Chapter 79 – Tolerance to Lysergic Acid Diethylamide: Overview, Correlates, and Clinical Implications

The first reports on tolerance to the serotonergic hallucinogen lysergic acid diethylamide (LSD) were published half a century ago, yet hitherto, a systematic review on this topic is not available. In this chapter, we discuss tolerance to LSD with regard to its psychedelic and somatic effects in humans, as well as selected behaviors in animals. In humans, mental tolerance to LSD substantially manifests 24 h after its first administration and reaches a maximum by around the fourth day. Once established, tolerance cannot be overcome even if the initial dose is quadrupled. Mental tolerance to LSD generalizes to psilocybin and mescaline but not to tetrahydrocannabinol or amphetamine. As to LSD’s somatic effects, mental tolerance most reliably is accompanied by tolerance to mydriasis. Five days of abstinence is sufficient for tolerance to be reversed; symptoms of withdrawal are not encountered. In animals, LSD-induced shaking behavior, limb flicking, and hallucinogenic pausing are undermined by tolerance, too; the first-mentioned behaviors, for instance, are subject to tachyphylaxis. Mechanistically, pharmacodynamic adaptations of serotonin 5-HT2A and/or (downstream) glutamate receptors are likely to account for tolerance; a learning-related precipitation, however, has also been described. The rapid onset of mental tolerance probably is a main reason LSD generally is not taken on an everyday basis by humans. Given its rapid reversal, on the other hand, a once-per-week abuse cannot be excluded.