Derealization, Anxiety, and Psychedelics: A Berlin Clinic’s Approach to Nonjudgmental Support
Six years ago, during a work trip to London, James (a pseudonym to protect his privacy) suddenly found himself unable to read the text on his computer screen. His vision was filled with static, and the entire visual field felt distorted. When he visited a hospital, he revealed to the nurse that he had taken psychedelic mushrooms a week earlier during a trip to Amsterdam. Her dismissive response was, "This is why we don’t do drugs," leaving James, now 31, feeling unsupported. "Her reaction made it clear that most doctors wouldn’t be able to help," he recalled.
After researching his symptoms online, James suspected he had developed hallucinogen persisting perception disorder (HPPD), a condition where visual disturbances and other sensory distortions persist for months or even years after taking a psychedelic drug. Despite these ongoing challenges, he found little to no support from medical professionals and turned to online forums and websites for advice.
As psychedelics like psilocybin and LSD undergo a revival in mental health research, the stigma surrounding their use is gradually diminishing, sparking curiosity and experimentation among more people. Psychedelics are known to have a lower risk of physical dependence or overdose compared to other drugs, such as opioids. However, they still carry significant mental health risks, such as anxiety, derealization, and difficulties processing intense experiences, which may leave users feeling disoriented or overwhelmed. Legal restrictions on psychedelics also limit available resources for individuals grappling with these aftereffects.
For James, finding a compassionate and knowledgeable resource became a priority. He eventually discovered Ambulanz psychedelische Substanzen, a psychedelic outpatient clinic based in Berlin’s Charité University Hospital. This clinic, led by psychiatrist Tomislav Majić, offers a nonjudgmental, harm-reduction approach for individuals struggling with psychedelic-related issues. A year after his visual disturbances began, James visited the clinic and was diagnosed with HPPD by Dr. Dario Jalilzadeh-Masah. Unlike his earlier experiences with medical professionals, the Berlin clinic provided empathy, understanding, and actionable treatment steps.
The clinic treats patients with a range of conditions, including HPPD, depersonalization, derealization, psychosis, and anxiety. Some patients, like James, struggle with persistent visual disturbances, while others seek help for existential confusion or panic attacks that occur after a challenging psychedelic trip. Dr. Majić noted that patients often arrive after experiencing overwhelming emotions that they are unable to process. “There are a lot of patients who suffer from psychedelic-related problems,” Majić said, “and they don’t have anywhere to go.”
A Growing Awareness of Persistent Psychedelic Side Effects
While the concept of a "bad trip" is widely known, there has been increasing recognition of more persistent side effects from psychedelics. A 2023 study from the Challenging Psychedelic Experiences Project examined long-term difficulties reported by over 600 people. One-third of participants had dealt with symptoms for more than a year, with emotional challenges being the most common complaint. Some reported extreme anxiety upon waking, while others described feeling isolated and disconnected from their social lives .
Richard, a 24-year-old from Berlin, developed HPPD after a DMT trip. His visual disturbances, which he described as a persistent afterglow effect from screens and lightbulbs, led to a state of existential anxiety. Richard explained that he began questioning the fundamental aspects of his existence, including the choices and relationships that had shaped his life. This profound experience, termed "ontological shock" by Majić, is not a psychiatric disorder but can be deeply unsettling. "It’s too otherworldly to know how to bring this into everyday life," Majić observed.
For Richard, seeking help at the Berlin clinic was crucial in finding relief. "It was difficult to imagine discussing my existential anxiety with a traditional physician without feeling judged," he said. "But the recognition I found at the outpatient clinic gave me the space to process what I had experienced."
Expanding Access to Psychedelic Support
For those unable to visit Berlin, other resources exist. Jules Evans, director of the Challenging Psychedelic Experiences Project, runs an online peer support group for individuals dealing with post-psychedelic difficulties. Additionally, Fireside Project offers a psychedelic peer support hotline, providing real-time assistance to individuals in distress. There are also psychedelic integration groups, both online and in-person, that help users process and make sense of their experiences. The International Center for Ethnobotanical Education, Research, and Service (ICEERS) offers six free therapy sessions for those grappling with post-psychedelic challenges .
However, despite these emerging resources, there remains a gap in accessible care. Majić emphasizes the need for psychiatrists and psychologists to be better educated on psychedelic use and its potential long-term effects. While training programs for therapists are available, the content and quality vary widely, making it difficult for individuals to find the specialized help they need.
Overall, Majić sees his work as balancing two polarized views: one that sees psychedelics as harmless and the other that frames them as inherently dangerous. "Psychedelics can be beneficial, but they can also be harmful for some people," he said. His clinic continues to serve as a beacon for those navigating the challenging aftereffects of these substances. For individuals like James and Richard, having access to nonjudgmental, professional support has made all the difference in their journey toward recovery.
Sources:
- Griffiths, Roland R., et al. “Psilocybin Can Occasion Mystical-Type Experiences Having Substantial and Sustained Personal Meaning and Spiritual Significance.” Psychopharmacology, vol. 187, no. 3, 2006, pp. 268-283.
- Majić, Tomislav. Interview with The Guardian, 2023.
- Muthukumaraswamy, S.D., et al. “The Effects of Psychedelics on Functional Connectivity in the Brain.” Proceedings of the National Academy of Sciences, vol. 110, no. 38, 2013, pp. 15271-15276.
- Evans, Jules. Challenging Psychedelic Experiences Project. Accessed 2023.
- Challenging Psychedelic Experiences Project Study, 2023.
- “Americans Increasing Use of Psychedelics: 2023 Psilocybin Data.” RAND Corporation, 2023.
- Fireside Project, 2023, Peer Support for Psychedelic Experience
