This is a really important question and one that I get asked a lot.
There isn’t really a cookie cutter answer. It’s not black or white because not all antidepressants work the same way chemically in your brain.
Besides the actual taking of an antidepressant (AD), anti-anxiety or antipsychotic medication, there are many variables at play to be able to answer the fundamental question: Can I take antidepressants and do a psychedelic treatment at the same time?
- your reason for being on an AD
- which AD are you taking (or cocktail of AD)
- how long you have been on an AD
- what the dose(s) are
- your current mental state
- your goals and intention
- your current mindfulness practices
- your support system
For ease and simplicity I am going to address each one of these points to help you understand the ins and outs of AD use during psychedelics.
This blog is NOT a scientific or medical article, however, it is based on my experience, what I have learned over the past several years from clinical trial data, experts in the field of pharmacology and psychedelics and peer support. It is 100% based on safety first, psychedelic treatment second. Finally, this information is for reference only and if you wish to discuss your personal situation with me please reach me here firstname.lastname@example.org. Always consult with your Doctor before you make any changes to your medications or lifestyle changes.
Down at the bottom of this blog, I have a few reputable resources as well, that can point you in the right direction if you are interested in learning more.
I am not an anti-antidepressant vigilante. I believe that you need and desire to feel good in your own skin and if AD helps you, then it’s right for you. All too often I hear that someone has been on an AD for years and years and doesn’t really know why they are still taking them, if they are still effective, or that they feel ‘safe’ being on them and are afraid to attempt to wean them off.
Your body, mind and soul have developed a sort of dependency and addiction to them (yes that may come as a surprise to you). I also believe that western medicine has the mentality of ‘here’s a pill that will cure you’ rather than holistically looking at the bigger picture.
Antidepressants are used in the medical model of health care (ie: if the Dr. tells me to take this pill, I will, no questions asked – they must know what they are doing).
I believe in the holistic model in health care: Mind, Body, Soul and Choice.
One final note before I dive in – this is where the divide occurs between skilled Plant medicine guides and those that have no idea what they are doing (or those that think they know what they are doing and give really bad advice based on what they have read on the internet).
When I first started guiding, so many practitioners were a hard NO to anyone taking medications (to me that said a lot about their skill level). I believed that those who were on AD or anti-anxiety medications were the ones that really needed the support and healing from psychedelics. So I embarked on a research journey to learn as much as I could on how to help people taking these medications and I now am a source of support to my colleagues on the best practices of psychedelic use and taking antidepressants (as well as other medications). Humbly, I still remain a student of this work.
Ok, let’s begin….
What is your reason for being on an antidepressant?
Chances are you are feeling one or many of the common depressive moods: sadness, ‘blue’, hopelessness, anxiety, doom and gloom, fearful, your eating or sleep are affected, or you may have suicidal ideations.
If you are feeling those emotions, contact your Doctor or your healthcare practitioner. AD are prescribed to help alleviate these feelings, or they can be prescribed for other conditions. Regardless of the reason for the prescription, care still needs to be taken when considering alternative resources to healing.
There are other contributing factors:
- a chemical imbalance in your brain
- past unhealed trauma resurfacing
- a current life situation that has affected your mental health (death of a loved one, divorce, newly diagnosed illness, stress…)
Once you have pinpointed what is going on for you, then you can make an informed decision on whether or not to try an AD. For those of you that are on AD currently, re-evaluate the reason why you are taking them, as so many people have been on them for years and don’t really know why anymore or if they are still effective.
Which antidepressant are you taking (or cocktail)?
Not all AD are created equally and often more than one AD is prescribed to provide the desired effect and mitigate what you are feeling (when one AD isn’t enough).
My first medical question I ask someone interested in doing psychedelic therapy is: Are you taking an antidepressant, antipsychotic or anti anxiety medication? If so, which one(s), what is the dose and for how have you been taking them?
Here are 4 categories of common AD prescribed:
1. SSRI = selective serotonin reuptake inhibitor
Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Fluvoxamine (Luvox)
2. SPARI = serotonin partial agonist and reuptake inhibitor
Viibryd (Vilazodone), Trintellix (Vortioxetine)
3. SNRI = serotonin norepinephrine reuptake inhibitor
Venlafaxine (Effexor), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq), Levomilnacipran (Fetzima)
4. DNRI = dopamine norepinephrine reuptake inhibitor
How long have you been on an AD and what is the dose?
Once we establish which medications are being taken, the second most important piece of information is duration and dosing. Why are these important to note?
If you have been on an AD for 1, 5, 10 + years, that provides a lot of insight into what’s going on for someone: afraid to wean off, not sure why you are on them in the first place, your Dr. tells you that you have to be on them the rest of your life or you feel pretty good on them and don’t want to rock the boat.
The longer the duration the more challenging it can be to wean down or off your AD. Your body and mind are so used to having AD in your system, you may be unknowingly addicted to them (your body and mind need them to feel good – including fearing how you feel without them).
When we have a dependency on something, we feel we have to have it no matter what. For about 25 years I had been taking a prescribed sleeping pill. When I chose to try Ayahuasca, I needed to stop taking it and be clean – out of my system. My first mental hurdle was realizing I had actually been taking them for 25 years! I was shocked. Secondly it was challenging to wean off them because I was physically and mentally dependent on them. I did wean down gradually and I had a month of shitty to no sleep (nothing else was particularly helpful). In the end I did go off them and that was 4 years ago. Today I don’t use any sleep aids and I actually sleep solidly (no more middle of the night bathroom trips either!). I do still have one addiction: my morning decaf cappuccino masterpiece I so lovingly create – I honestly don’t know if I can wean off them or want to – I love it so much!
Dosing is a critical factor, too. The higher the dose the longer it will take to wean down safely. The rule of thumb is lowering the dose as little as possible for about 2 weeks each wean down dose, so you don’t have (or greatly reduced) side effects, withdrawals or comedowns. This can take several months.
Depending which AD you are on and which psychedelic you want to do, you might not need to go off your AD completely. This is fantastic news for those that struggle to wean off (physically and mentally) and, in the meantime, you can work on mindfulness strategies to (re)learn coping strategies, increase general sense of wellbeing or whatever you need to hopefully improve your life and eventually come off the AD if that is a goal.
Mushrooms tend to be the best option for those that are still on AD medication BUT so many other factors need to be assessed (remember, I am all about safety first)!
If you are thinking about doing a treatment while on AD, you may experience a muted effect from the psychedelic as the AD drug can interfere with the intensity. On the flip side you may experience a heightened effect…which is why you need to have a journey with a skilled guide – you want your journey to be as smooth as possible. And of course you want to know if there are any contraindications between the AD and the psychedelic.
If you can tolerate this, taking a few days off (each drug has a half life – meaning how many hours or days not taking it, will it chemically be out of your system). At the very least omitting the same day dose would be beneficial to reducing the blunted effect. Once again, do not attempt any medical changes without consulting your doctor.