On the Relationship between Classic Psychedelics and Suicidality: A Systematic Review

This review (2021; 64 studies) investigated the literature and found no clear relationship (finding correlation both ways, and non-significant results) between non-clinical use of psychedelics and suicidality. There is preliminary evidence for acute and sustained decreases in suicidality after psychedelic therapy.

Abstract

“Use of classic psychedelics (e.g., psilocybin, ayahuasca, and lysergic acid diethylamide) is increasing, and psychedelic therapy is receiving growing attention as a novel mental health intervention. Suicidality remains a potential safety concern associated with classic psychedelics and is, concurrently, a mental health concern that psychedelic therapy may show promise in targeting. Accordingly, further understanding of the relationship between classic psychedelics and suicidality is needed. Therefore, we conducted a systematic review of the relationship between classic psychedelics (both non-clinical psychedelic use and psychedelic therapy) and suicidality. We identified a total of 64 articles, including 41 articles on the association between non-clinical classic psychedelic use and suicidality and 23 articles on the effects of psychedelic therapy on suicidality. Findings on the association between lifetime classic psychedelic use and suicidality were mixed, with studies finding positive, negative, and no significant association. A small number of reports of suicide and decreased suicidality following non-clinical classic psychedelic use were identified. Several cases of suicide in early psychedelic therapy were identified; however, it was unclear whether this was due to psychedelic therapy itself. In recent psychedelic therapy clinical trials, we found no reports of increased suicidality and preliminary evidence for acute and sustained decreases in suicidality following treatment. We identify some remaining questions and provide suggestions for future research on the association between classic psychedelics and suicidality.“

Authors: Richard J. Zeifman, Nikhita Singhal, Leah Breslow & Cory R. Weissman

Notes

A review of 64 studies investigated the relationship between suicidality and the use of psychedelics. The first part of the review looked at the relationship in natural use (not in the clinic) and found non-significant and significant relationships in both directions. Of the studies where suicidality was linked to psychedelics, often there was a lack of clear relationship between both (i.e. there were psychedelics in someone’s system but that may not be the cause of the suicide).

Modern clinical studies with classical psychedelics (e.g. psilocybin) showed decreases in suicidality after treatment. The participants in these studies also were suffering from other mental health disorders (e.g. depression) and mechanisms like regression to the mean may partly also explain the positive results.

More on psychedelics and suicidality

• Studied now need to be done that incorporate more controls as recommended in the first article, one other suggestion from this article is the use of waitlist controlled studies (to account for the regression to the mean)
• Several studies on ketamine and suicidality also look promising and show rapid and immediate reductions in suicidality. The effects, however, do seem to fade within a week to a month
• On a population level, lifetime use of classical psychedelics is associated with lower psychological distress and suicidality. Correlation doesn’t equal causation though

Psychedelics are being studied for everything from depression to weight loss. Suicidality is a growing problem and future studies might find a place for psychedelics in the acute or long-term treatment for those suffering from suicidal ideation.