Effects and Risks of LSD (Lysergic Acid Diethylamide)
LSD is a potent psychoactive substance that produces significant alterations in consciousness with substantial risks including psychosis-like symptoms, and should be avoided outside of controlled clinical research settings due to safety concerns and legal restrictions.
Pharmacology and Mechanism of Action
LSD is one of the most potent psychoactive agents known, producing dramatic alterations of consciousness after submilligram (≥20 μg) oral doses 1. It primarily works by:
- Modulating serotonin (5-HT2A) receptors, which influence brain networks involved in emotional processing and cognition 2
- Producing effects that typically begin within 30-60 minutes of ingestion and can last 8-12 hours
Acute Psychological Effects
LSD produces pronounced alterations in consciousness that typically last 12 hours 3, including:
- Visual hallucinations and distortions
- Audiovisual synesthesia (fusion of sensory impressions)
- Derealization and depersonalization phenomena
- Altered perception of time and space
- Heightened mood and emotional lability
- Feelings of increased well-being, happiness, openness, and trust
- Psychosis-like symptoms (measured on the Psychotomimetic States Inventory) 4
Physiological Effects
LSD produces significant physiological changes, including:
- Increased blood pressure and heart rate
- Elevated body temperature
- Pupil dilation
- Increased plasma cortisol, prolactin, oxytocin, and epinephrine levels 3
- Autonomic stimulation affecting various bodily systems 5
- Changes in time perception, with users experiencing faster subjective time perception 6
Risks and Adverse Effects
Acute Risks
- Anxiety and panic reactions
- Psychosis-like symptoms
- Impaired cognitive control, especially at higher microdoses (20 μg) 6
- Reduced alertness and thought control 6
- Emotional vulnerability during the experience 2
Long-term Risks
- Hallucinogen-persisting perception disorder (HPPD) - visual disturbances that persist after use 2
- Potential for triggering latent psychological disorders in vulnerable individuals
- Spontaneous recurrence of the LSD experience ("flashbacks") 5
- Chronic drug dependence with subsequent personality changes and depressive reactions in some users 5
High-Risk Populations
- Individuals with pre-existing psychiatric conditions, particularly:
- Unresolved identity problems
- Severe ego abnormality
- Ambulatory schizophrenia
- Chronic impulse disorders
- Borderline personality states 5
Potential Therapeutic Applications
Recent research has begun exploring potential therapeutic applications of LSD in controlled settings:
- Treatment for anxiety, depression, and alcohol use disorder 2
- Psychedelic-assisted psychotherapy where mystical-type experiences may be linked to improved psychological well-being 2
- Some studies report increased optimism and trait openness two weeks after controlled LSD administration 4
Safety Considerations
- LSD is physiologically very safe and non-addictive when used in controlled experimental settings 1
- However, it is classified as a Schedule I controlled substance in the US, indicating high potential for abuse and no accepted medical use 1
- The FDA requires that LSD be kept out of reach of children, and in case of overdose, medical help or Poison Control Center should be contacted immediately 7
Important Caveats
- Effects are highly variable between individuals and can be unpredictable
- Set (mindset) and setting (environment) strongly influence the experience
- There is currently no reliable method to determine who will have an adverse reaction and what the nature of that reaction will be 5
- LSD is not currently approved for routine clinical use outside of research settings 2
- Most research on potential therapeutic benefits involves small sample sizes with variable dosing protocols 2
LSD remains primarily a subject of research rather than an approved therapeutic agent, with significant risks that must be carefully weighed against any potential benefits in controlled research settings.