Join host Jimmy Nguyen as he delves into the complex interplay between antidepressants and the world of psychedelics. In this episode, special guest Dr. Ben Malcolm, the Spirit Pharmacist, unlocks the secrets of his extensive background in public health and pharmacology.
He provides a nuanced perspective on the variability in individual responses to co-administration of antidepressants and psychedelics, touching upon the complexity of conversion-related issues, absorption-related issues, and genetic variations in serotonin receptors.
The episode delves into practical approaches for individuals on different classes of antidepressants who are contemplating a psychedelic experience. Dr. Malcolm introduces the concept of “dose testing,” suggesting a gradual and cautious exploration starting with microdoses to assess sensitivity.
The conversation addresses the challenges of tapering antidepressants, emphasizing the need for a personalized and gradual approach. Dr. Malcolm offers suggestions of what to avoid during tapering and how to safely explore individual tolerance to psychedelics.
This article is inspired by our insightful podcast episode hosted by Psychedelic Passage co-founder, Jimmy Nguyen, which you can listen to on all streaming platforms.
Key Takeaways
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- Evolution of Perception: The understanding of interactions between SSRIs and psychedelics has shifted dramatically in the past decade, dispelling the once prevalent notion of their deadly combination. This evolving perspective opens up therapeutic possibilities never thought possible before.
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- Compatibility Insights: Different medications impact psychedelic experiences differently. While serotonergic medications like SSRIs may dampen typical psychedelic effects, substances like ketamine prove to be more compatible. Ayahuasca, with MAOIs, poses risks of serotonin syndrome when combined with serotonergic medications.
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- Tapering Considerations: Tapering off antidepressants before a psychedelic experience is an individual choice, contingent on factors like the duration of medication use. Dr. Malcolm challenges aggressive tapering protocols, advocating for a more gradual, personalized approach.
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The Ever-Evolving Scientific Understanding of SSRI & Psychedelic Interactions
Just 10-15 years ago the general consensus was that mixing SSRIs and psychedelics was deadly. Now we know that there are safe ways to combine them, opening up a host of options for those seeking therapeutic psychedelic experiences.
“I realized that there was absolutely no way I was convincing anyone through a comment on Facebook of anything and that I was wasting time. So I thought, ‘what can I do about this?’” — Dr. Ben Malcolm
Due to the misinformation he saw flooding the internet, Dr. Malcolm felt called to create a resource where people could get reliable information on drug interactions and began academic blogging.
Thankfully, the scientific community is beginning to have a more informed understanding of the nuanced relationship between different types of psychotropic medication and psychedelics.
Contrary to a one-size-fits-all approach, the unique circumstances of each person determines the most fitting approach to mixing or tapering medication. While some may experience reduced psychedelic effects, others might navigate the relationship without tapering off their antidepressants.
Numerous uncertainties persist regarding the varying effects of different drugs and medications on individuals. Only time and the continuation of scientific research may unveil these mysteries. For now, this is what we do know.
Compatibility of SSRI’s and Various Psychedelics
Medications that have serotonergic mechanisms have counterproductive effects to serotonin-based psychedelics such as psilocybin, LSD and MDMA, and appear to block or dampen the typical subjective “psychedelic” experience.
“Maybe 50 percent do notice some diminished effects, but they can take a higher dose and still get pretty close to the level of effect that they want. Whereas maybe the other half of persons for whatever reasons can’t get the effects where they want.” — Dr. Ben Malcolm
A psychedelic like ketamine however, which works through glutamate modulation, is compatible with serotonin-based medications like SSRI or SNRI antidepressants, and has the potential to complement them.
Psychedelics such as ayahuasca that contain MAOIs or monoamine oxidase inhibitors have a dangerous interaction with serotonin-based medication, with the possibility of leading to serotonin syndrome.
Difference in Administration of Psychedelics and SSRIs
SSRIs and other psychiatric medications are more of a daily medication meant to reduce symptoms and increase functionality, whereas psychedelics are more curative, working towards symptom alleviation by getting to the root cause.
“You also meet people that start an antidepressant and then get therapy and maybe work with a personal trainer and change their diet and really integrate their mental health treatment into other aspects of their lives…
…and find themselves with really nice reductions of symptoms sometimes to the point that they really can taper and live pretty well off of the medications as well.” — Dr. Ben Malcom
There are also people who use psychedelics on a semi-regular basis because the symptoms do come back, but it’s needed on a less frequent basis than daily medication.
The compatibility and overall function of psychedelics versus psychiatric medications remain subjects of exploration. Both approaches exhibit similarities and differences, with psychedelics leaning towards emotional catharsis and the potential for sustained remission through infrequent dosing.
The contrast in the administration of psychedelics and prescribed medications may reflect a shift in the medical paradigm.
Unlike the prevalent daily ingestion and symptom-reduction focus of most prescription drugs, the rising popularity of psychedelics introduces the notion of addressing issues comprehensively, even beyond the immediate presence of the drug in the body.
Tapering Off Antidepressants: What to Consider
The decision to taper off antidepressants before a psychedelic experience becomes an individual choice based on various factors. One of the most important factors when considering tapering off psychotropic or serotonergic medication is how long you have been taking it.
The tapering protocol for someone who has been on medication for 8-10 years to stabilize their mood will look a lot different from someone who began taking it a year ago to help deal with a stressful event.
Tapering is not a necessary requirement for someone looking to have a psychedelic experience, as previously thought, and should never feel forced.
Tapering Protocols
Standard psychiatric guidance has a rather steep protocol for tapering off medication, while other resources such as survivingantidepressants.org have a much more prolonged protocol.
The generally accepted protocol for tapering off medication is a 25% decrease every 4-7 days. Dr. Malcolm believes that this protocol sets people up for withdrawal symptoms, especially for those with prolonged use at higher doses.
Dr. Malcolm’s general rule of thumb to avoid withdrawal symptoms without prolonging the process is a 10-25% reduction every 2-4 weeks, as tolerated.
Support websites like Surviving Antidepressants have a general rule of 10%, where if you go above a 10% dose reduction the chances of encountering withdrawal symptoms are greatly increased.
Dr. Malcolm believes that a more tedious protocol is better suited for those with a sensitivity withdrawal. This is a voice that has been minimized by the psychiatric community, but is equally important to the conversation.
It is crucial to recognize the ambiguity surrounding withdrawal symptoms and to distinguish them from symptoms related to your illness.
“Imagine I was taking morphine on a daily basis, and then I took a 50% reduction in my morphine dose. And three days later, I was in total body pain and sick as a dog.
And the doctor looked at me and said, see, this is your pain condition. No, it’s not. It’s an opioid withdrawal condition.” —Dr. Ben Malcolm
Intuitive Dosing & Individual Difference
As we move into a new paradigm, shedding the idea that one protocol can be used for everyone is crucial. An individual’s unique path towards healing can’t be simplified into a prescriptive “one fits all” protocol, and should involve a layer of personal intuition.
This individualized approach allows for your priorities to take precedence, what is your main goal for taking a psychedelic substance? What do you hope to achieve?
If your desire to have an altered state of consciousness experience overrides your concern about withdrawal symptoms during tapering, then maybe tapering is right for you.
“I generally think that there is a way of getting to a pretty potent full dose psychedelic experience while remaining on the antidepressant. If there are no perceived effects at 6-7 tenths of a gram of dried mushrooms…
…I think that makes it reasonably clear that they will need to taper to restore effects of psilocybin, or if they’re not ready for that process there are other options like ketamine.” — Dr. Ben Malcolm
Dosing Customization
Dr. Malcolm introduces a practical approach to dose testing, starting with microdoses to gauge sensitivity and safety. This method allows for a personalized exploration, offering valuable insights for those contemplating a full psychedelic experience.
Tailoring doses based on a person’s specific predispositions and responses to medication can significantly impact their therapeutic journey.
For example, small doses of antidepressants like Lexapro have been found to minimize the anxiety that many find comes with psilocybin.
Anecdotal reports find that less than typical doses of lexapro (2.5 mg compared to 10) during a therapeutic psychedelic experience, can still offer anti-anxiety effects without getting the dampening effects of a higher dose.
Some users report feeling a sense of emotional numbness or a buffer between thoughts and feelings, which can actually create space between thoughts and feelings, so stressful events are less overwhelming and easier to deal with.
On the other hand, some users may find that emotional numbness to be more repressant than helpful, which is why individual differences are such an important aspect of intuitive healing.
If you want to stay on your medication, but recognize you may need a higher dose in order to feel the effects you want, acquiring a Qtest can help you to find the exact dosage you would like.
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Frequently Asked Questions
1. Can I safely combine SSRIs with psychedelics?
The once-prevailing belief that mixing SSRIs and psychedelics is deadly has evolved. The scientific community now acknowledges safe ways to combine them.
However, effects vary among individuals, and it’s crucial to consider personal circumstances and potential reduced psychedelic effects.
2. Are there specific medications that are incompatible with psychedelics?
Medications with serotonergic mechanisms, like SSRIs, can counterproductively impact serotonin-based psychedelics (e.g., psilocybin, LSD, MDMA), potentially dampening the typical psychedelic experience.
However, substances like ketamine, working through glutamate modulation, are compatible with SSRIs or SNRIs and may complement them.
3. Is tapering off antidepressants necessary for a psychedelic experience?
Tapering off antidepressants before a psychedelic experience is an individual choice based on various factors. It’s not a mandatory requirement, and Dr. Malcolm emphasizes the importance of considering the duration of medication use when deciding on a tapering protocol.
4. What is the recommended tapering protocol for antidepressants?
Standard psychiatric guidance often suggests a steep tapering protocol, while Dr. Malcolm advocates for a more gradual, individualized approach.
A general rule of 10-25% reduction every 2-4 weeks, as tolerated, is recommended to avoid withdrawal symptoms without prolonging the process.
5. How can I tailor my psychedelic experience to my unique needs?
Dosing customization is key. Dr. Malcolm introduces a practical approach to dose testing, starting with microdoses to gauge sensitivity and safety.
This personalized exploration allows individuals to tailor their doses based on specific predispositions and responses to medication, impacting their therapeutic journey.
