The Post-LSD Syndrome

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Contents

Foreword..................................................................viiChapter 1 The Clinical Syndrome...........................................1Chapter 2 The History of LSD..............................................13Chapter 3 My First Patient—Barry....................................18Chapter 4 Typical Patients................................................22Chapter 5 Atypical Cases—Depression.................................28Chapter 6 Atypical Cases—Addictions.................................34Chapter 7 Miscellaneous Atypical Cases....................................41Chapter 8 Treatment, Course of Illness, and Prognosis.....................53Chapter 9 Psychiatric Literature..........................................61Chapter 10 Discussion.....................................................67Bibliography..............................................................78Author Biography..........................................................80

Chapter One

I want to bring attention to a generally unrecognized condition which results in a serious, at times severe, dysfunction in people who have experienced LSD previously. I have termed this condition The Post-LSD Syndrome. The bad news is that there is a severe condition, The Post-LSD Syndrome, which can occur as a result of even a single exposure to LSD, even decades after the exposure. The good news is that it can be relatively easily treated. I have gradually become aware of this condition over a course of more than 40 years of private and institutional practice of Psychiatry and Psychoanalysis, particularly in the last ten years, and have now recognized more than 300 patients with this condition. Surprisingly, after a lengthy search of the literature, I have found nothing in the literature which specifically describes The Post-LSD Syndrome, and there are only a handful of cases in the literature which touch on the problem indirectly.

As I see it, The Post-LSD Syndrome (The Syndrome) is a discrete, unique syndrome which encompasses a particular group of severe symptoms which can be viewed as a triad of 1) a severe sleep disturbance, 2) a severe anxiety state which often is tantamount to a panic state, and 3) mental instability, i.e., impaired ego functioning and emotional instability. Some patients experience an acute onset with extreme distress, panic, and psychotic-like symptoms, while others have a gradual progression of symptoms over months or even years. Many patients experience these symptoms severely in a chronic form for years, and often resort to various measures such as medications, alcohol, or drugs to relieve the distressing symptoms, particularly the severe anxiety.

Etiologically, the Post-LSD Syndrome is a long-term consequence of LSD usage which has resulted in LSD interfering with brain function, occurring from a few months to decades after even only a single exposure to LSD. Some patients report having been long-term, heavy users of LSD for years, while others report they used LSD for a short period of time, and then decided to stop it because it didn't do much for them. On closer examination, these latter patients often can identify that they began to feel unstable when using LSD which caused them to discontinue its use. A few patients initially report they never used LSD, but then can recall having a bad trip which had symptoms of acute LSD toxicity, and felt at the time that something had been slipped to them without their knowledge or consent.

The Manifestations of The Post-LSD Syndrome:

The following is a detailed description of the symptoms and manifestations of The Post-LSD Syndrome.

1) The sleep disturbance is present in virtually all patients with this condition, and is the most common chief complaint. It has unique qualities. It typically consists of severe insomnia, racing thoughts when trying to fall asleep, and vivid, terrifying nightmares. Patients describe being unable to fall asleep, being unable to remain asleep or sleep soundly, and awakening frequently during the night. They are severely distressed by being able to achieve little or no sound sleep. This lack of sleep contributes to irritability and exhaustion, and they find it difficult to function the next day, especially at work. They often resort to a variety of measures, particularly prescription medications, alcohol, and/or marijuana, to try to gain some sleep.

They typically report that when they are unable to fall asleep, they have racing, rushing thoughts. These racing thoughts may occur during the day, but are particularly prominent at night. Patients describe thinking rapidly of one thing after another, jumping from subject to subject, with a feeling that the mind can't shut off. They report that they feel they have no control over their thoughts. They describe their racing minds with metaphors such as a runaway train, having a tornado of thoughts, and being caught in a movie that never ends. The thoughts cover any and all subjects which concern them, and the patients report their minds jump from one subject to another without resolving any of the concerns and without formulating any constructive course of action. This is subjectively a much different experience than the more common situations of being preoccupied by the concerns of the day or obsessing about an issue.

The nightmares are unique, significant, and most distressing. They are remarkably intense and horrible, usually bizarre and unreal, and usually have a psychotic-like lack of restraint and control. The dreamers typically awaken disoriented and terrified, convinced that the dream was real, and are greatly relieved when able to gradually reorient and realize they were dreaming. The dreams may present a fairly realistic situation, or an actual memory, in an extreme and distorted way, or a bizarre, unreal situation involving monsters, aliens, or devils. The dreamer typically is threatened in a very dangerous situation, is often on the verge of being killed, and may even actually die in the dream, which rarely occurs in the common nightmare. Or a loved one, such as a child, may be in mortal danger, and even may actually be murdered. The dreamer may kill assailants to defend the child or himself.

The dreams often are in color, and bloody. Many patients cannot fall back asleep after awakening from one of these horrible dreams for fear it will recur. Many patients who do not dream actually abort the dreams by awakening frequently, and thus they may report that they sleep very little. Some patients experience these dreams frequently, while others may be able to abort the dreams and report only having had one or two. It cannot be overemphasized how uniquely horrible, terrifying, and upsetting these dreams are, with an unusual intensity and vividness that is usually seen only in a delirium or a psychosis, and I believe these dreams are pathognomonic of The Post-LSD Syndrome when they occcur in the absence of a psychosis or a delirium. That is to say, one does not see dreams with this frightening intensity in other conditions, except in a psychosis or in a delirium.

2) The severe anxiety is an overwhelming sense of anxiety which is akin to what has been called LSD panic, and, like the sleep disturbance, is present in virtually all patients who suffer from this condition. I believe Eveloff was the first to coin the phrase over 40 years ago....