Primum non nocere: The onus to characterize the potential harms of psychedelic treatment
Abstract
The last few years have seen exponential growth in interest, investment, advocacy, and research into psychedelics as therapeutics. This reflects an optimism about the potential promise of psychedelics as therapeutics. As with all therapeutic interventions, research is needed not only into their benefits but also potential risks. Indeed, when substances with therapeutic potential are scrutinized over time, especially in broad populations with psychiatric and medical comorbidities typically excluded from clinical trials, and applied in less well-regulated or controlled settings, a greater understanding of the cautions emerges. Here, we review the literature on the known and potential harms, including enduring perceptual disturbances; triggering or enhancing the risk for onset of mania or psychosis; overuse, misuse, and dependence; challenging experiences or "bad trips"; risks associated with increased neuroplastic potential; and acute and cumulative cardiovascular effects. Each of these issues is addressed in this review, along with the call for continued research, including recommendations for further research and monitoring.
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Little evidence exists to assess the range of psychedelic effects, safety considerations, and applicability of treatment for patients with personality disorders.
“Little evidence exists to assess the range of psychedelic effects, safety considerations, and applicability of treatment for these patients (12, 13).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [12]
Most clinical studies on PAT have explicitly excluded individuals with personality disorders.
“However, the potential for psychedelics to treat personality disorders remains unclear, as most clinical studies on PAT have explicitly excluded individuals with these conditions.”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [12]
A scientific gap exists around the potential for psychedelic therapies to treat personality disorders.
“Thus, a scientific gap exists around the potential for psychedelic therapies to treat personality disorders.”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [12]
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- Authors
- Ghaznavi, S., Ruskin, J. N., Haggerty, S. J., King, F., & Rosenbaum, J. F.
- Affiliations
- Harvard University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2025-01-01
- Volume
- 182
- Issue
- 1
- Pages
- 47-53
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W4405955639
- Cited by
- 12
- References
- 70
- Citations by year
- 2026: 7 · 2025: 5
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Keywords
- psychedelics, psychedelic therapy, adverse effects, perceptual disorders, psychosis risk, mania, substance abuse, dependency, bad trips, neuroplasticity, cardiovascular effects, off-label drug use
- MeSH terms
- Bipolar Disorder, Hallucinogens, Humans, Neuronal Plasticity, Substance-Related Disorders
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