Psychedelic Safety: What You Need to Know Before Taking the Trip
For a long time, people have talked about the safety of psychedelics based mostly on personal experiences and word of mouth. The general belief has been that they’re safe, but the real question is: safe for whom? Thanks to more research, we’re now able to dig deeper into the risks and understand which individuals might need to be extra cautious before considering psychedelics as a treatment.
A recent article in the January 2025 issue of The American Journal of Psychiatry, titled “Primum Non Nocere: The Onus to Characterize the Potential Harms of Psychedelic Treatment”, sheds light on some key safety concerns. Let’s break them down!
1. Lingering Effects (HPPD)
Ever heard of people experiencing “flashbacks” after a psychedelic trip? This is likely indicative of Hallucinogen Persisting Perception Disorder (HPPD). Not to be confused with the “afterglow”, which is a period of improved mood and productivity following trips, HPPD can manifest in various ways such as continuing to see things like visual trails, intensified colors, or distorted objects long after their trip is over. Some people experience this in short bursts, while others experience it in a more long-term, distressing way. In severe cases, it can lead to anxiety, panic attacks, and even suicidal thoughts.
🧠 My Take:
I don’t see HPPD often in the research setting, but that doesn’t mean it’s not a real risk. Anyone considering psychedelics needs to be aware of this. This is where preparation sessions are key. If someone does experience HPPD, they need proper support. This is why integration (the process of making sense of your experience afterward) is just as important as the trip itself.
2. Mania & Psychosis – Who’s at Risk?
One of the biggest concerns with psychedelics is how they might trigger mania or psychosis, especially in people with a personal or family history of bipolar disorder or schizophrenia.
Here’s the tricky part:
• People with a genetic vulnerability to bipolar disorder or schizophrenia report higher rates of mania after psychedelics. Not necessarily psychosis.
• When researchers ask their parents, more cases of psychosis are reported instead.
• Psychedelics can “unmask” mania or psychosis in people who had no previous signs of these conditions.
🧠 My Take:
I see a lot of patients with treatment-resistant depression (TRD) who are interested in psychedelics. Sometimes, when I dig deeper, I find out they have a family history of bipolar disorder or schizophrenia, even if they’ve never had symptoms themselves. This is a red flag in TRD patients as it raises concern for underlying bipolar, warranting further investigation and more nuanced treatment approaches. I’ve also worked in emergency psychiatry, where I’ve seen firsthand how psychedelics can trigger new-onset mania or psychosis that doesn’t go away.
Bottom line? Proper screening is everything. If you or a family member has a history of these conditions, the cons of psychedelic use may outweigh the pros. However, further research is required to draw more than a casual link.
3. Can You Get Addicted to Psychedelics?
Research suggests this isn’t likely! Classic psychedelics (like psilocybin and LSD) have a low risk of addiction or dependence. There also don’t appear to be significant withdrawal symptoms or strong cravings. MDMA (a.k.a. ecstasy), however, is a different story. It has a slightly higher risk for misuse, especially when used recreationally.
🧠 My Take:
Just because the addiction risk is low doesn’t mean psychedelics should be taken without structure and support. Following proper protocols (instead of having a more unstructured approach to dosing) helps promote safety and prevent misuse.
4. Not Every Trip is a Good One (Is that REALLY such a Bad Thing?)
Not all psychedelic experiences are sunshine and rainbows. Some are hard emotionally, mentally, and even physically. But does that mean challenging trips are bad? Not necessarily.
Research suggests that these tough experiences can actually be therapeutic. They often bring up underlying emotional wounds that need healing. But for some people, the distress sticks around for days, weeks, or longer. In extreme cases, it can trigger intense anxiety or nihilism (a deep sense of meaninglessness).
Some factors that increase the risk of a challenging trip include:
Using psychedelics while on mood stabilizers like Lithium
Lack of preparation beforehand
Being in a bad mindset going into the trip
A lack of psychological support
Being in an unsafe or uncomfortable environment
Experiencing a major life event beforehand
The last three are the biggest predictors of profoundly difficult experiences. But even in the most controlled, supportive settings, some people still have challenging trips.
🧠 My Take:
I believe challenging experiences can be valuable. However, you need to be prepared to navigate them. That’s why I emphasize solid preparation before any psychedelic session. When people know what to expect and have a safe place to process things afterward, the experience tends to be much more constructive.
5. The Brain is More Moldable - For Better or Worse
Psychedelics supercharge brain plasticity, meaning they make your brain more adaptable and open to change. This is a double-edged sword. On one hand, it can help you break out of rigid thought patterns (which is great for depression, PTSD, substance use disorders, and anxiety). But if you return to a toxic environment, that increased openness can make negative influences hit even harder.
🧠 My Take:
Environment is everything. It’s not just about where you live. It’s who you spend time with, where you work, and what you do in your free time. If those factors don’t change, it’s unlikely that any treatment – psychedelic or otherwise – will create lasting improvement.
6. Heart Health Matters More Than You Think
From a medical standpoint, cardiac risks are one of the biggest safety concerns with psychedelics.
Standard doses of psychedelics increase heart rate and blood pressure in a relatively predictable fashion. This usually is not a big deal. But in rare cases, especially when combined with other substances, psychedelics have been linked to:
Heart attacks
Cardiomyopathy
Cardiac arrest
Limb ischemia (lack of blood flow to limbs)
Stroke
There’s also some concern about psychedelics causing heart valve issues over time due to their effects on a specific serotonin receptor (5-HT2B).
🧠 My Take:
Do these risks mean people with heart issues can’t use psychedelics? Not necessarily. But they need to be properly evaluated. In severe cases of mental illness where psychedelics might be the best option, heart concerns wouldn’t necessarily rule them out, but they’d be part of a serious risk-benefit conversation.
Final Thoughts: Safety First, Always
At the end of the day, psychedelics have immense potential, but they also come with risks that shouldn’t be ignored. Ethical providers are already doing rigorous screening and emphasizing safety. Where I see the biggest gaps:
People taking psychedelics on their own without proper preparation or support
Practices focused on high patient volume rather than curated care
With great power comes great responsibility (yes, I’m quoting Spider-Man!). Psychedelics can be life-changing, but they should never be taken lightly!
Until next time,
Dr. McCall
