Before you read any further, I would like to mention that I am neither a doctor nor a pharmacist. There is a risk that I will give bad advice based on everything I do not know, but I am writing this article because I believe the advice I give here is better than what you will find (or not find) in most other places.
Many of my clients are on different medications and it is a topic that therefore comes up weekly. Which medications can you continue to take? Which ones must be discontinued in order not to dampen the effect? Which ones 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 easy to follow and some tips on how to do research on your own. If you are going to stop taking medications, 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. Stepping down on stabilizing medications is often destabilizing in itself and a psychedelic experience destabilizes even more. It is important to get enough sleep during the first few days after an experience.
Antidepressants and psilocybin/LSD/DMT
When I started working on this in 2020, it was always said that “you have to come off antidepressants at least two weeks before a psychedelic experience”. This applied to the clinical studies that were done and at various retreat centers around the world. This is not because it is dangerous to combine (with the exception of with 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 posted an overview of tapering off for various antidepressants here . This has mostly been based on anecdotes from people who have tried it. In late 2021, a placebo-controlled study from Compass Pathways was published that showed that participants who were on SSRIs during psilocybin treatment still got comparable results to those who were not on SSRIs. This is a small study, but it shows that many people can get good results from psilocybin treatment despite still taking 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 psilocybin to have an effect if you are also taking antidepressants.
Antidepressants and MDMA
Here too, the current advice has been to stop taking antidepressants two weeks before an experience. Here the reason has been twofold, both that most antidepressants seem to significantly reduce the effect of MDMA, but also the (low) risk of serotonin syndrome. When a small study looked more closely at the results of those who stopped taking an antidepressant two weeks before an MDMA therapy session, the therapeutic effect was reduced by over 60%. Spirit Pharmacist has a hypothesis that one must taper off much further 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 benzodiazepines (e.g. Vival/Valium/Xanor/Xanex) can significantly reduce 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 sometimes referred to as a “trip killer” because they stop the psychedelic experience.
Antipsychotics/neuroleptics such as quetiapine/Seroquel and olanzapine/Zyprexa are also said to attenuate the psychedelic experience. Antipsychotics can be prescribed for various indications/symptoms, but 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 classical psychedelics.
Dangerous combinations
There are also some medications that are very unpleasant or dangerous when combined with psychedelic substances. I list some of these here.
- Lithium with classic psychedelics (psilocybin, LSD, DMT) has been shown to cause seizures, shock and, in the worst case, death in approximately 50% of recorded cases.
- MAO inhibitors (an uncommon antidepressant, but also an ingredient in ayahuasca) can cause serotonin syndrome when combined with MDMA. This can be fatal. It is therefore especially important not to take MDMA too close to an ayahuasca experience.
- Some migraine medications (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 medications 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 need to find out if medications can be combined with psychedelics, I simply start on Reddit for anecdotal evidence. There are many on Reddit who have tried almost every possible combination of medications and drugs and that can at least give an indicator of how dangerous it can be. In addition, I can also Google the effects of the medications in question to see if they clash with psychedelics in any way. The migraine medication Zomig, for example, should not be combined with ergotamine according to the Common Drug Catalog, a substance that is closely related to LSD. Another medication can be a strong strain on liver function, for example, and therefore be dangerous in combination with MDMA which also puts strain on the liver. And the general drug advice "Start low. Go slow." is always good to have with you.
Feel free to contact us for a free, short consultation here or a full paid hour here for some advice along the way.