The author proposes the recognition of a condition, which he terms The Post-L.S.D. Syndrome, in which patients who have had prior experience with L.S.D. experience a triad of distressing and debilitating symptoms. This triad of unique symptoms consists of a sleep disturbance, anxiety, and forms of mental instability which are described in detail. These symptoms can occur after decades of even only one exposure to L.S.D. . The author describes in detail a variety of case studies which illustrate the various forms of pathology which the condition can manifest. Typical cases which consist of a fairly clear and direct presentation of the basic triad of symptoms are described, as are atyplcal cases in which other symptoms may appear to predominate, such as depression and addictions. Situations in which other conditions may coexist with The L.S.D.-Syndrome and in which they reenforce each other, such as P.T.S.D., are also described. The book is written for the benefit of the general public as well as for professionals, in the hope of helping people obtain proper treatment.

The Post-LSD Syndrome

Diagnosis and TreatmentBy Edwin I. Roth

AuthorHouse

Copyright © 2011 Edwin I. Roth, M.D.
All right reserved.
ISBN: 978-1-4634-1198-5

Contents

Foreword..................................................................viiChapter 1 The Clinical Syndrome...........................................1Chapter 2 The History of LSD..............................................13Chapter 3 My First Patient—Barry....................................18Chapter 4 Typical Patients................................................22Chapter 5 Atypical Cases—Depression.................................28Chapter 6 Atypical Cases—Addictions.................................34Chapter 7 Miscellaneous Atypical Cases....................................41Chapter 8 Treatment, Course of Illness, and Prognosis.....................53Chapter 9 Psychiatric Literature..........................................61Chapter 10 Discussion.....................................................67Bibliography..............................................................78Author Biography..........................................................80

Chapter One

The Clinical Syndrome

I want to bring attention to a generally unrecognized condition which results in a serious, at times severe, dysfunction in people who have experienced LSD previously. I have termed this condition The Post-LSD Syndrome. The bad news is that there is a severe condition, The Post-LSD Syndrome, which can occur as a result of even a single exposure to LSD, even decades after the exposure. The good news is that it can be relatively easily treated. I have gradually become aware of this condition over a course of more than 40 years of private and institutional practice of Psychiatry and Psychoanalysis, particularly in the last ten years, and have now recognized more than 300 patients with this condition. Surprisingly, after a lengthy search of the literature, I have found nothing in the literature which specifically describes The Post-LSD Syndrome, and there are only a handful of cases in the literature which touch on the problem indirectly.

As I see it, The Post-LSD Syndrome (The Syndrome) is a discrete, unique syndrome which encompasses a particular group of severe symptoms which can be viewed as a triad of 1) a severe sleep disturbance, 2) a severe anxiety state which often is tantamount to a panic state, and 3) mental instability, i.e., impaired ego functioning and emotional instability. Some patients experience an acute onset with extreme distress, panic, and psychotic-like symptoms, while others have a gradual progression of symptoms over months or even years. Many patients experience these symptoms severely in a chronic form for years, and often resort to various measures such as medications, alcohol, or drugs to relieve the distressing symptoms, particularly the severe anxiety.

Etiologically, the Post-LSD Syndrome is a long-term consequence of LSD usage which has resulted in LSD interfering with brain function, occurring from a few months to decades after even only a single exposure to LSD. Some patients report having been long-term, heavy users of LSD for years, while others report they used LSD for a short period of time, and then decided to stop it because it didn't do much for them. On closer examination, these latter patients often can identify that they began to feel unstable when using LSD which caused them to discontinue its use. A few patients initially report they never used LSD, but then can recall having a bad trip which had symptoms of acute LSD toxicity, and felt at the time that something had been slipped to them without their knowledge or consent.

The Manifestations of The Post-LSD Syndrome:

The following is a detailed description of the symptoms and manifestations of The Post-LSD Syndrome.

1) The sleep disturbance is present in virtually all patients with this condition, and is the most common chief complaint. It has unique qualities. It typically consists of severe insomnia, racing thoughts when trying to fall asleep, and vivid, terrifying nightmares. Patients describe being unable to fall asleep, being unable to remain asleep or sleep soundly, and awakening frequently during the night. They are severely distressed by being able to achieve little or no sound sleep. This lack of sleep contributes to irritability and exhaustion, and they find it difficult 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 typically report that when they are unable to fall asleep, they have racing, rushing thoughts. These 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 report that they feel they have no control over their thoughts. They describe their racing minds with metaphors such as a runaway train, having a tornado of thoughts, and being caught in a movie that never ends. The thoughts cover any and 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. This is subjectively a much different experience than the more common situations of being preoccupied by the concerns of the day or obsessing about an issue.

The nightmares are unique, significant, and most distressing. They are remarkably intense and horrible, usually bizarre and unreal, and usually have a psychotic-like lack of restraint and control. The dreamers typically awaken disoriented and terrified, convinced that the dream was real, and are greatly relieved when able to gradually reorient and realize they were dreaming. The dreams may present a fairly 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 even 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 back 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. Some patients experience these dreams frequently, while others may be able to abort the dreams and report only having had one or two. 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, and I believe these dreams are pathognomonic of The Post-LSD Syndrome when they occcur in the absence of a psychosis or a delirium. That is to say, one does not see dreams with this frightening intensity in other conditions, except in a psychosis or in a delirium.

2) The severe anxiety is an overwhelming sense of anxiety which is akin to what has been called LSD panic, and, like the sleep disturbance, is present in virtually all patients who suffer from this condition. I believe Eveloff was the first to coin the phrase over 40 years ago. Anxiety is the second most common chief complaint, causing the patient to seek treatment almost as frequently as does the sleep disturbance. The overwhelming anxiety is accompanied by a sense of dread and doom, often with feelings of despair and impending death and often is severe enough to warrant being termed a panic state. The anxiety can occur several times a day, and may last for hours.

Patients often experience any of the usual physical symptoms which may accompany severe anxiety and panic, e.g., shortness of breath, rapid heart beats, chest pain, sweating, weakness, dizziness, nausea, and faintness. They often present at an Emergency Room because the discomfort of the palpitations, dyspnea, chest pain, etc., causes them to fear they are having a heart attack. They may even be hospitalized for observation on a Cardiac Unit briefly. Patients often say they would rather be dead than experience the severe distress of the anxiety state, although they are not suicidal. However, they often are misdiagnosed as depressed and suicidal. They usually desperately seek relief, and turn to medications, alcohol or illegal drugs with varying degrees of incomplete benefit. They may easily become addicted to alcohol, drugs, or prescription medications while seeking to obtain relief.

Some patients are able to link their subjective feeling of panic to their experience with LSD, and recognize they experience the same panic currently as they did when they used LSD. For example, one patient reported that during his panic he got a tightening of his throat, felt he couldn't breathe, and had the same bad taste in his throat he'd experienced during his last few LSD trips many years previously. Many patients experience a moderate to severe degree of anxiety for years, often using various coping devices such as medications, alcohol, drugs, counseling, etc. before seeking medical or psychiatric attention. Other patients may seek medical or psychiatric treatment early in the course of their illness, but the prescribed medications, especially antidepressants, usually are only partially beneficial, resulting in the patients feeling disappointed and desperate, and then often resorting to substance abuse. Some patients are able to avoid significant awareness of the underlying anxiety generated by the chronic LSD effect by abusing substances chronically, and only begin to experience anxiety in its full intensity as they try to discontinue their substance abuse.

3) The mental instability may be seen in any area of ego functioning, and actually is a manifestation of impaired ego functioning. There is instability in both the emotional and cognitive areas. Objectively, one can see emotional lability with tearfulness, irritability and increased anger, as well as impaired cognitive functions and coping skills. These patients are not psychotic, as they have basically intact egos. However, they may say they feel as if they are becoming psychotic because of these distressing, exhausting symptoms which are caused by LSD chronically interfering with brain function.

The emotional instability is described by patients as getting stressed and emotional easily and being unable to cope with pressure. Many become tearful easily and embarrass themselves by crying in public with only mild provocation. Some become irritable and argumentative, may get surges of anger which feel difficult to control, and may even have violent impulses which are not characteristic of them. As a result of this emotional lability, many feel uncomfortable around people and seek to withdraw and isolate themselves. Objectively, this emotional lability may be seen as tearfulness or anger in the clinical session, and the patients may feel embarrassed and apologize. In some patients, especially men who have experienced The Post-LSD Syndrome for years, the anger surges may be prominent, even dominating, and lead to brawling and sadism. Such patients may feel this behavior is an inherent part of their personality which could never change. However, the anger may actually be ego-alien and undesirable, and some patients become aware that they dislike the aggression after they begin to benefit from treatment.

The cognitive impairment is a serious area of dysfunction. Patients report difficulty in focusing and concentrating, and can't think as quickly or clearly as they should. They can't work as effectively, and often feel their businesses will fail, or they will be fired from their jobs. They particularly note that they have become unable to enjoy reading, and find themselves rereading pages and being unable to recall what they have just read. They are unable to study and learn, and often fail subjects and drop out of school. Objectively, these patients usually are found to have severe inhibitions of the ability to concentrate and study, of the ability to focus on a problem and solve it, and of the ability to tolerate the stress of performance. It cannot be overstated how serious and distressing a problem it is when their inability to work leads to failing academic performance, poor performance at work, and/or business losses. Patients often become secondarily depressed as a result of their inability to concentrate and function normally and as a result of the realistic consequences of their underperformance. Deceptively, on superficial examination these patients often appear to be fairly intact, although they actually are significantly impaired intellectually. They may appear to perform adequately on mental status questions such as calculations, abstractions and general knowledge, but they often report that they are not responding and performing as well as they normally could.

Psychoanalytic concepts of ego functions can be subsumed in this category, and we can recognize that sophisticated ego functions of defenses, integration and synthesis are significantly impaired in this condition, causing severe impairment of functioning academically and professionally.

Let me describe a typical patient to bring the clinical picture into a more clear focus. She was one of the first patients in whom I recognized this condition.

Case 1) Mrs. A. was an intelligent, educated, personable 42-year old married woman who had experienced increasing anxiety and depression for two years, and sought consultation with me because she felt she was getting worse despite counseling and various antidepressants and tranquilizers. Although she had significant emotional issues which she had been discussing in her therapy, she was most concerned about her symptoms which did not improve with her therapy. First and foremost, she had a sleep disturbance consisting of severe insomnia, racing thoughts which kept her awake for hours, and terrifying, vivid nightmares when she did fall asleep. As a result, she was only getting a few hours of fitful sleep a night, despite her medications. She also had anxiety attacks during the day which bordered on panic and caused her to feel disabled and unable to function. She had trouble concentrating, and generally felt confused and distracted. An extremely competent person fundamentally, she had been able to hold her job, but felt she was barely able to hang on and perform, and knew she was performing below her ability. She felt her weekly therapy helped her to maintain herself, but really wasn't improving her condition.

She was clinically mildly depressed, primarily in reaction to her continual insomnia and functional impairment, and in reaction to the failure of treatment, including medications, to substantially relieve her distressing symptoms. Her severe anxiety was more prominent and impressive than her depression. She had no manifestations of psychosis, e.g., she had no thought disorder or disturbance of affect, and her ego was basically intact, although her performance and her ability to cope with anxiety, affects, and stress was impaired. She felt her satisfactory performance on the mental status exam I gave her was actually below her true ability. She denied any drug use or alcohol abuse, but, upon reflection, did recall a terrible experience at a party when she was 17. She felt something had been put into her drink because she developed a prolonged "bad trip" in which she felt panic, felt she was going to die, was frightened and paranoid, and had visual disturbances. She hallucinated and thought the walls were moving in on her. She was unable to sleep that night, but finally felt better the next day. We concluded she most likely had been slipped some LSD, which she knew was at the party. She said her mind never felt quite right after that—she always felt anxious, easily disturbed and distracted.

She agreed to medication, and I started her on a low dose of Olanzapine (Zyprexa). To her great relief and our mutual surprise, when she returned one week later she reported a remarkable improvement. Her sleep disturbance had cleared up completely! She no longer had racing thoughts, insomnia, or nightmares, and she slept soundly all night. Her anxiety had also decreased significantly. Her other symptoms gradually improved over the next few weeks; she felt less distracted, more able to focus and concentrate, and was less depressed. Over the next few months these symptoms continually improved and faded away. She continued her Olanzapine, gradually decreased and discontinued her other medications, and went into full remission, i.e., she no longer had any symptoms of The Post-LSD Syndrome. She continued to have emotional issues, but she was able to cope with them and with internal and external stresses without becoming overwhelmed. She felt greatly relieved, no longer felt depressed, felt she was herself again and no longer felt distracted. She said she would decide later whether or not to return to her previous therapist to complete her psychotherapy.

(Continues...)

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