Thanks for another excellent post! There were some real interesting points in this one. I'm most intrigued by the chemistry of psychedelics, and my ears perked up at the section about concerns surrounding drug interactions. I'm not altogether surprised that few negative interactions have been found so far, simply because of the physiological strangeness of psychedelics. But this point made me think about the unexpected interactions between all sorts of different substances. For example, the fact that many (if not most??) medications interact pretty dramatically with grapefruit (which happens to be my favorite fruit) in either a depressive or stimulatory capacity depending on the mechanism of metabolism. I'm wondering if anyone is looking into the effects of grapefruit on psychedelics? Super cool stuff!
Hi Marianne, I'm the lead author of the paper here. I love questions and curiosities like the ones you brought up. Public education and discourse on drug interactions are important to public health safety. So! Grapefruit juice inhibits a specific liver metabolism of drugs called the cyp p450 enzymes, specifically one called 3a4. Any time another drug is also metabolized by that enzyme they will therefore compete for metabolism. One example is statins. Grapefruit juice will slow the metabolism of the statin, leading to higher serum levels. Thankfully psilocybin does not get metabolized by the p450 system. MDMA, however, does! MDMA's metabolism is quite messy. This could actually increase the odds of MDMA overdose in some cases, though that'd have to be quite a bit of grapefruit juice. Cheers! --Aryan Sarparast
"There's a huge deficit in the scientific literature," said lead author Aryan Sarparast, M.D., assistant professor of psychiatry in the OHSU School of Medicine. "There's a major incongruence between the public enthusiasm and exuberance with psychedelic substances for mental health issues—and what happens when they combine with the existing mental health treatments that we have now."
I'm a bit puzzled by this argument. The goal is not to supplement existing treatments, it is to supplant them. To me, the major incongruence here is between the continued use of existing mental health treatments such as antidepressants and the evidence behind them. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199395/
One of the lessons I've learned in psychedelic science and as a physician, is that multiple truths and paths may co-exist. I do believe there is a role for traditional treatments like antidepressants and modern interventions like psychedelic-assisted psychotherapy.
Thanks for another excellent post! There were some real interesting points in this one. I'm most intrigued by the chemistry of psychedelics, and my ears perked up at the section about concerns surrounding drug interactions. I'm not altogether surprised that few negative interactions have been found so far, simply because of the physiological strangeness of psychedelics. But this point made me think about the unexpected interactions between all sorts of different substances. For example, the fact that many (if not most??) medications interact pretty dramatically with grapefruit (which happens to be my favorite fruit) in either a depressive or stimulatory capacity depending on the mechanism of metabolism. I'm wondering if anyone is looking into the effects of grapefruit on psychedelics? Super cool stuff!
Hi Marianne, I'm the lead author of the paper here. I love questions and curiosities like the ones you brought up. Public education and discourse on drug interactions are important to public health safety. So! Grapefruit juice inhibits a specific liver metabolism of drugs called the cyp p450 enzymes, specifically one called 3a4. Any time another drug is also metabolized by that enzyme they will therefore compete for metabolism. One example is statins. Grapefruit juice will slow the metabolism of the statin, leading to higher serum levels. Thankfully psilocybin does not get metabolized by the p450 system. MDMA, however, does! MDMA's metabolism is quite messy. This could actually increase the odds of MDMA overdose in some cases, though that'd have to be quite a bit of grapefruit juice. Cheers! --Aryan Sarparast
"There's a huge deficit in the scientific literature," said lead author Aryan Sarparast, M.D., assistant professor of psychiatry in the OHSU School of Medicine. "There's a major incongruence between the public enthusiasm and exuberance with psychedelic substances for mental health issues—and what happens when they combine with the existing mental health treatments that we have now."
I'm a bit puzzled by this argument. The goal is not to supplement existing treatments, it is to supplant them. To me, the major incongruence here is between the continued use of existing mental health treatments such as antidepressants and the evidence behind them. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199395/
One of the lessons I've learned in psychedelic science and as a physician, is that multiple truths and paths may co-exist. I do believe there is a role for traditional treatments like antidepressants and modern interventions like psychedelic-assisted psychotherapy.