The Clinical Syndrome

I want to bring attention to a generally unrecognized, serious, at times severe, dysfunction in people, which is usually misdiagnosed as an emotional problem, but is actually an organic disturbance of brain function caused by the prolonged effect of LSD. I have termed this condition The Post-LSD Syndrome. The bad news is that there is a severe condition, The Post-LSD Syndrome (TPLSDS), which can result from even a single exposure to LSD, even decades after the exposure. The good news is that proper treatment can induce a complete remission fairly easily.

As I see it, TPLSDS is a discrete, unique group of severe symptoms which can be viewed as a tetrad of 1) a severe anxiety state, 2) a severe sleep disturbance, 3) impaired intellectual functioning, and 4) emotional instability. Most patients experience an acute onset with extreme anxiety, panic, inability to sleep, inability to concentrate and think clearly, and surges of emotion. Some fear they are becoming psychotic. Many patients remain acutely symptomatic for years unless treated effectively. Among the patients I saw, none had received effective treatment, and had been ill for months or years. Some had gone into a spontaneous remission for a time, then had a recurrence of symptoms. This cycle can occur repeatedly. Some patients who are acutely ill for a prolonged period may eventually go into a chronic phase which I will discuss below.

The Symptoms of the Basic Condition

The following is a detailed description of the symptoms and clinical findings of the tetrad that constitutes the basic condition of the TPLSDS. The four symptoms may have a simultaneous onset, but frequently the anxiety is primary, followed within a few days by the insomnia. The impaired intellectual functioning follows in a few days to several weeks, and the emotional instability accompanies it, or follows shortly after. By the time a physician is consulted, usually all symptoms are present.

1) The anxiety is a severe and most distressing symptom, often close to a panic state, and usually causes patients to seek treatment. They usually have no psychological explanation for their anxiety. This overwhelming anxiety is often accompanied by a sense of dread, doom, and despair and a fear of impending death. It is akin to what was termed LSD panic in the past. It can occur frequently, last for hours, and even be present most of the time, interfering severely with ability to function. Some patients say they would rather be dead than experience the severe anxiety for a prolonged period.

The anxiety often causes somatic symptoms, e.g., dyspnea, tachycardia, chest pain, weakness, sweating, dizziness, and faintness. Patients often present at an Emergency Room fearing a heart attack, and some have been briefly admitted to a Cardiac Unit. This severe anxiety causes patients to desperately seek a measure of relief, and they turn to medications, alcohol, or illegal drugs with incomplete benefit, but many become addicted while seeking relief.

Some patients linked their feeling of panic to prior experience with LSD, and said they experienced the same panic currently as they did when they used LSD months or years previously. Some reported reexperiencing somatic symptoms; e.g., visual distortions, hallucinations, odors, a bad taste, etc. One patient reported a sequence of tightening of his throat, then feeling unable to breathe, and then having a bad taste in his throat just as he'd experienced during his last few LSD trips many years previously. It was these connections to LSD which patients brought which enabled me to recognize the role of LSD in causing TPLSDS. Surprisingly, patients consistently reported that doctors insisted that LSD was unrelated to their condition, even when the patients told of their past use and the return of old symptoms caused by the past use.

2) The sleep disturbance, like the anxiety, is present in virtually all patients with this condition, and is equally responsible for patients seeking treatment. The sleep problem has unique, distressing qualities. It typically consists of severe insomnia, racing thoughts when trying to fall asleep, and vivid, terrifying nightmares. Patients are unable to fall asleep, tossing for hours, sleep fitfully, and awaken frequently. They achieve little or no sound sleep, and are irritable and exhausted, unable 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 report 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 feel they have no control over their thoughts, which they describe with metaphors such as a runaway train, a tornado of thoughts, and a movie that never ends. The thoughts cover 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.

The unique, distressing nightmares are the final and most significant symptom of the sleep disturbance. They are remarkably vivid, intense, horrible, usually bizarre and unreal, and typically have a psychotic-like lack of restraint and control. The dreamer typically awakens disoriented and terrified, convinced that the dream was real, and is greatly relieved when able to gradually reorient and realize he was dreaming.

The dreams may present a 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 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 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. 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. I believe these dreams are pathognomonic of TPLSDS when they occur in the absence of a psychosis or a delirium.

3) The impaired intellectual functioning is mild to severe and can be devastating. Patients feel distracted and unable to focus, concentrate, or think clearly. They often are unable to watch TV or play a game. They may become unable to read, finding themselves rereading pages and unable to recall...