Thomas discusses what we know — and don’t know — about potential interactions between psychedelics and SSRIs.
I would be careful to not state that SSRI’s and psychedelics are all safe together since an important exception is the ayahuasca vine, which contains significant MAO inhibition effect.
I just discovered this forum. I want to know more about serotonergic drugs and valvular heart disease--like an essay on that alone-- since I've never heard of the problem.
I recently tapered off 125 mg of sertraline and 50 mg of trazadone for an MDMA journey to treat PTSD. For those interested in tapering off an SSRI, you must must must find a medical professional that supports your goals and do not take it upon yourself to do this on your own. Tapering over the course of 6 weeks was one of the most difficult things I have ever done, I was in deep despair towards the end and suicide occurred to me more than a few times (this is def out of the ordinary for me.) When I got to 50 mg of sertraline and then 25 mg it was the most difficult. I had to stay on 12.5mg longer than had been originally planned because to put it mildly, I became unhinged. It was only with the support of two licensed and highly-skilled healers that I made it through. I was completely off both sertraline and trazadone for two weeks before the MDMA session. I was offered a boost 90 min after taking the first dose. It was then that I was gifted some incredible insights ... and I've been in talk therapy all of my life as well as underwent four years (200+ sessions of EMDR) to help me be functional enough to have a healthy marriage and two beautiful children.
Some additional commentary for those who are interested in microdosing psilocybin: I started with 100mg of psilocybin 2x day while I was tapering off the SSRIs. I have yet to feel the effects of microdosing psilocybin, even now having been off SSRIs for almost five weeks. I haven't given up on it yet, my guides have told me that because I've been on trazadone for over a decade and sertraline for almost as long, that it may take my receptors longer to become sensitive again. I don't have as much technical knowledge as others on this thread but thought this might be helpful for interested parties to know. I'm hoping in the next few months that I might begin to feel the effects of microdosing. I don't want to go back on sertraline and even without the microdosing yet working, my internal state and chemistry does feel steady again (for the most part ~o^). Anyways -- blessings to all on your paths to further healing!
(Here is a note I added after I posted my previous comments:
Ever since I first "tripped" on a psychedelic substance. it has been EXTREMELY clear to me that taking an unknown amount of an unknown substance [or mixture of unknown substances] can cause great harm, even death. I have spent more than half a century loudly spreading the message that when it comes to drugs, ignorance can easily cost a person their life. More than a dozen of my friends died after taking an unknown amount of a substance or substances they obtained in the illegal underground marketplace.
Regarding 5 microgram microdoses of LSD:
My written instructions that came with each of the many packets of microdoses that I distributed for free in the late 1980s did NOT advocate frequent or daily use. LSD is an incredibly powerful substance and it is well known that people can experience horrible problems if they do not deeply respect that fact.
I continue to be utterly appalled and deeply disgusted when I observe the dangerously ignorant, crass, and immoral pushing of "microdosing" by so many greedy and self-righteous fools. Especially those harmfully delusional uneducated [and mis-educated] young fools who have convinced themselves that they are qualified to do "psychedelic-assisted therapy".)
I'm wondering if there are any recent developments in finding substances that effectively stop or lessen the effects from a psychedelic drug overdose, or an experience that goes badly awry. Something more nuanced and precisely targeted to buffer the disorientation than a benzo tranquilizer like Valium, or antipsychotics like Thorazine that contract consciousness with brute force. I haven't had the experience of having the brakes slammed on like that, but it seems to me that there has to be a better way.
Recovery from SSRIs (defined in this context as regaining a full response to psychedelics) partially depends on the drug's half-life (pharmacokinetics) after discontinuation. There are numerous subjective effects from chronic, long-term SSRI use that often take a greater amount of time to reverse. This is largely due to the way the drug has modified the body's functions (pharmacodynamics) at the cellular level. This might explain why some individuals need to refrain from SSRIs for several months before they react fully to psychedelics or MDMA. As an additional point, it's not uncommon for people to need several months to entirely cease their SSRI dose, with the final 25% requiring a more gradual taper than the initial 75% in order to tolerate the withdrawal effects.
To follow on to Davivid's comment, is there any data on valvular heart disease within members of the Santo Daime who regularly consume the Daime, with many having done so for decades? While the sample size was small, the Hoasca Project that looked at long term use in the UDV claims to have measured EKG as part of their study. I don't have a good reference for this other than:
The outcome of the study did find the UDV practice of ayahuasca consumption safe. I don't know the frequency of use of ayahuasca within the UDV, but to Davivid's point, wouldn't long-term, regular use of a 5HT2B agonist (in macro-dose quantity) result in cardiac trouble manifesting in such groups over time?
Given the escalating interest and use of these substances, this would seem to be a critical area badly in need of careful study.
Really? If I take microdoses of LSD I might get Valvular Heart Disease, which can result in "death"?
(I invented the word "microdose" in 1980, and subsequently produced and distributed a large quanity of microdose LSD. I first took LSD in 1969. I kept written records of the more than 5,000 higher dose LSD "trips" I have taken since 1969. I have NEVER heard of anyone developing Valvular Heart Disease after taking microdoses [or any other kind of doses] of LSD. Considering the incredibly huge quantities of LSD I have seen distributed and taken in Berkeley over the past 54 years, if taking 5 or 10 micrograms of LSD seriously harmed the user's heart, it seems to me that the streets of Berkeley would be littered with bodies!)
Thank you very much for this interview, which is, I am sure, of significant interest to many of us who are taking SSRIs. My own experience was that I tapered off Paxil for 2 weeks before taking MDMA. I had a good response to the MDMA (not sure the does, but it was 'typical' according to my sitter).
My response to psilocybin was not as strong, even though by then I'd been off Paxil for well over a month. Subsequent to 2 psilocybin sessions, my depression returned in a profound form, so the least I can say is that the psilocybin didn't help there, but given my weak response to it, perhaps that makes sense.
I think in the end, this is highly individual, and of course, it will be a while before this subject is a priority in the research. I hope that time is shorter rather than longer.
The interview was not very clear. Is he essentially saying that most people who have ever taken SSRIs, or even tapered off of them, are likely to experience little on MDMA or psilocybin? In my experience, I tapered off 40mg of Celexa, then microdosed Psilocybin for two months, and then did MDMA and psilocybin. I felt nothing on 150mg/75mg booster on MDMA, and next to nothing on 16g — yes, 16g of dried psilocybin mushrooms — while wearing eyeshades. I did see the carpet pattern moving a bit without eyeshades. What I wonder is if serotonin receptors can become more sensitized if one stays off SSRIs for a significant time — a couple years? — before trying psychedelics again? Or how ayahuasca would affect me differently than mdma and psilocybin?