Psychiatric risks for worsened mental health after psychedelic use

Study findings and statistical concerns

• Commenters unpack the headline number: ~16% negative responders, ~28% non-responders, ~55% positive — far from “84% positive.”
• Several see this as a nontrivial risk: for mental health treatment it’s “a coin toss” whether it helps, with a notable chance of worsening symptoms.
• Others criticize the study as underpowered: ~800 starting sample with >50% dropout, weak significance, and potential attrition bias that could even distort meta-analyses.

Risk–benefit framing vs other psychiatric meds

• Multiple participants argue psychedelics should be held to the same standard as SSRIs and other psych meds, not a higher or lower one.
• Some claim antidepressants have comparable or worse adverse profiles (e.g., suicidality and violence risks, black box warnings) yet are normalized, while psychedelics are scrutinized more harshly.
• There is debate over mechanisms of SSRI-linked suicidality (energy-before-mood vs disinhibition), but agreement that these risks exist and are often undercommunicated by prescribers.

Heterogeneous effects and vulnerable subgroups

• Table-based subgroup results (e.g., OCD showing 0% negative responders) are viewed as intriguing but unreliable due to tiny n (e.g., OCD n=16, psychotic disorder n=4).
• One commenter notes aggregate data are more meaningful; history of psychiatric illness may not clearly predict worse outcomes.
• The paper’s suggestion that personality disorders may require more support is seen as plausible but thin, prompting “publish or perish” skepticism.

Personal experiences: benefit, trauma, and psychosis

• Anecdotes cover the full spectrum: life-changing relief from depression/OCD-like rigidity, profound insights, and long-term functional users.
• Others describe acute psychosis, manic breaks, religious delusions, and at least one case where ayahuasca use is believed to have contributed to suicide.
• High-dose DMT and mushroom trips are cited as sometimes purely traumatic; not all such stories have a “redemptive arc.”

Hype, self-medication, and context

• Several criticize a “psychedelics as cure-all” narrative and dismissive psychonaut subcultures that downplay harms.
• Others counter that bad trips and risks are widely discussed, but many users still self-medicate with unknown doses and poor “set and setting.”
• Clinical, guided use with known substances/doses is seen as qualitatively different from festival or party use.

Cognitive change and “firmware” worries

• Some are alarmed by reports of permanent worldview shifts, likening psychedelics to irreversible “brain firmware upgrades” without a backup.
• Others argue that perspective shifts are common from many life events (travel, major experiences), that changes may be overstated or fade over time, and that meaningful insights don’t require mysticism.

Meta: expertise, culture, and policy

• Several warn against armchair interpretation of complex psych/neurology research and note a tendency, especially among engineers, to overestimate their expertise.
• There is broader debate about the war on drugs, possible pharma and political biases, and comparative harm rankings where classic psychedelics appear less harmful than alcohol or opioids.