What are the effects and treatment of Lysergic acid diethylamide (LSD) overdose?

Effects and Treatment of LSD Overdose

LSD overdose primarily causes psychological distress, autonomic changes, and altered perception, requiring supportive care focused on managing anxiety and preventing self-harm, as there is no specific antidote.

Clinical Manifestations of LSD Overdose

Psychological Effects

• Altered consciousness and perception of time 1
• Anxiety, fear, and psychosis-like symptoms 1, 2
• Increased intensity of emotional responses 1
• Potential for panic reactions or "bad trips" 1

Physiological Effects

• Autonomic changes including:
  • Increased galvanic skin responses
  • Pupil dilation
  • Elevated blood pressure 1
  • Increased heart rate 3
• Physical discomfort, headache, fatigue, nausea 1
• Insomnia and sleep disturbances 1
• Dizziness and somatization 1

Treatment Approach for LSD Overdose

Immediate Management

1. Ensure patient safety

   • Remove from stimulating environments
   • Prevent self-harm behaviors
   • Maintain calm, reassuring presence

2. Pharmacological interventions

   • Benzodiazepines (first-line) for anxiety and agitation
   • Antipsychotics only if severe psychosis persists despite benzodiazepines

3. Supportive care

   • Monitor vital signs
   • Maintain hydration
   • Provide reassurance that effects are temporary

Important Clinical Considerations

• LSD is physiologically well-tolerated with minimal risk of fatal overdose 4
• Psychological reactions can typically be controlled in a medically supervised setting 4
• Effects are dose-dependent, with threshold for perceptible effects starting at approximately 20μg 5
• Duration of effects typically 8-12 hours, with residual effects potentially lasting 24 hours

Special Populations and Risks

High-Risk Individuals

• Patients with pre-existing psychiatric conditions
• Individuals with personal or family history of psychosis
• Adolescents (19% of incarcerated youth report LSD use) 1

Potential Complications

• Hallucinogen-persisting perception disorder (HPPD) 3
• Prolonged psychosis in predisposed individuals
• Emotional vulnerability during and after intoxication 3
• Risk of accidents or self-harm during intoxication

Follow-up Care

• Assess for persistent perceptual changes or psychological distress
• Screen for underlying psychiatric conditions that may have been triggered
• Consider referral to substance abuse treatment if use is problematic

Clinical Pearls

• LSD does not cause physical dependence or addiction 5
• No fatal overdoses from LSD alone have been documented in the literature
• The primary risks are psychological distress and dangerous behavior while intoxicated
• Reassurance and a calm environment are often more effective than medication