Past-Year Hallucinogen Use in Relation to Psychological Distress, Depression, and Suicidality among US Adults

This study used a sample from the U.S. National Survey on Drug Use and Health (n=241,675) to assess if past-year psychedelic use is associated with reporting past-year serious psychological distress (SPD), major depressive episode (MDE), and suicidality. LSD was associated with an increased likelihood of MDE and suicidal thinking. MDMA use was associated with a decreased likelihood of SPD and suicidal thinking.

Abstract

Background: There is renewed interest in the clinical application of hallucinogenic substances to treat a range of psychiatric conditions. However, there is mixed evidence regarding how the use of such substances outside of medical settings relates to psychological distress, depression, and suicidality.

Methods: We examined data from a US representative sample of noninstitutionalized adults from the 2015-2020 National Survey on Drug Use and Health (N=241,675). We evaluated whether past-year use of specific hallucinogens (i.e., LSD, DMT/AMT/Foxy, salvia divinorum, ecstasy (MDMA/Molly), ketamine) is associated with reporting past-year serious psychological distress (SPD), major depressive episode (MDE), and suicidality. Generalized linear models using Poisson and log link were used to estimate adjusted prevalence ratios (aPRs), controlling for sociodemographic characteristics and past-year use of various other illegal drugs.

Results: LSD use was associated with an increased likelihood of MDE (aPR=1.23, 95% CI: 1.10-1.37) and suicidal thinking (aPR=1.21, 95% CI: 1.09-1.34). Similar associations were observed between salvia divinorum use and suicidal thinking (aPR=1.41, 95% CI: 1.00-1.98) and between DMT/AMT/Foxy use and suicidal planning (aPR=1.81 95% CI: 1.17-2.81). On the other hand, ecstasy use was associated with a decreased likelihood of SPD (aPR=0.83, 95% CI: 0.77-0.89), MDE (aPR=0.91, 95% CI: 0.83-0.99), and suicidal thinking (aPR=0.86, 95% CI: 0.75-0.99).

Conclusion: Findings suggest there are differences among specific hallucinogens with respect to depression and suicidality. More research is warranted to understand the consequences of and risk factors for hallucinogen use outside of medical settings among adults experiencing depression or suicidality.

Authors: Kevin H. Yang, Benjamin H. Han & Joesph J. Palamar

Author Highlights

• Hallucinogens differ with respect to their link with depression and suicidality.

• LSD use was associated with an increased likelihood of major depressive episodes and suicidal thinking.

• Salvia divinorum use was associated with an increased likelihood of suicidal thinking.

• DMT/AMT/Foxy use was associated with an increased likelihood of suicidal planning.

• Ecstasy/MDMA use was associated with a decreased likelihood of psychological distress, major depressive episodes, and suicidal thinking.

Summary

Hallucinogen use is related to psychological symptoms, including distress, depression, and suicidality, among US adults.

46 Abstract

We examined data from a US representative sample of noninstitutionalized adults from the 2015-2020 National Survey on Drug Use and Health to determine whether past-year use of specific hallucinogens was associated with reporting past-year serious psychological distress, depression, and suicidality. LSD use, salvia divinorum use, DMT/AMT/Foxy use and suicidal thinking were associated with increased likelihood of major depressive episode (MDE) and suicidal thinking, whereas ecstasy use was associated with decreased likelihood of MDE and suicidal thinking.

HALLUCINOGEN USE IN RELATION TO PSYCHIATRIC SYMPTOMS 145 146 147 148 149 150 151 152 153 154

We examined data from a US representative sample of noninstitutionalized adults from the 2015-2020 National Survey on Drug Use and Health to evaluate the association between past-year use of specific hallucinogens and reporting past-year serious psychological distress, major depressive episode, and suicidality.

Depressive disorders are common in the US, affecting more than 10% of adults in any given year. Studies have shown that depression is one of the strongest risk factors for suicidal behavior, and that adults experiencing depression or suicidality may be at risk for other psychoactive substance use as well.

Little is known about how use of hallucinogens relate to psychiatric symptoms on a population level. We examined aggregated data from adults aged 18 and older, from the 2015-2020 National Survey on Drug Use and Health to determine how past-year use of specific hallucinogens is associated with adults reporting past year SPD, MDE, and suicidality.

In a representative annual cross-sectional survey of non-institutionalized individuals in the US, participants were asked about use of LSD, salvia divinorum, ecstasy or “Molly” (MDMA), and ketamine, as well as misuse of prescription tranquilizers, sedatives, stimulants, and opioids. We defined hallucinogens to include LSD, DMT/AMT/Foxy, salvia divinorum, ecstasy/MDMA, and ketamine. These drugs were used in the NSDUH and are listed in the Handbook of Medical Hallucinogens.

NSDUH used the Kessler-6 (K6) distress scale to assess nonspecific psychological distress over the past 30 days and coded affirmative MDE in the past year when participants reported experiencing at least five of the nine MDE Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. We estimated prevalence of past-year use of each drug and all dependent variables, and used generalized linear models to determine the association of specific hallucinogens with SPD, MDE, and suicidality.

This secondary analysis used data from a survey to examine the relationship between income, education, marital status, and use of cannabis, cocaine, methamphetamine, and heroin. A total of 1.0% of individuals used ecstasy/MDMA in the past year, 0.8% used LSD, 0.2% used ketamine, 0.2% used DMT/AMT/Foxy, and 0.1% used salvia divinorum. Those who used each hallucinogen were more likely to experience SPD, MDE, and suicidality.

Although all hallucinogens were associated with increased risk in bivariable models, only some associations held in multivariable models. Adults reporting past-year use of LSD, salvia divinorum, and/or DMT/AMT/Foxy were more likely to report experiencing depression and/or suicidality. Our findings are consistent with previous epidemiologic studies evaluating associations between hallucinogen use and depression and suicidality. Furthermore, our study suggests that these positive associations are applicable to past-year use and not just lifetime use.

Several studies have found conflicting results regarding the associations between psychedelic use and depression, suicidality, and other outcomes. Our study suggests that past-year use of LSD, salvia divinorum, and DMT/AMT/Foxy may be associated with depression and/or suicidality. There may be direct causal links between hallucinogens and specific psychological and behavioral consequences. For example, LSD use can cause depression and suicidality.

Hallucinogens may increase suicidality and may be associated with impaired cognitive functioning and impulsivity. However, more information is needed to determine the prevalence of such adverse outcomes. The present study found no associations between ketamine use and SPD, MDE, or suicidality in multivariable models, but use of ketamine was a risk factor in bivariable models. Further research is needed to determine the risk factors for ketamine use among adults experiencing psychiatric symptoms.

This study assessed past-year substance use and mental health in adolescents and found that past-year recreational ketamine use is a risk factor for reporting current depressive symptoms among adolescents. However, further research is needed to determine the misuse potential and relationship to psychiatric symptoms. The large sample size of the present study allows evaluation of potential associations given the low prevalence of many hallucinogens explored.

Results provide epidemiological evidence that specific hallucinogen use is associated with better or worse mental health.

Hallucinogen use is associated with mental health and addictive problems and impulsivity in university students. A systematic review of human studies suggests that ayahuasca, dimethyltryptamine, and psychosis are associated with increased risk of suicide.

Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population, and lifetime use of MDMA/ecstasy and psilocybin is associated with reduced odds of major depressive episodes. MDMA/ecstasy use and psilocybin use are associated with lowered odds of psychological distress and suicidal thoughts in a sample of US adults. 477 LSD use in the United States: Trends, correlates, and a typology of us. Krebs, T. S., Johansen, P.-., Larsen, J. K., Amada, N., Jungaberle, H., Schecke, H., & Klein, M. (2020). Microdosing psychedelics: Motivations, subjective effects and harm reduction.

Former chronic methylenedioxymethamphetamine (MDMA or ecstasy) users report mild depressive symptoms. 491 MacInnes, N., Handley, S. L., & Harding, G. F. A. (2001).

A two-site randomized controlled trial of ketamine for treatment-resistant major depression found that the drug was effective. The study was conducted by the Pacific Rim College of Psychiatrists, the American Journal of Psychiatry, and the Frontiers in Psychiatry. Ketamine for rapid reduction of suicidal ideation: A randomized controlled trial. The link between use of psychedelic drugs and mental health problems. Ketamine use in relation to depressive symptoms among high school seniors: Media coverage affects perceived likelihood of engaging in recreational use. Ayahuasca rapidly improves symptoms of treatment-resistant depression, but not risk-based memory. Pokorny, Duerler, P., Seifritz, E., Vollenweider, F. X., & Preller, K. H. (2020).

Yockey, King, Araujo, Zeifman, Palhano-Fontes, Hallak, J., Arcoverde, E., Maia-Oliveira, J. P., & Araujo, D. B. (2019).

563 Cannabis, cocaine, methamphetamine, and heroin use and misuse were more common among women than men. 564

Data from years 2015-2020 are pooled. Adjusted analyses controlled for age, sex, race/ethnicity, annual household income, education, marital status, and use of cannabis, cocaine, methamphetamine, and heroin.