Introduction

Few substances in the history of chemistry are as notorious as lysergic acid diethylamide (LSD).

Known for its ability to profoundly alter one’s perception of reality, it has been called everything from a miracle drug to Richard Nixon’s declaration that LSD guru, Timothy Leary, was “the most dangerous man in America.” Some of the most renowned artists and thinkers of the past century have ascribed their inspiration to it. In the early days of its discovery, therapists embraced it as a near-miracle for mental health problems. Through it all, detractors have warned that it could destroy society as we know it. Suffice it to say, it has quite a reputation.⁽¹⁾

Though it’s been largely characterized by its association with the counterculture movement of the 1960s, before its prohibition, LSD enjoyed over two decades of avid research among psychiatrists who considered it a game changer. However, much of that research was lost when the work was halted following the prohibitory measures associated with the War on Drugs, which began in June of 1971. It has only recently begun to reemerge as a potential tool in the mental health space, as proponents have successfully captured the attention of the public with impressive evidence of its therapeutic potential.⁽²⁾

---

The History of LSD

While researching lysergic acid derivatives, the Swiss chemist Albert Hofmann first synthesized lysergic acid diethylamide (LSD) on November 16, 1938. His main intention for the synthesis was to discover a respiratory and circulatory stimulant, otherwise known as an analeptic. He set aside LSD for five years until April 16, 1943, when he decided to take a second look at it. While re-synthesizing LSD, he accidentally absorbed some of the compound and discovered its powerful psychedelic effects.

On April 19, 1943, Hofmann purposely ingested 0.25 milligrams (250 micrograms) of LSD, which resulted in intense perceptual changes. He journeyed home by bicycle and would recount this initial experience with LSD many times, describing it as both beatific and hellish. In honor of the significance of his discovery, this day has been commemorated by LSD enthusiasts as “Bicycle Day.” 

LSD saw several decades of interest and a flurry of research within the psychiatric community before the compound became embroiled in the political machinations of the Nixon administration’s War on Drugs. 

Most research on LSD halted in 1965 when Sandoz Laboratories stopped producing the drug owing to increased concern about its use in the general public. LSD use was associated with anti-war activism during the Vietnam War, which many believe helped to drive efforts to criminalize the substance. Much of the “moral panic” surrounding LSD was also largely due to sensationalized media reporting and resulting stigma. 

The federal government officially banned LSD in 1967. It would be another 40 years until the next scientific study on LSD-assisted psychotherapy would appear.

---

What is LSD, and Why is it Remarkable?

LSD is a powerful classical psychedelic compound that acts primarily on the brain’s serotonin system. Given its potency, LSD is always dosed in micrograms and offers a fairly long-lasting experience (around 12-18 hours). As mentioned, historically, it has been associated with the “flower power” movement of the 1960s. However, researchers in the 1950s through the early 1960s explored the compound as a tool to help treat mental health conditions such as depressive disorders, neurosis, and obsessive disorders. Over 1,000 scientific papers on LSD and other psychedelics were published in the 1950s and 1960s, and LSD was prescribed as a treatment to over 40,000 patients during that time.^(3, 4)

Researchers such as Dr. Humphry Osmond (who notably provided mescaline to Aldous Huxley) gave LSD to alcoholics in Alcoholics Anonymous (AA) who had failed to quit drinking. Osmond and his colleague Dr. Abram Hoffer reported that 40% to 45% of the alcoholics treated with LSD had not returned to drinking after a year. Osmond believed that psychedelics produced a terrifying artificial delirium that might frighten an alcoholic into change, though subsequent researchers have rejected this theory.⁽⁵⁾

Throughout the 1950s and 1960s, research was conducted to investigate LSD’s potential to treat mental health conditions. In 1961, a study conducted by Stanley Yolles found that 69% of participants reported improvement in their depression symptoms after taking LSD. Similarly, research conducted by the Czech psychiatrist Stanislav Grof in the 1960s demonstrated that LSD could reduce the frequency and intensity of symptoms experienced by schizophrenic patients. However, modern conventions do not recommend that individuals with schizophrenia or other schizoid disorders use LSD.⁽⁶⁾

Psychedelic-peak therapy involved higher doses, as this was believed to help patients by providing a mystical experience (also known as a “peak” or “transcendent” experience), which may produce a sense of unity with the environment. The aim was to catalyze rapid and fundamental changes in the value system and self-image of the subject.^(7, 8)

Stanislav Grof believed that LSD helped his patients resolve difficult early fetal and neonatal experiences. He built on Otto Rank’s theory of birth trauma, which is the idea that the trauma experienced at birth is key to understanding anxiety and neuroses later in life.^(9, 10)

---

The LSD Experience

LSD induces a classical psychedelic experience. This means that after taking LSD, you may experience open or closed-eyed visual effects, such as color enhancement, objects morphing and “breathing,” the appearance of geometric patterns, and auditory or time distortions. Positive feelings like euphoria and an enhanced sense of connection are also common.^{(11, 12, 13)}

The LSD experience differs from that of other classical psychedelics, such as psilocybin, in some important ways. One key factor is that it is known to be more physically energizing and stimulating. Meaning, you’ll likely have a stronger desire to move around. The visuals may also be different and appear more “electric,” bright, sharp, and angular.

---

What We Know About LSD-Assisted Psychotherapy

Historically, LSD has been used for alcoholism, end-of-life anxiety, and anxiety disorders featuring depressive symptoms.^{(14, 15, 16)}

Researchers have proposed different theories about the LSD experience and how it can help alleviate emotional distress. There has often been a focus on psychedelics’ influence on our relationship to our emotions. Researchers in the ‘50s and ‘60s believed that LSD might benefit various conditions by altering the sense of self, shifting people away from limiting and negative beliefs about themselves, and towards more positive ones.^(17, 18)

As is theorized with other psychedelics, LSD may also benefit patients with various mental health problems by promoting neuroplasticity (broadly speaking, the brain’s ability to change and grow), which has been observed in animal models.^(19, 20)

---

When Will LSD Be Legalized for Medical Use?

LSD remains a Schedule I drug in the United States, which means the federal government views it as having no recognized medical value and a high potential for abuse. Most psychedelic trials have focused on other compounds, such as MDMA and psilocybin (found in magic mushrooms). For this reason, both MDMA and psilocybin will likely gain approval as a legal treatment on a state and federal level before LSD. It’s hard to say how long it will take for LSD-assisted psychotherapy to be legalized.

However, some proposed initiatives have included LSD, including California’s Senate Bill 519 (which didn’t pass), Iowa’s House Bill 480 (which was introduced but has since failed), Maryland’s House Bill 1054 and Senate Bill 0784 (both not yet passed), and Missouri’s House Bill 2429 (which has not yet passed).^{(21, 22, 23, 24, 25)}

(Note: these legal changes and initiatives are evolving in real time.)

LSD hasn’t always been so strictly prohibited. In her article on LSD’s storied history, Madison Margolin explores the mysteries of this dynamic compound. Madison also takes us through the LSD experience and the many wonders that the “Grandfather of Psychedelics” may hold. 

---

Accessing LSD Therapy

Given LSD’s legal status, the only way to access LSD-assisted psychotherapy, other than participating in a trial, is through an underground therapist. They wouldn’t provide the compound. In this situation, you would obtain the LSD yourself, and then take it in the presence of the therapist, who might also work with you before and/or after your session so that you can prepare for, and make sense of, the experience. 

However, you should bear in mind that underground psychedelic therapy is unregulated. You should also be very careful about consuming any LSD purchased recreationally, as it may be a more harmful substance. For example, an NBOMe compound (a synthetic hallucinogen developed for brain and synapse mapping).⁽²⁶⁾

There are currently 27 ongoing and planned Phase I-III clinical trials for LSD. When some of these Phase III clinical trials have been published, this may help convince the government to begin considering a path to legalizing LSD-assisted psychotherapy for treating certain conditions. Generally, if a compound passes Phase III trials and gains FDA approval, it must undergo mandatory rescheduling within 90 days.⁽²⁷⁾

If you’d like to participate in a clinical trial involving LSD, you have a few options. The first and most direct route would be using clinicaltrials.gov. This website lists all active or recruiting trials in the U.S. and allows you to search for trials by conditions or keywords (like LSD). You can navigate to the trial organizer’s website and apply from there. Typically, researchers will interview potential participants and screen them for any medical issues that may preclude their participation.  

Another route would be to contact research hospitals and universities near you. They will often have information available regarding trials, and may be able to assist you in the application process.

---

The Risks and Side Effects of LSD

As mentioned, LSD, perhaps more than any other psychedelic, is often associated with much of the propaganda propagated by the War on Drugs, which perpetuated fears that if you take it, you risk “losing your mind” and never returning. Anti-drug campaigns that focused on telling people that LSD ruined people’s mental health can be traced to the 1960s and 1970s.

The history of LSD is complex. In some cases, recreational users took high doses of the drug (250 micrograms and above) without preparation and in less-than-ideal settings, resulting in isolated instances of psychiatric hospitalization. Marketing campaigns and news stories that included overblown scare tactics contributed to this negative impression of LSD.⁽²⁸⁾

The Nixon administration quickly capitalized on this hysteria in order to marginalize individuals associated with the counterculture and anti-Vietnam War movements. The few unfortunate cases of people suffering LSD-induced psychosis would be used to frighten regular Americans and U.S. legislators into supporting the establishment of the Controlled Substances Act of 1970.

The actual risks of LSD are similar to other classical psychedelics. Distressing experiences are more likely to occur if you take too high a dose, without psychological support, and when you fail to respect “set and setting” (your current mindset and the environment in which you take the drug — more on that below). The use of LSD may worsen certain pre-existing mental health conditions, such as schizophrenia. As with any psychedelic (or other drugs), you should proceed with caution.^{(29, 30, 31)}

LSD does carry risks like most substances, so it is important to consult a health professional before use. Clinical trials utilizing LSD ensure that these sorts of risks are minimized. Participants are screened for conditions that don’t mix well with the substance. They also receive plenty of support before, during, and after the experience. In a controlled and supervised setting, a positive and valuable experience is more than possible.

Common LSD side effects include:

The day after your LSD journey, you may experience a positive side effect of psychedelics: the “afterglow.” This is a period, sometimes lasting weeks, when you feel more joyous, energized, optimistic, and confident. 

There have been some extremely rare cases of LSD triggering a condition called Hallucinogen Persisting Perception Disorder (HPPD). HPPD can cause some people to continue experiencing visual and auditory perceptual changes for months or years after a psychedelic event. However, it is not common.

---

The Spiritual and Consciousness-Raising Impact of LSD

LSD may impart a “mystical” or “spiritual” experience associated with the expansion of consciousness. These experiences tend to be accompanied by a sensation of ego loss, which can be experienced as a dissolution of barriers between the self and the outside world, a feeling of “oneness” with the universe, and the transcendence of time and space. Underpinning all of these sensations is the perception of the revelation of spiritual truth. These mystical experiences can have a profound, almost ubiquitously positive impact on the individual, altering their views on existence and spirituality in a way that can persist for weeks, years, or even a lifetime. This experience is by no means rare. In fact, studies have shown that as many as 64% of LSD users undergo some form of partial or complete mystical experience.^(32, 33)

Researchers validate a mystical experience via the metrics prescribed by the Mystical Experience Questionnaire (MEQ30) in which test subjects rate various aspects of their LSD journey and the effect it had on their consciousness. However, the study included additional questions that deviated from the standard questionnaire. In addition to reporting profound levels of openness, joy, oneness, ecstasy, a loss of normal space/time, reverence, and the conviction that what they’ve experienced was “real,” subjects also assert that the experience was ineffable and impossible to describe with words.⁽³⁴⁾

There is no consensus on why LSD inspires mystical experiences, let alone why it does so with such reliability. While studies have shown that psychedelics cause the brain to function similarly to when a person is dreaming, researchers have yet to uncover proof of the exact biological basis. In other words, we don’t know why it happens, only that it does.⁽³⁵⁾

---

How To Microdose LSD

LSD (along with psilocybin) is one of the few psychedelics that is easy to microdose. This is the process of taking small, sub-perceptual (below the feeling threshold) doses of a drug, in this case, LSD. Anecdotal evidence suggests that microdosing may enhance things like creativity, performance, mental acuity, focus, and more. It’s what’s known as a “flow state.” Some proponents of microdosing believe it can do all of these things, though the science is still nascent on the subject. Typically, those who microdose follow something akin to the chart below, which is based on the Fadiman protocol.⁽³⁶⁾

According to the Fadiman protocol, this schedule should be followed for one or two months, with a two to four week reset upon completion.

Again, the chart above is based on a technique known as the Fadiman protocol, but there are other methods that people use to microdose. Typically you will start with one-tenth to one-twentieth of a recreational dose of LSD and (potentially) scale up from there to find a dose that works best for you. If you are using the Fadiman protocol, you may wish to use the transition day as an opportunity for self-growth. Some individuals enjoy taking time to journal, do yoga, or contemplate their goals. Others simply see it as an off-day to help prevent tolerance buildup.

---

How to Prepare for Your LSD Trip

The LSD experience tends to be rather long — as mentioned, sometimes lasting as long as eight to 12 hours. Over the course of this period, individuals are likely to oscillate through a wide array of powerful emotions. The experience can be quite positive and pleasurable, but you should be prepared to deal with some feelings that may be more challenging. One of the ways to ensure that you derive the greatest benefit from the journey, while minimizing difficulties, is by properly mentally preparing yourself and creating a comfortable environment — this is known as your “set and setting.”⁽³⁷⁾

As the LSD experience is prolonged and can be psychologically taxing, it’s important to prepare your set and setting to maximize your physical and mental well-being for the duration by:

When it comes to your setting, again, it’s important to consider the lengthy duration of the LSD experience. Make sure your setting (physical space) is optimal. This simply means that you should be in a place where you feel safe, secure, and comfortable. It’s a good idea to have things available that you find comforting, such as a favorite blanket, plush toy, or comfy chair. LSD inspires much more activity than other classical psychedelics, so it’s often beneficial to have space to move around. Ideally, you will have access to both indoor and outdoor/natural spaces — even a small garden will do. 

It’s also helpful to consider:⁽³⁸⁾

---

What to Expect From Your LSD Trip

LSD trips are extremely unpredictable in terms of the psychological content that may arise, but the physical experience tends to follow a somewhat reliable progression:^(39, 40)

• Once you take LSD, you may not feel anything for 15-120 minutes.
• You’ll often see the change before you feel it. The world around you will appear in increasingly high contrast. In this window of time, you might realize that you’re feeling a bit “lighter” and notice that you’re laughing more than usual.
• When the effects become more obvious, you may begin to see subtly moving patterns overlaying the world around you. You may feel warm to the point of sweating, and may feel LSD’s most common negative physical side effect: nausea. While unpleasant, it will generally pass within about 20 minutes.
• About 90-120 minutes into the experience, you will begin to “peak.” This is typically the highest point in the journey, and is often when you’ll experience the apex of the mystical experience. You may feel as if you’ve lost the boundaries of your body, and fused with the oneness of the universe. You may experience elaborate hallucinations that completely transform the world around you. You may lose the ability to speak, move with coordination, or even remember your name or the names of those around you. All of this is frequently accompanied by high levels of awe, joy, ecstasy, fear, or some mix of many emotions. It is advisable to sit someplace comfortable and simply take it all in during this period. Remember that you will likely forget most of the details of what you experience during a peak, though you may retain a general impression.
• After the peak of your LSD trip, the effects of the drug will remain strong for another four to six hours. For many, this is the most enjoyable period of the journey. While the world isn’t quite as transformed as during the peak, it may still appear extraordinarily altered. You may experience a wide range of emotions and insights, often accompanied by a general sense of physical pleasure. Hallucinations are unpredictable, but you will likely experience vivid colors, light tracers, moving patterns (particularly when your eyes are closed), and sometimes dramatically transformed landscapes. It might appear as if you’re in a painting. Plants and structures will probably shift and move. The ground or sky may boil or ebb and flow like the tide. It’s impossible to guess the specifics, but visuals will likely occur.
• At some point, you’ll sort of snap out of it, and you’ll realize that you’re no longer as deep in the experience as you once were. You’ll likely continue feeling the effects of the LSD for another two to four hours, but they will be significantly diminished. Your thoughts may be somewhat scattered, and you may feel physically shaky, hungry, and tired. 

While many opponents of psychedelics cite the much-touted “bad trip” as a reason to avoid the experience, the fact is that many who undergo a challenging journey later report that it resulted in an improvement in their sense of well-being, and even cite it as one of the most important experiences of their lives.⁽⁴⁰⁾

Even if you have a more difficult journey, it may not really be so “bad.” Mattha Busby’s article The Good Part of A Bad Trip explores how these events can be opportunities to learn about ourselves and our relationship with psychedelics.

Challenging trips tend to arise for a variety of reasons. They may be the result of improper set and setting, or because an individual is confronting a painful topic. The latter is often, in fact, precisely the opportunity for growth and positive change that one is seeking in the first place.

That said, when a challenging trip looms, you can do a few things to alleviate, or even make the best of, the situation:

---

Integrating Your LSD Journey

After you’ve begun to come down, it’s time for integration. Integration is the process of reviewing and thinking about your experience to determine what, if any, key insights can be taken away from it. Some people enjoy journaling — during and/or after their trip — to integrate things they’ve learned. You could also find a knowledgeable counselor with psychedelic experience and discuss your trip with them. 

At its core, integration is about taking the potentially life-changing lessons of these journeys, and grounding them into your daily life. This is transformational work that can inspire and create lasting change. For example, suppose you have an insight that your temper is damaging your relationships. In that case, you may integrate that insight by practicing breathing techniques when you feel anger rising in your daily life. Be gentle with yourself, and seek support as needed. 

Integration comes in many forms, but a few common examples include:

• Talking with a trained therapist, counselor, or guide knowledgeable about the LSD experience. Or seeking out support groups or circles.
• Speak with your tripsitter, friends who have also used LSD, or people you trust.
• Write down your experience. You can write down all that you remember for posterity and to help you anchor it into your consciousness, but it’s likely best (and more manageable) to choose one to three insights to focus on at a time.
• Create wonderful works of art that reflect the things you saw and discovered.
• Meditation, yoga, or mindfulness practices can help to recenter you.
• Create daily rituals that reinforce things you’ve learned. If you’ve realized that you’re not treating yourself with as much love as you’d like, think about doing one thing each day that feels self-nourishing.

The list can be endlessly tailored to your personality and intentions. Whatever the case, this is your time to play with, and integrate, the lessons and epiphanies LSD has imparted.