybin |
| Keywords | Medicine Suicidal ideation Odds ratio |
| Citations | 3 |
| Key finding | Psychedelic therapies show mixed effects on suicide-related outcomes, with randomized trials indicating reductions in suicidal ideation for psilocybin and MDMA-assisted therapy, but non-randomized studies revealing increased odds of suicidality with LSD and no significant effects for DMT. |
Abstract
Background/Objectives: Suicide accounts for 1.4% of global deaths, and the slow-acting nature of traditional treatments for suicide risk underscores the need for alternatives. Psychedelic therapies may rapidly reduce suicide risk. This systematic review evaluates impact of psychedelic therapies on suicide-related outcomes. Methods: A systematic search of MEDLINE, Embase, PsycINFO, and ClinicalTrials.gov was conducted up to November 2024. Results: Four randomized controlled trials (RCTs) evaluated suicidality as a secondary outcome or safety measure, showing significant reductions in suicidal ideation with psilocybin (three studies) and MDMA-assisted therapy (MDMA-AT; one study). Effect sizes, measured by Cohen’s d, ranged from =0.52 to 1.25 (p = 0.01 to 0.005), with no safety issues reported. Five additional RCTs assessed suicidality as a safety measure, showing reductions in suicidal ideation with psilocybin (two studies) and MDMA-AT (three studies; p = 0.02 to 0.04). Among 24 non-randomized and cross-sectional studies, results were mixed. Psilocybin (three studies) reduced suicidal ideation, with odds ratios (OR) of 0.40–0.75. MDMA-AT (five studies in PTSD patients) had a pooled effect size of d = 0.61 (95% CI: 0.32–0.89). LSD (six studies) showed increased odds of suicidality, with odds ratios ranging from 1.15 to 2.08. Studies involving DMT (two studies) and multiple psychedelics (three studies) showed mixed results, with DMT studies not showing significant effects on suicidality and studies involving multiple psychedelics showing varying outcomes, some reporting reductions in suicidal ideation and others showing no significant change. Conclusions: The effect of psychedelic therapies on suicide-related outcomes remains inconclusive, highlighting the need for further trials to clarify safety and therapeutic mechanisms.