Before you read on, I would like to mention that I am neither a doctor nor a pharmacist. There's a risk that I'm giving bad advice based on everything I don't know, but I'm writing this article because I believe the advice I'm giving here is better than what you can (or can't) find most other places.
Many of my clients are on various medications and it is a topic that therefore comes up weekly. Which medications can be continued? Which ones must be weaned off so as not to dampen the effect? Which can be dangerous in combination with psychedelic therapy? Since there are countless medications and combinations, the answer is not entirely simple. But there are some guidelines that are good to follow and some tips on how to do research on your own. If you are going to stop taking medication, it is important to do this in consultation with a doctor/psychiatrist/psychologist/friends/family so that you do this in a good way and others are informed about the process. Tapering off stabilizing medication is often destabilizing in itself and a psychedelic experience destabilizes further. It is important to get enough sleep during the first few days after a psychedelic experience.
Antidepressants and psilocybin/LSD/DMT
When I started working with this in 2020, the common advice was "you must stop your antidepressants at least two weeks before a psychedelic experience". This applied to the clinical studies that were carried out and at various retreat centers worldwide. This is not because it is dangerous to combine (with the exception of ayahuasca), but rather based on the assumption that antidepressants dampen the effects of classic psychedelics such as psilocybin and LSD. An American pharmacist who calls himself Spirit Pharmacist has published an overview of tapering for various antidepressants here. This has mostly been based on anecdotes from people who have tried. In late 2021, a placebo-controlled study from Compass Pathways was published which showed that participants who took SSRIs during psilocybin treatment nevertheless obtained comparable results to those who did not take SSRIs. This is a small study, but in any case it shows that many people can get good results from psilocybin treatment despite the fact that they are still on antidepressants.
My experience suggests that the risk of having a subdued experience with psilocybin is slightly higher if you are also taking antidepressants, but that most people get the expected effect. I have a thin hypothesis that it may take longer for the psilocybin to have an effect if you are also taking antidepressants.
Antidepressants and MDMA
Here, too, the current advice has been to go off antidepressants two weeks before an experience. Here the reason has been twofold, both that most antidepressants seem to dampen the effects of MDMA significantly, but also the (low) risk of serotonin syndrome. When we in a small study have looked more closely at the results of those who went off an antidepressant two weeks prior to an MDMA therapy session, the therapeutic effect was reduced by over 60%. Spirit Pharmacist has a hypothesis that you have to taper off much longer in advance to get the normally expected effect, at least 4 to 6 weeks. This hypothesis is based on the fact that it often takes 4-6 weeks for antidepressants to start working and that it is natural that it will take the same amount of time for the effect to disappear again.
Anxiolytics and antipsychotics
Anti-anxiety medications such as benzodiazapines (e.g. Valium/Xanax) can significantly dampen the effects of both MDMA and classic psychedelics such as psilocybin, LSD and DMT and should therefore be tapered off prior to an experience. These are therefore sometimes referred to as a "trip killers" because they stop the psychedelic experience.
Antipsychotics/neuroleptics such as quetiapine/Seroquel and olanzapine/Zyprexa are also said to dampen the psychedelic experience. Antipsychotics can be prescribed according to different indications/symptoms, and it is important to note that one should be especially careful if they are prescribed for diagnoses such as schizophrenia, mania or psychosis, which is a group with a high risk of worsening symptoms after a psychedelic experience. This applies to a lesser extent to MDMA, and to a high extent to classic psychedelics.
Dangerous combinations
There are also some medicines that are very unpleasant or dangerous in combination with psychedelic substances. I list some of these here.
- Lithium in combination with classic psychedelics (psilocybin, LSD, DMT) has been shown to cause convulsions, shock and, in the worst case, death in approximately 50% of recorded cases.
- MAO inhibitors (an unusual antidepressant, but also an ingredient in ayahuasca) can cause serotonin syndrome in combination with MDMA. This can be fatal. It is therefore particularly important not to consume MDMA too close to an ayahuasca experience.
- Some migraine medicines (such as eletriptan and Zomig) are not recommended for a period of 24 hours before and after a trip with LSD, psilocybin and DMT.
- I think one should be careful with other medicinal mushrooms such as reishi and chaga in combination with psilocybin based on experience.
What about other medications?
How medicines interact with each other is complex and since your GP may know less about psychedelics than you do, it is unfortunately rare to get good answers there. When I want to find out if medicines can be combined with psychedelics, I simply start on Reddit for anecdotal evidence. There are many people on Reddit who have tried almost every possible combination of medications and recreational drugs and that can in any case give an indicator of how dangerous it may be. Additionally, I can also Google the effects of the meds in question to see if they interact with psychedelics in any way. The migraine medicine Zomig, for example, should not be combined with ergotamine according to the Joint Catalogue, a substance closely related to LSD. Another medicine can be a strong stressor on liver function, for example, and therefore be dangerous in combination with MDMA, which also stresses the liver. And the general drug advice "Start low. Go slow.” is always nice to have with you.
Feel free to contact me for a free, short consultation here or one full paid hour here for some advice along the way.
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