The psychedelic afterglow phenomenon: A systematic review of subacute effects of classic serotonergic psychedelics
Open accessAbstract
Background: Classic serotonergic psychedelics have anecdotally been reported to show a characteristic pattern of subacute effects that persist after the acute effects of the substance have subsided. These transient effects, sometimes labeled as the 'psychedelic afterglow', have been suggested to be associated with enhanced effectiveness of psychotherapeutic interventions in the subacute period. Objectives: This systematic review provides an overview of subacute effects of psychedelics. Methods: Electronic databases (MEDLINE, Web of Science Core Collection) were searched for studies that assessed the effects of psychedelics (LSD, psilocybin, DMT, 5-MeO-DMT, mescaline, or ayahuasca) on psychological outcome measures and subacute adverse effects in human adults between 1950 and August 2021, occurring between 1 day and 1 month after drug use. Results: Forty-eight studies including a total number of 1,774 participants were eligible for review. Taken together, the following subacute effects were observed: reductions in different psychopathological symptoms; increases in wellbeing, mood, mindfulness, social measures, spirituality, and positive behavioral changes; mixed changes in personality/values/attitudes, and creativity/flexibility. Subacute adverse effects comprised a wide range of complaints, including headaches, sleep disturbances, and individual cases of increased psychological distress. Discussion: Results support narrative reports of a subacute psychedelic 'afterglow' phenomenon comprising potentially beneficial changes in the perception of self, others, and the environment. Subacute adverse events were mild to severe, and no serious adverse events were reported. Many studies, however, lacked a standardized assessment of adverse effects. Future studies are needed to investigate the role of possible moderator variables and to reveal if and how positive effects from the subacute window may consolidate into long-term mental health benefits.
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This neuroplastic window has been related to improvement in grief, depressive mood, stress, mindfulness, acceptance, emotion regulation, social behavior, wellbeing, and quality of life.
“This period has been related to improvement in grief, depressive mood, stress, mindfulness, acceptance, emotion regulation, social behavior, wellbeing, and quality of life (45).”
From Ayahuasca-assisted meaning reconstruction therapy for grief: a non-randomized clinical trial protocol (2025) · cites this paper as [45]
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“54 d Four studies collected complaints in the subacute follow-up using a standardized list of complaints: three of these studies reported no change, 29,39,41 one study reported an increase in complaints after 1 day but not 1 week.”
BackgroundA Clinical Study of LSD Treatment in Alcoholism
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Ayahuasca Improves Self-perception of Speech Performance in Subjects With Social Anxiety Disorder
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More Realistic Forecasting of Future Life Events After Psilocybin for Treatment-Resistant Depression
Lyons, T., & Carhart-Harris, R. L. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01721 · Cited by 77 · cited 1× · see citing works
“48 Four studies reported on the two subscales ‘attitudes toward life and self’ of the Persisting Effects Questionnaire.”
BackgroundChanges in Spirituality Among Ayahuasca Ceremony Novice Participants
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Psychedelic Research and the Need for Transparency: Polishing Alice’s Looking Glass
Petranker, R., Anderson, T., & Farb, N. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01681 · Cited by 69 · cited 1× · see citing works
“88,89 Before replication in larger, preregistered, and controlled studies, results of this review should therefore not be considered to represent the average of expected subacute effects, but a summary of previously observed effects under favorable conditions.”
BackgroundThe Altered States Database: Psychometric Data of Altered States of Consciousness
Schmidt, T. T., & Berkemeyer, H. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01028 · Cited by 68 · cited 1× · see citing works
“91 Precise knowledge of the progression of postacute effects could help to optimize the clinical application of psychedelics, for example, through the augmentation of drug effects with extra-pharma-cological interventions.”
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“16 However, this work combined subacute with long-term effects, preventing conclusions restricted to effects specific to the subacute period.”
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“65 A decrease was reported in authoritarianism 47 and pessimism.”
BackgroundLSD in the Supportive Care of the Terminally Ill Cancer Patient
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“60 Six studies reported on 12 outcome measures assessing specific personality traits/values/attitudes.”
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“88,89 Before replication in larger, preregistered, and controlled studies, results of this review should therefore not be considered to represent the average of expected subacute effects, but a summary of previously observed effects under favorable conditions.”
BackgroundEffects of LSD-25 on Relatives of Schizophrenic Patients
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BackgroundValues in Alcoholics After LSD-25
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BackgroundLysergic Acid Diethylamide (LSD) and JB 318: A Comparison of Two Hallucinogens
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Clinically relevant acute subjective effects of psychedelics beyond mystical experience
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“Of note, psychoactive effects have been observed to linger for some time at a markedly low intensity, referred to as ‘afterglow’ 95 .”
Efficacy and Safety of Psilocybin in Treatment-Resistant Major Depression
Mertens, L. J., Koslowski, M., Betzler, F., Brand, M., Evens, R., Kärtner, L., Jungaberle, A., Jungaberle, H., Majić, T., Schmitz, C. N., et al. (2026) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2026.0132 · Cited by 28 · see citing works
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“Future work should evaluate how long this vagal rebound may last if it is indeed associated with increased BDNF, oxytocin, and beta-endorphins, and to what extent it may underlie the frequently occurring post-psy-chedelic “afterglow” phase (Evens et al., 2023).”
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“…crossover design, all participants took part in active and placebo sessions, which were a minimum of 28 days apart (thought to remove any subacute effects or afterglow of psilocybin Aday et al., 2020; Evens et al., 2023; Studerus et al., 2011, an average of 67.55 days apart, SD = 69.53).”
BackgroundInfluentialSporadic use of classic psychedelics and neuropsychological performance: A cross-sectional analysis
Reiche, S., Hirschfeld, T., Gröticke, A., Traub, M., Hafiz, N. J., Haas, R., Sedlaczek, L., Ortlieb, L., Leistenschneider, G., Basedow, L. A., et al. (2025) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2025.111353 · Cited by 7 · see citing works
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Palitsky, R., Canby, N. K., Dam, N. T. V., Levin-Aspenson, H. F., Kaplan, D. M., Maples‐Keller, J. L., Raison, C. L., Grant, G. H., Dunlop, B. W., & Britton, W. B. (2024) · International Review of Psychiatry · doi:10.1080/09540261.2024.2420745 · Cited by 7 · see citing works
“Changes that may be innocuous in the short term, such as alterations to sleep architecture, as have been observed in meditation (Britton et al., 2014) and psy chedelics (Dudysová et al., 2020; Evens et al., 2023), may constitute AEs if they contribute to enduring dif ficulties.”
Sabucedo, P., Andión, O., Neimeyer, R. A., Soto-Angona, O., Javkin, J., Haro, J. M., Farré, M., & González, D. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1484736 · Cited by 6 · see citing works
“This period has been related to improvement in grief, depressive mood, stress, mindfulness, acceptance, emotion regulation, social behavior, wellbeing, and quality of life (45).”
The emotional architecture of the psychedelic brain
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“141,142 145 These symptoms are also evident in acute stress reactions and disorders caused by traumatic events.”
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“Importantly, the subacute window is often associated with a variety of predominantly beneficial psychological effects (for a review, see Evens et al., 2023).”
InfluentialOrlowski, P., Hobot, J., Ruban, A., Szczypiński, J., & Bola, M. (2024) · Psychophysiology · doi:10.1111/psyp.14583 · Cited by 5 · see citing works
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Psychedelic Modulation of Excitation/Inhibition Balance: A Dual-Phase Neurodevelopmental Model
Kandilakis, C. L., & Papatheodoropoulos, C. (2026) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.5c00892 · Cited by 4 · see citing works
Leistenschneider, G., Majić, T., Reiche, S., & Riemer, T. (2024) · Scientific Reports · doi:10.1038/s41598-024-82216-x · Cited by 4 · see citing works
How do psychedelics impact people with a history of non-affective psychosis? A qualitative study
Dourron, H. M., Copes, H., Grossman, D. H., Bradley, M., Nicholas, C. R. N., Turner, J. A., Allen-Clark, G., Gossage, M., & Hendricks, P. S. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1716545 · Cited by 3 · see citing works
Sanitizing psychedelics: the biopolitics of non-hallucinogenic psychoplastogens
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Classifying Psychedelic-Related Complications
Majić, T., Gouzoulis‐Mayfrank, E., & Evens, R. (2026) · Current topics in behavioral neurosciences · doi:10.1007/7854_2026_614 · Cited by 3 · see citing works
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“The psychedelic’s afterglow period, characterized by emotional openness, improved mood, and enhanced verbal fluency, might also help patients adopt healthier behaviors (like exercise or stress reduction techniques) that benefit long-term disease management [63,164].”
Managing Psychological Challenges in the Subacute (“Afterglow”) Window of Psychedelic Drug Effects
Evens, R., Uyar, A., & Majić, T. (2025) · Current topics in behavioral neurosciences · doi:10.1007/7854_2025_612 · Cited by 2 · see citing works
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“For instance, Evens et al. (2023) found that around half (52”
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david, J., Berkovich‐Ohana, A., & Dor‐Ziderman, Y. (2024) · doi:10.31234/osf.io/tmeb3 · Cited by 2 · see citing works
Whelan, J., Noller, G., & Ward, R. D. (2024) · Drug Science Policy and Law · doi:10.1177/20503245241274170 · Cited by 1 · see citing works
“Experience of an ‘ afterglow ’ effect, which is commonly associated with psy-chedelics (Evens et al., 2023), but also MDMA (Freye, 2009), was also reported by most of the sample.”
Psilocybin as a psychophysical adaptogen in chronic pain rehabilitation
Cherup, N. P., & Finan, P. H. (2025) · Journal of Pain · doi:10.1016/j.jpain.2025.105507 · Cited by 2 · see citing works
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Koning, E., Gamberg, S., & Keshen, A. R. (2026) · Behavioral Sciences · doi:10.3390/bs16030376 · Cited by 1 · see citing works
“…(2–4 weeks) of heightened neuroplasticity induced by psilocybin, often termed the ‘psychedelic after-glow,’ is hypothesized to potentiate the cognitive and behavioral patterns introduced by CBT-ED, thereby supporting durable therapeutic change (Evens et al., 2023; Jones, 2025; Maji´c et al., 2015).”
Dino, F. (2025) · Cureus · doi:10.7759/cureus.80707 · Cited by 3 · see citing works
“This refers to a pattern of subacute effects that persist well beyond the drug’s elimination from the body [36].”
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Impacto das práticas de mindfulness no sono: uma revisão narrativa
de Paula, V. Q., Rodrigues, M. D. A. N., & Huang, N. (2023) · Congresso Brasileiro de Medicina do Estilo de Vida · doi:10.61661/congresso.cbmev.6.2023.10
Open MDMA: An Open Source Framework and Practical Guide for the Therapeutic use of MDMAPreprint
Groeneveld, M., & Harper, T. (2024) · doi:10.31234/osf.io/aps5g
Intact neurophysiological markers of death denial in ayahuasca veteransPreprint
Dor‐Ziderman, Y., david, J., & Berkovich‐Ohana, A. (2024) · doi:10.31219/osf.io/my9sd
Groeneveld, M., & Harper, T. (2024) · doi:10.31234/osf.io/aps5g_v1
Groeneveld, M., & Harper, T. (2025) · doi:10.31234/osf.io/aps5g_v3
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Neurocomputational evidence of sustained Self-Other mergence after psychedelicsPreprint
Mallaroni, P., Mason, N. L., Preller, K. H., Razi, A., Ereira, S., & Ramaekers, J. G. (2025) · medRxiv · doi:10.1101/2025.10.07.25337510
Intact neurophysiological markers of death denial in long-term ayahuasca users
Dor‐Ziderman, Y., David, J., & Berkovich‐Ohana, A. (2025) · Psychopharmacology · doi:10.1007/s00213-025-06963-z
“…active psychiatric illnesses (e.g., epilepsy, depression), loss of a first degree relative (spouse, parent, child, or sibling) within the last 12 months, and consumption of ayahuasca or other psychedelics in the 28 days preceding the assessment (for avoiding afterglow effects (Evens et al. 2023).”
Design, Spectral Insights, and Enhanced Antioxidant Potential of Novel Phenothiazine Derivatives -1
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“37 59–64 Among the subjective subacute consequences (‘afterglow’), a recent systematic review 44 reports that psilocybin (especially at high doses) could promote: (1) positive changes in behaviour, socialisation, spirituality, attitude towards life and oneself, predisposition to positive emotions;…”
Exploring new avenues: Psychedelic‐assisted therapy for young people
Vamvakopoulou, I. A., Nicholls, D., Nutt, D. J., & Simplicio, M. D. (2026) · British Journal of Clinical Pharmacology · doi:10.1002/bcp.70579
Insight to Action: The Role of Occupational Therapy in Psychedelic Integration
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Ten practical suggestions for setting up a psychedelic study
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“For reviews, see Aday et al., 2020, Evens et al., 2023, and Goldberg et al., 2020.”
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Cannabis and Psilocybin Co-use: Associations with Stress and Well-being
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- Authors
- Evens, R., Schmidt, M. E., Majić, T., & Schmidt, T. T.
- Affiliations
- Humboldt-Universität zu Berlin (DE)
- Freie Universität Berlin (DE)
- St. Hedwig-Krankenhaus (DE)
- Corresponding author
- Evens, Ricarda
- Venue
- Therapeutic Advances in Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2023-01
- Volume
- 13
- Pages
- 20451253231172254-20451253231172254
- ISSN
- 2045-1253 (ISSN-L)
- 2045-1261
- PMC
- PMC10240558
- OpenAlex
- W4379598244
- Cited by
- 56
- References
- 92
- Citations by year
- 2026: 17 · 2025: 18 · 2024: 18 · 2023: 3
- FWCI
- 2.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Therapeutic Advances in Psychopharmacology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- edoc Publication server (Humboldt University of Berlin) (submittedVersion, cc-by)
- Refubium (Universitätsbibliothek der Freien Universität Berlin) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Universitätsbibliothek der FU Berlin Hochschulschriftenstelle u. Dokumentenserver (cc-by)
- edoc Publication server (Humboldt University of Berlin) (cc-by)
- Funders
- Deutsche Forschungsgemeinschaft (491192747)
- Humboldt-Universität zu Berlin
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Social Sciences › Psychology › Social Psychology › Paranormal Experiences and Beliefs
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Keywords
- LSD, psilocybin, DMT, 5-MeO-DMT, mescaline, ayahuasca, psychological distress, well-being, mood, mindfulness, spirituality, personality change, creativity, psychotherapeutic interventions, long-term mental health
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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