Introduction

In recent years, the therapeutic potential of serotonergic psychedelics and 3,4-methylenedioxymethamphetamine (MDMA) for treating various mental disorders has gained increasing attention. This interest is based on promising outcomes from small-scale clinical trials that suggest these substances could offer novel treatment avenues for conditions that are currently challenging to manage with conventional medications.

Adverse Events Associated with Serotonergic Psychedelics and MDMA

The systematic review conducted by Breeksema et al. (2022) highlights the current landscape of adverse events (AEs) associated with serotonergic psychedelics (such as psilocybin, lysergic acid diethylamide, and ayahuasca) and MDMA, drawing on 44 articles covering treatments administered to 598 patients since the year 2000. The findings indicate that while treatments with these substances were generally well-tolerated, common acute AEs included nausea, headaches, and anxiety. Late AEs varied across the substances, with psilocybin and MDMA treatments sometimes followed by headaches, fatigue, low mood, and anxiety, particularly with MDMA. Notably, a serious AE occurred in one instance during MDMA administration, which required brief hospitalization due to an increase in premature ventricular contractions.

Challenges in Defining and Reporting Adverse Events

The review underscores the challenges in defining and reporting AEs in the context of psychedelic treatments. Many studies lacked systematic assessment methods for AEs, leading to a probable underreporting of such events. Moreover, except for ayahuasca treatments, a significant portion of patients had prior experience with psychedelic drugs, which could influence the incidence and reporting of AEs.

Implications for Future Research and Patient Safety

This body of evidence stresses the need for more rigorous and systematic reporting of AEs in future research on psychedelic treatments. Understanding the full spectrum of AEs is crucial for making informed treatment decisions and for the development of harm reduction strategies. It also highlights the importance of setting expectations and preparing patients for the possible acute and late adverse effects of these treatments. As interest in psychedelic-assisted therapy grows, so does the responsibility to ensure patient safety through comprehensive risk assessment and management strategies.