How does LSD induce short-term psychosis but long-term optimism?

sigmond

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Rachel Jonas - Aeon

When most people think of LSD (lysergic acid diethylamide) the image that comes to mind is hallucinating hippies at Woodstock, but the drug’s original use was psychotherapeutic. As early as the 1960s, researchers showed that LSD reduces depression, anxiety and pain in patients with advanced cancer, and recent years have seen a resurgence of interest in the drug’s beneficial effects. In 2014, Swiss psychiatrist Peter Gasser published the results of a study showing that LSD could alleviate the symptoms of severe anxiety disorder. And a 2016 study from Imperial College London showed that LSD could increase levels of optimism and openness for extended periods of time.

The LSD story goes back to Albert Hofmann, a Swiss chemist who first synthesised the compound in 1938. Hofmann accidentally discovered its hallucinogenic effects after ingesting 250 μg (a very large dose!) before his evening commute home. Being the good scientist that he was, he recorded a detailed account of his experience in his notebook. His initial, paranoia-filled reaction was followed the next day by a blissful experience, in which ‘everything glistened, and sparkled in a fresh light’.

It was this final, uplifting insight that the researchers at Imperial set out to re-explore in rigorous fashion, starting with 20 participants recruited by word-of-mouth.

[...]

Much like Hofmann himself, test subjects reported feeling the effect of the LSD as quickly as ten minutes after the infusion, with the experience lasting for nearly eight hours in all. Several hours into the dosing, they were asked to answer a series of questions regarding their psychological wellbeing. Participants remained in the research centre for the remainder of the day with a psychiatrist present until they were functioning normally. In order to determine longer-term effects, they filled out the same questionnaires two weeks later.

Shortly after taking the drug, participants who received LSD reported an increase in psychosis-like symptoms, including visual hallucinations, spiritual experiences and paranoia. It was an outcome the researchers had expected. But interestingly, those given LSD were more likely to feel positive, and even ‘blissful’ emotions, as opposed to the negative and ‘anxious’ feelings sometimes associated with psychedelic drugs. What was even more striking was that two weeks after taking LSD, these individuals reported increased optimism and openness, making them more creative and curious, as compared with those who received the placebo.

How can a drug that creates a temporary psychosis lead to such pronounced long-term optimism? This is a mostly unanswered question, but researchers think it has something to do with the serotonin 2A receptor (5-HT2AR). This receptor is expressed all over the brain, particularly in regions associated with cognitive functions and social interactions. Stimulation of this receptor has been directly linked to cognitive flexibility, enhanced imagination and creative thinking. Disorders associated with variants of the 5-HT2AR include schizophrenia, depression, obsessive-compulsive disorder and attention deficit hyperactivity disorder – in other words, a panoply of psychiatric illness.

It turns out that LSD functions by binding to and stimulating 5-HT
2AR in the cerebral cortex, which is thought to regulate an enzyme called phospholipase C, and eventually leads to psychoactive effects. In fact, blockage of this receptor has been linked to a remediation of the hallucinatory effects of LSD in rats.

The precise biology behind LSD’s transformational potential remains a mystery. But researchers at Imperial suggest that once LSD binds to the receptor, it’s possible that the initial ‘blast’ of stimulation results in more intense, acute psychotic-like symptoms, whereas the longer-term effects produce a ‘loosening’ of network dynamics, and a general increase in optimism and wellbeing.

shameless-plug

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Aeon is one of more interesting webzines i've read. the articles are often written by academics, are essay length, and occasionally have an audible option; example
 
I think it's very facile to describe LSD as 'a drug that induces short-term psychosis'. That description is certainly accurate in a minority of cases (particularly in naive users when the dose is too high - I've seen it plenty of times), but you'd be hard-pressed to say an average user is psychotic when under the influence (much less an experienced one).

Most importantly, I hope researchers don't adopt the mindset that reaping long-term psychological benefits from LSD use requires a psychosis-inducing overdose of the drug.
 
I think it's very facile to describe LSD as 'a drug that induces short-term psychosis'. That description is certainly accurate in a minority of cases (particularly in naive users when the dose is too high - I've seen it plenty of times), but you'd be hard-pressed to say an average user is psychotic when under the influence (much less an experienced one).

Most importantly, I hope researchers don't adopt the mindset that reaping long-term psychological benefits from LSD use requires a psychosis-inducing overdose of the drug.

Good answer sir.
 
what do you think a psychiatrist would say if told them you were experiencing audio and visual hallucinations? laughing uncontrollably for [x] hours would be considered 'psychosis-like'. admittedly, i didn't care for this article much. the main reason i posted it is because i posted the original research paper in another section earlier this year. oh, and the shameless plug is real.
 
Audio and visual hallucinations? Dreams.

Laughing uncontrollably for hours? A particularly funny stand-up comedian.

I don't care much for psychiatrists let alone definitions of psychosis that may be way off the mark. A change of consciousness does not necessarily equate to psychosis.
 
of course you would be laughing regardless if a stand-up comedian, or perhaps anyone else, is around. lsd inducing symptoms similar to what a schizophrenic experiences isn't a new concept.
 
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That seems like a bit of a stretch to me - I've seen people experiencing mild-moderate psychosis, as well as people under the effect of various psychedelics (including LSD), and the only real similarity seems to be that they're both perceiving reality in a manner different to normal waking life.

They're even connected to different systems of neurotransmitters, the way I understand it - as the article points out, LSD acts on the serotonin receptors, whereas psychosis is strongly related to dopamine activity (a lot of anti-psychotic drugs reduce dopamine, and drugs which increase dopamine excessively, such as amphetamines, can induce psychosis).
 
When I use LSD, I don't laugh uncontrollably for hours. I also think there is a very real, very important distinction to be made between believing hallucinations are real and experiencing hallucinations while knowing that they are not real.
 
That seems like a bit of a stretch to me - I've seen people experiencing mild-moderate psychosis, as well as people under the effect of various psychedelics (including LSD), and the only real similarity seems to be that they're both perceiving reality in a manner different to normal waking life.

They're even connected to different systems of neurotransmitters, the way I understand it - as the article points out, LSD acts on the serotonin receptors, whereas psychosis is strongly related to dopamine activity (a lot of anti-psychotic drugs reduce dopamine, and drugs which increase dopamine excessively, such as amphetamines, can induce psychosis).

Agreed. I also have seen people in a major psychosis, and in mania and people on various drugs like LSD and mushrooms, and I have taken high, moderate, and low doses of both LSD and mushrooms and it's not akin to a psychosis or mania where the person actually believes that everything is real or is literally hallucinating and believing that all sort of things are happening to them, or even seeing people or having things done to them that are not really happening at all to them.

Even with high doses of LSD and mushrooms I still always would remember in the back of my mind that I had taken something, and that it was a psychedelic drug causing the effects I was getting. It's not like this at all for people who are experiencing actual psychosis, or mania.
 
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