Psychedelic substance use is increasing, but most research focuses on therapeutic benefits in controlled settings, leaving persistent negative effects from naturalistic use poorly understood. This paper offers a clinically relevant overview of enduring mental health problems after psychedelic use, drawing on clinical work and a narrative literature review. Three broad domains of post-psychedelic difficulties are presented: anxiety and feelings of unreality, persistent changes in perception, and existential distress. These groupings are suggestive rather than authoritative. Challenges and recommendations for psychotherapeutic work with this subgroup are discussed within an evidence-based practice framework.
Interest in and use of psychedelic substances is growing in the population. Research has primarily focused on therapeutic applications in formal treatment settings, and there is little knowledge about persistent negative effects from naturalistic use. The article provides a clinically relevant overview of the phenomenology and symptom picture of long-term mental distress after psychedelic use. Three central problem areas are presented, based on clinical work with a subgroup and a narrative literature review: 1) anxiety and derealization, 2) lasting changes in perception, and 3) existential distress. These categories are broad and intended as suggestions for frameworks, not as an authoritative division of complications from recreational use.