WHAT IS PSILOCYBIN?
Psilocybin (the active component of “magic mushrooms”), a serotonergic agonist, targets the 5-HT2A receptors in the central nervous system and gastrointestinal tract. Serotonin, known as the “happy hormone” present in SSRI antidepressants like fluoxetine (prozac), plays a crucial role in modulating mood, cognition, and memory. With 90% of serotonin receptors located in the gut, psilocybin’s physical side effects can mirror those of antidepressants, leading to symptoms like nausea, diarrhoea, and constipation.
Viewing psilocybin from a medical perspective highlights its excellent safety profile. According to the Global Drug Survey, it carries minimal risk, constituting only 0.2% of Emergency Department visits in the US. Evaluating any adverse effects involves weighing the risk/benefit ratio relative to the individual’s condition. For those battling severe, chronic depression or suicidal thoughts, the potential relief offered by psilocybin may outweigh the risks associated with its side effects. Understanding the context is paramount in such considerations.
In comparison to LSD, psilocybin is viewed as a gentler option due to its shorter duration of action (5-6 hours vs. LSD’s 10-12 hours). While LSD is often likened to an “atomic bomb” in the psychedelic realm, psilocybin is described as a “weapon of conventional strength.” In settings like palliative care, where patients may lack the stamina to endure the prolonged effects of LSD, psilocybin may offer a more manageable choice.
Physiologically, serotonin’s impact on blood vessels can vary, leading to either constriction or dilation, affecting blood pressure levels. In rare cases, activation of the 5-HT2A receptor by psilocybin can trigger coronary artery spasm, potentially elevating blood pressure by around 10mmHg. This increase, akin to the spike sometimes experienced in medical settings due to anxiety, may push someone with already high blood pressure into a critical situation. It’s advisable to have a baseline blood pressure check before psilocybin use.
POTENTIAL EFFECTS
On a psychological level, psilocybin can induce visual distortions, unsettling thoughts, paranoia, panic, and mild anxiety. Individuals may become acutely aware of bodily sensations like their heartbeat or blood flow, with fear and delusions possibly leading to self-harm or aggression. However, adverse effects are generally minimal and heavily influenced by the individual’s environment, emotional state, and mindset. A study by John Hopkins University involving 1193 participants revealed that only 2.1 percent reported a “bad trip”. Challenging experiences, if properly integrated, can offer profound insights and should not be necessarily dismissed as failures.
Physiologically, serotonin can cause both blood vessel constriction (vasoconstriction) and blood vessel dilation (vasodilation), causing either an increase or decrease in blood pressure. Rarely, stimulation of the 5-HT2A receptor through psilocybin use can cause coronary artery spasm. Psilocybin has been shown increase a person’s blood pressure an average of 10mmHg. This means a person who has healthy blood pressure of 130/80 may be expected to increase to 140/90. This increase is marginal, however, with someone who has a very high baseline blood pressure, this increase may send them into a crisis. Getting a routine blood pressure check before taking psilocybin is a good idea.
Psychologically, a person may experience visual disturbances, troubling thoughts, paranoia, panic and mild anxiety when taking psilocybin. They may have hyperawareness of their bodily processes, feeling their heartbeat intensely for example, or feeling their blood flowing. Fear and paranoid delusions can potentially lead to aggressive behaviours towards self and others. That being said, side effects are generally minimal and are more likely influenced by a poor set and setting, and the person’s emotional state. From a research study performed by John Hopkins University, it was found that from a cohort of 1193 participants, only 2.1 percent described having a “bad trip”. A difficult trip should not be written off as a failure, because even difficult experiences can hold significant meaning when integrated properly
EXCLUSIONS AND CONSIDERATIONS
The Human Hallucinogen Research Guidelines outline potential exclusions for individuals considering working with psilocybin. Exclusions may involve a personal history of psychosis, severe psychiatric disorders, or a family history of certain mental health conditions like psychosis, schizophrenia, or bipolar disorder. Other factors such as hypertension, cardiac disease, and alcohol abuse are also considered.
Assessing a participant’s psychiatric history is crucial. There are varied opinions on which client groups should be excluded from psilocybin work, as the impact can be profound. While prolonged trips and acute psychosis are rare, they can occur, often associated with recreational LSD use. In a clinical trial setting, the risk is minimised. Integration psychotherapy, support groups, and guidance from a trained therapist specialising in psychedelics can help individuals navigate and derive positive insights from such experiences.
It’s essential to be aware of medications that interact with psilocybin, as certain serotonergic medications and psychostimulants can affect its effectiveness and potentially lead to adverse outcomes. Discontinuing antidepressants like SSRIs or SNRIs should be done under medical supervision to mitigate risks of discontinuation. Balancing medication use with psilocybin work depends on individual expectations and desired outcomes.
When considering medications that interact with psilocybin, it’s important to note that certain serotonergic medications, including commonly used antidepressants like SSRIs, SNRIs, MAOIs, Tricyclics, St John’s Wort, and 5HTP, as well as some anti-nausea medications such as ondansetron and metoclopramide, along with dextromethorphan cough medicine found in products like Benylin, may impede the effectiveness of psilocybin. This could potentially lead to a reduced reaction to psilocybin.
On the other hand, psychostimulants like Ritalin, an amphetamine used to treat ADHD, have the potential to enhance the stimulant effects of psilocybin. This combination may increase the likelihood of experiencing psychotic symptoms and cognitive enhancement effects, potentially reducing the chances of ego-dissolution. While these medications can impact the effectiveness of psilocybin, it’s crucial to be mindful of these interactions as they may not always result in a strict contraindication.
Alcohol and psilocybin should never be combined. Alcohol impairs the body’s ability to metabolise psilocybin, increasing the risk of adverse effects. Research shows that most severe reactions to psilocybin, such as suicidality, occur when alcohol is also consumed. It is crucial to avoid alcohol when using psilocybin.
Another significant risk factor when working with psilocybin is accidents. Engaging in activities like driving, operating heavy machinery, caring for small children, or being in a hectic or hazardous environment after a psilocybin experience is extremely unsafe. It is important to prioritise safety and avoid such situations to prevent any harm.
Serotonin syndrome, a potential medical emergency linked to certain psychedelic medications, arises from the concurrent intake of serotonergic drugs such as the mentioned antidepressants. Notably, when it comes to psilocybin, there is minimal documented evidence of such occurrences, alleviating significant concerns.
In scenarios necessitating the discontinuation of a serotonergic antidepressant, the typical recommendation involves a two-week tapering period for most cases, extending to six weeks for fluoxetine (prozac). It is advisable to consult with medical professionals for personalised guidance on this process.
AND FINALLY…….
Psilocybin, known for its relative safety, requires some precautions:
– Understand the substance you are consuming.
– Be aware of your health status, including getting a blood pressure check.
– Establish a secure environment before, during, and after the experience.
– Conduct a safety and risk assessment to prevent accidents during and for at least 8 hours post-experience.
– Avoid consuming alcohol before, during, and after a psilocybin session.
PLEASE NOTE: This blog is intended for information only and does not substitute medical advice. I do not advocate the illegal use of substances.