LSD treatment in Scandinavia: emphasizing indications and short-term treatment outcomes of 151 patients in Denmark

This retrospective follow-up study (n=151) assessed the case material of 151 patients who applied for financial compensation for harms elicited by psychedelic treatments administered between 1959 to 1973 and re-evaluated in 1986. It found that one-third of the patients experienced a transient improvement in their mental state independent of the diagnosis, while the mental state of another third of the patients deteriorated with treatment.

Abstract

“Background: New research has suggested the clinical use of lysergic acid diethylamide (LSD) and psilocybin in selected patient populations. However, concerns about the clinical use of LSD were advanced in a large Danish follow-up study that assessed 151 LSD-treated psychiatric patients approximately 25 years after their treatment in the 1960s.

Aims: The purpose of the present study was to give a retrospective account of the short-term outcome of LSD treatment in these 151 Danish psychiatric patients.

Methods: The LSD case material in the Danish State Archives consists of medical case records of 151 LSD-treated patients, who complained and received economic compensation with the LSD Damages Law. The author carefully read and reviewed the LSD case material.

Results: LSD was used to treat a wide spectrum of mental disorders. Independent of diagnoses, 52 patients improved, and 48 patients worsened acutely with the LSD treatment. In a subgroup of 82 neurotic patients, the LSD dose-index (number of treatments multiplied by the maximal LSD dose) indicated the risk of acute worsening. In another subgroup of 19 patients with obsessive-compulsive neurosis, five patients later underwent psychosurgery. A small subgroup of 12 patients was treated with psilocybin. The long-term outcome was poor in most of the patients.

Conclusions: Despite the significant limitations to a retrospective design, this database warrants caution in mental health patients. The use of LSD and psilocybin in mental health patients may be associated with serious short- and long-term side effects. Until further trials with rigorous designs have cleared these drugs of their potential harms, their clinical utility in these groups of patients has not been fully clarified.”

Author: Jens K. Larsen

Summary

A Danish follow-up study assessed 151 LSD-treated psychiatric patients approximately 25 years after their treatment in the 1960s.

Background

Recently, new research suggested that psychedelic drugs, such as LSD and psilocybin, may benefit patients with difficult-to-treat anxiety, including end-of-life anxiety, addiction or post-traumatic stress disorder. Furthermore, a small open-label study found support for the use of psilocybin in treatment-resistant depression.

LSD was extracted from Claviceps purpurea (ergot) in 1938 by Albert Hofmann. It was marketed in 1947 under the trade-name Delysid and used in analytical psychotherapy and experimental studies on the nature of psychoses.

In 1957, the treatment of LSD was started in Sweden, 1960 in Denmark and 1961 in Norway. Follow-up studies were performed 18 years after the collection of data, but little information was presented about the short-term treatment effect.

Aims

The aim of this study was to give a retrospective account of the short-term and long-term effects of LSD treatment in Danish psychiatric patients.

Materials and methods

From 1959 to 1973, nearly 400 patients were treated with LSD in Denmark. 151 of these patients complained about harm caused by the LSD treatment, and reparatory compensation could be given for LSD-inflicted physical and psychological damage.

The Danish National Health Service sent a circular to all Danish doctors in May 1986, and the Ministry of Interior was going to brief municipalities and county authorities on the law.

Each application was handled by a tribunal under the Ministry of Social Affairs. The tribunal asked eight questions.

The questions were critically examined in specialist certificates in 111/154 patients from more than 20 psychiatrists, and in the remaining cases, the matter was elucidated by obtaining written responses from the various psychiatric departments.

The present author was granted access to LSD case material in the Danish State Archives and respected confidentiality. The short-term effect of LSD treatment was not previously performed.

Results

LSD was used on a wide spectrum of mental disorders, and the improvement of symptoms was rated according to any objectively described or subjectively reported longer lasting or transient recovery of the symptoms.

Subgroup analyses

The outcome of the LSD treatment in the subgroup of patients with neurotic disorders was compared with the number of LSD sessions and LSD dose. A significantly higher LSD dose-index was found in the group of patients who acutely deteriorated compared to the improved patients.

LSD was observed to benefit patients with obsessive-compulsive neurosis. Five of the eight patients who underwent psychosurgery were from this group, and two more were recommended to undergo psychosurgery, but declined.

In many patients, LSD treatment continued for months or even years, and in nine patients, the mental state deteriorated with the first treatment or later. One patient believed that LSD treatment should continue until she recovered, although she often felt depressed, agitated and alarmed between sessions.

Psilocybin treatment

The LSD tribunal handled applications for compensation due to psilocybin treatment, because the tribunal did not differentiate between the two psychedelics in terms of their potential risk of causing harm.

Discussion

The LSD case material includes more detailed clinical data at follow-up (1986 – 1988) than at the time of LSD treatment in the 1960s. The study from 1964 showed no deterioration in the mental state in any patient, but recorded two suicides, four tentative suicides and one homicide as side effects.

Although 109/151 patients applied for compensation, I made no attempt to differentiate between the outcome of treatment at Frederiksberg Hospital and similar outcomes at other Danish hospitals. Acute deterioration was seen in applicants from all hospitals, even if only a few patients were compensated.

In the early days of LSD treatment in Denmark, very little was written about diagnostic selection criteria and treatment procedure. However, in one case study, a 30-year-old male with compulsive neurosis underwent 57 sessions during 15 months and was reported to be cured or much improved.

Thorkil Vanggaard suggested that LSD treatment should be reserved for patients with high ego strength and a well-functioning habitual personality. However, Ole Herman Robak did not find LSD therapy encouraging for borderline cases.

According to the Danish State Archives, LSD treatment was not carefully selected, and the therapists did not adhere to the contraindications. This may explain the high percentage of acute deterioration for patients suffering from depression and manic-depressive psychosis.

The Swedish psychiatrist Lennart Kaij stated that the therapeutic value of LSD was indisputable, and that four out of five treatment-resistant patients with anancastic neurosis improved or recovered after receiving LSD.

The Norwegian follow-up studies from Modum Bads Nervesanatorium included a wide spectrum of diagnostic categories, including therapy-resistant patients. The Norwegian study found fewer patients worsened than the present Danish sample, possibly due to the lower doses used and closer follow-up and assessment before LSD treatment.

In 2013, Krebs and Johansen concluded that psychedelic use was not an independent risk factor for mental health problems. A large population study of 130,152 US respondents found no correlation between psychedelic use and panic disorder, major depression, mania, social phobia, general anxiety disorder, agoraphobia, PTSD, and non-affective psychosis.

In the 1960s, there were no guidelines for the selection of patients for LSD treatment. In 2008, Johnson et al. prepared guidelines for safety, which are necessary and welcome.

The present study was conducted on a highly-selected sample of severely mentally ill patients who had ever used LSD before LSD treatment was established. Only eight patients answered yes to the question whether LSD treatment had tempted them to use LSD on their own.

One might wonder why the remaining 200 – 250 patients who received LSD treatment did not apply for compensation.

The study leaves many other questions unanswered, including whether the number of treatments or dose is important.

The use of psychedelics in patients with life-threatening cancer has not been reported, but in double-blind, randomized, placebo-controlled studies, LSD or psilocybin was found to produce sustained decreases in depression and anxiety scores.

Conclusions

LSD and psilocybin may be dangerous for severely ill mental health patients. Careful selection of patients, keeping the dose low, and not providing outpatient treatment may diminish the risk, but there is no guarantee of an unproblematic course.