Can I take antidepressants before psilocybin therapy?
Why Psilocybin Therapy at OUR HOUSE does not require stopping the use of SSRIs
An increasing body of evidence supports that psilocybin is effective for the treatment of depression (and other psychiatric disorders). With approximately one in six American adults currently taking antidepressant medication, many of the people who come to us wonder whether psilocybin assisted therapy is safe for them. The question is not surprising: trials typically exclude people on antidepressants, giving the impression that medication is contraindicated or unsafe. Moreover, clinicians often recommend tapering and discontinuing antidepressants prior to psilocybin use to prevent serotonergic overload, aka “Serotonin Shock” syndrome, which refers to serotonin toxicity, a potentially life-threatening drug reaction caused by too much serotonin accumulating in the body. But the risk of serotonin syndrome remains theoretical, with no solid evidence supporting it.
Let us share the pharmacological facts, as well as our own experiences in supporting clients on anti-depressants with psilocybin mushroom therapy at OUR HOUSE.
Research conducted by our teacher at Fluence, psychopharmacologist, researcher and professor at Touro University California College of Pharmacy, Dr. Kelan Thomas, shows why the combination of psilocybin and SSRIs or SNRIs is not deemed dangerous.
1) Classic psychedelics (DMT, Psilocybin and LSD) do not increase intrasynaptic serotonin levels. SSRIs function by blocking the reuptake of serotonin, leaving more natural serotonin floating in the synapse. Classic psychedelics do not flood the brain with extra serotonin. (Instead, they are direct agonists—they simply "mimic" serotonin and bind directly to the 5-HT2A receptors.)
2) Psilocybin only partially stimulates post-synaptic 5-HT receptors. Because SSRIs increase synaptic serotonin, that natural serotonin occupies many of the brain's 5-HT2A receptors. When a classic psychedelic is introduced, it must compete with the body’s own serotonin to bind to those same sites.
3) Classic psychedelics only partially activate second messenger intercellular signaling pathways and it’s those second signaling pathways that determine serotonin toxicity.
The Problem is Blunting, Not Toxicity. Because of the described receptor competition (and down-regulation of receptors caused by long-term antidepressant use), SSRIs weaken or blunt the subjective, psychedelic effects of the drug rather than making them dangerously high. Therefore, severe cases with psilocybin are very, very rare and primarily in those taking MAOIs or in those taking serotonin-affective medications. In general, MAOIs pose a risk of hypertension and hyperthermia. MAO-A inhibition could also reduce psilocin breakdown and potentiate its effects, making psilocybin generally contraindicated with MAOIs.
SSRIs like Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), paroxetine (Paxil) or fluvoxamine (Luvox) on the other hand are not contraindicated, nor are OUR HOUSE clients required to taper off ahead of joining any of our psychedelic programs.
Clinical Benefits of Maintaining SSRIs
Dr. Thomas and integrative mental health professional Dr. Erica Zelfand, point out that requiring patients to quit their antidepressants introduces real-world dangers, such as antidepressant discontinuation syndrome (severe withdrawal symptoms) and a relapse into severe depression. Allowing clients to safely stay on their SSRIs broadens access to psychedelic care without destabilizing their baseline mental health. As psychedelic mental health professionals, we know that set, the mindset our clients are on when entering into a psilocybin (or ketamine) journey, is always key to positive treatment outcomes.
At OUR HOUSE, we follow the Colorado state-regulated safety assessment to gather information on medications and supplements taken, as well as assessing the overall mindset and nervous system state to avoid any risk of serotonergic overload or destabilization.
Overall Conclusion
At OUR HOUSE, we connect clients to additional psychiatric services for safety, if needed. Following pharmacological, psychedelic guidelines for SSRIs and psilocybin have had positive results for our clients. These guidelines recommend chronic SSRI users take a psilocybin dose 30%-50% higher than users who are not on SSRIs. At OUR HOUSE, dosing is always done with a “go low & slow” approach, adjusted slowly yet effectively within each client’s journey experience. Clients on SSRIs typically start off at a somewhat higher dose and their experience is adjusted with a booster, 45 minutes after the initial starter dose. We rarely set out with a 50% increase as we haven’t found the need to do so. There is always time, for every client, to find the dose that is right for them.
To learn more about dosing, watch the dosing video in our psilocybin preparation course.
