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Mixing psychedelics with lithium poses significant risk of seizures

The findings from the review showed that combining lithium with a classic psychedelic involved seizures in 47 per cent of 62 reports.



Mixing psychedelics with lithium poses significant risk of seizures

A new review has suggested mixing classic psychedelics with lithium could pose a heightened risk of seizures.

The review of online trip reports documented on the websites Erowid, The Shroomery and Reddit, carried out by researchers at Johns Hopkins Centre for Psychedelic & Consciousness Research, has shown that mixing classic psychedelics, such as LSD or psilocybin, with the mood stabiliser lithium, could induce seizures in some individuals.

The findings from the review showed that combining lithium with a psychedelic involved seizures in 47 per cent of 62 reports, with 18 per cent resulting in “bad trips”, and 39 per cent involving medical attention.

Risk of seizures

A number of studies have shown that psychedelics hold promise for treating unipolar depression, however, the review highlights that patients living with bipolar disorder have been excluded from recent psychedelic trials.

MD, Post-Doctoral Research Fellow, at Johns Hopkins Centre for Psychedelic Research & Consciousness, Sandeep Nayak commented: “Mood stabilisers refer to drugs used to treat and prevent depression and mania in bipolar disorder. This typically refers to lithium and certain mood-stabilising, anti-seizure medications such as lamotrigine or valproate, but sometimes also refers to antipsychotics. 

“To my knowledge, there is not much research on this at all. People with bipolar disorder and seizure disorders are often excluded from modern psychedelic trials. I am aware of two cases of lithium use from an online survey in the 1990’s but that is it. There is good evidence from studies administering antipsychotics with psychedelics, and that was not the purview of this study. We looked at all mood-stabilisers, excluding antipsychotics, but only found sufficient reports of psychedelic use for lithium and lamotrigine.

“Roughly half of lithium reports involved seizures. This is a tonne, and was very surprising to me. In contrast, only ~2 per cent of all Erowid reports even mention the word “seizure”, and only a fraction of these would include people actually having them. Apart from seizures, an additional 18 per cent of lithium trips were considered “bad trips”. These are described as exceptionally bad, and often quite distinct from experiences when not on lithium.”

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In one anecdote cited in the report, an individual described a failed attempt at self-medicating with LSD. They said: “It was after finishing my exams, I was getting ready for Christmas vacation, was tired from studying but very relaxed and happy to have the chance to trip. I had a cold, I’d been taking over the counter cough syrup (Nyquil and Dayquil) which had apparently elevated my Lithium levels (I didn’t know there were certain over the counter drugs I was not supposed to take with Lithium). I took two hits of LSD that within 5 minutes it led to grand mal seizures that put me in the ICU for 3 days….”

It continued: “I’ve been told I stopped responding, fell off the couch, and starting seizing uncontrollably. I’m not sure how long the seizures lasted but from the ambulance report I was still having them all the way to the hospital and in the ER. I was given a spinal tap, cat scan, EKG, various drugs to stop the seizures, and admitted to the ICU where I stayed for 3 days. I remember bits and pieces from the ICU, and bits and pieces of the week following my release from the hospital. I had a lot of bruises, trouble walking, a very swollen chewed up tongue and was quite a mental and physical wreck for the next month, though conveniently it’s not well remembered.”

Another report included in the review cited: “I took lsd while on 900 mg of lithium and experienced the worst, most horrific trip of my life and haven’t touched lsd since. I had only taken 1 tab but the effects were akin to having doses 5 + tabs. I completely lost all touch with reality, everything I saw was drenched in blood, and I felt my throat closing up and felt like I was on fire-like my skin was burning. I somehow still managed to take a Seroquel despite having lost all touch with reality which brought me out of it after an hour or so I’m guessing (completely lost touch with time) and once I stopped hallucinating I was unable to speak for several hours.”

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Nayak highlighted that seizures with lithium were reported with LSD, psilocybin, 2C-I and 2C-C.

The dangers of self-medicating

Nayak noted that currently, there is a situation where people with a difficult to treat disorder, chiefly characterised by depressive episodes, such as bipolar disorder, read about exciting results from antidepressant trials of psilocybin which exclude people with their disorder and do not involve people taking mood stabilisers. 

“You can imagine this would lead some to try to treat themselves with psilocybin and exposing themselves to unknown risks,” Nayak said.

“Lamotrigine is relevant as a comparator, and of 34 reports, none were described as bad trips or seizures. In the majority (65 per cent) lamotrigine was not described as having effected the trip at all. In contrast, this was the case with lithium only 8 per cent of the time. Lamotrigine is an anti-seizure medication, so one could argue that ‘of course you won’t see seizures with lamotrigine’ for this reason, and that it is not really the lithium at all. This argument suggests that the kind of people who are likely to have seizures while using psychedelics and go on to write about it online were more likely to use lithium anyway. But I don’t think this is very plausible at all. In addition, there were four reports combining lithium and lamotrigine and in one someone reported a seizure. The remaining three were described as intensified.

“Online trip reports are not a good enough quality data source to establish safety or benefit, but I do think they are to establish some sense of potential harm, especially when better quality data is not forthcoming. So I think it is reasonable to conclude we should have concern about lithium and psychedelics, though this doesn’t mean lamotrigine is safe per se.”

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In order to improve understanding of the risk that psychedelics can pose to individuals who are taking mood stabilising drugs, Nayak says monitored dosing trials are an ideal starting point. 

“This is in the works for several drugs, including opioids and SSRIs, but also learning, in the form of studies like this or surveys, from the fact that people are already using psychedelics in combination with any number of other drugs. Ultimately, there will be psychedelic trials in people with bipolar disorder, and Josh Woolley at UCSF aims to do this, which I applaud.

“It’s really a unique situation,” added Nayak “where a drug is being investigated as a psychiatric treatment, but is already in widespread use all over the world. We should take advantage of the fact that people are already using psychedelic drugs and learn as much as we can from it.”

Nayak and his team currently have an ongoing survey of antidepressant use with psychedelics.

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Psilocybin therapy for end-of-life care supported by 79% of Canadians



The Entourage Effect in Mushrooms: Natural psilocybin may outperform synthetic

A new survey has revealed that over 79% of Canadians support psychedelic-assisted therapy for existential distress at the end of life.

People facing a terminal diagnosis often experience significant distress. Depression, anxiety, existential distress and loss of meaning or purpose can make this type of diagnosis difficult to deal with.

Current treatments consist of counselling of cognitive behaviour therapy (CBT), but these are not always effective for everyone, creating a need for innovative new approaches to end-of-life care.

Increasing research is now showing that psychedelic therapy may be beneficial for treating existential distress in patients diagnosed with incurable diseases.

For example, a review published in 2018 in Neuropsychopharmacol Biol Psychiatry found that patients with life-threatening diseases associated with symptoms of depression and anxiety benefitted from the anti-anxiety and anti-depressant properties of psychedelics.

The studies reviewed anecdotally reported that patients experienced quality of life improvements along with a reduced fear of death.

A randomized double-blind trial carried out by John Hopkins University also revealed that high-dose psilocybin produced significant decreases in depression, anxiety and death anxiety, and improvements in quality of life, life meaning, and optimism.

A further clinical trial from New York University found that 60% to 80% of participants experienced anti-anxiety and anti-depressive effects from the treatment, along with benefits for existential distress, quality of life, and attitudes towards death, noting that “the psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression.”

Supporting psychedelics for end-of-life care

In light of psychedelic therapy’s inclusion in Canada’s Special Access Programme in 2022, which enables authorised patients to receive access to these therapies if other treatments have been unsuccessful, a team of researchers set out to understand the public’s opinion on the potential easing of rules surrounding the medical use of psilocybin.

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The survey, published in Palliative Medicine and carried out by Michel Dorval and Louis Plourde at Université Laval’s Faculty of Pharmacy and researchers from McGill University, Université de Montréal and UQAR, revealed that nearly four out of five Canadians support the use of psilocybin as a treatment for end of life existential distress.

In a statement, Dorval commented: “Studies have already shown that psilocybin, combined with psychotherapy, produces rapid, robust and lasting anxiolytic and antidepressant effects in patients suffering from advanced cancer.

“This substance can bring about a profound awareness that leads the patient to view existence from a different perspective. Treatment with psilocybin, combined with psychotherapy, can produce relief for up to six months.

“Our results seem to indicate that the social acceptability of this intervention is high in the Canadian population. If we consider only Québec respondents, the acceptability rate is similar to the national average.”

The findings also revealed that public support for psilocybin is higher among respondents who have already been exposed to palliative care, as well as higher in respondents who have already used psilocybin.

“Having been close to loved ones at the end of life, or having witnessed their distress, could explain this openness to new approaches designed to help people at this stage of their life,” added Dorval.

“There are still many prejudices against psychedelic substances. Familiarity with these substances probably helps to better understand their true effects as well as their therapeutic potential.”

The authors write: “The social acceptability of psilocybin-assisted therapy for existential distress at the end of life is rather high in Canada. These findings may contribute to efforts to mobilise resources and improve access to this emerging therapy in palliative and end-of-life care settings.”

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Ketamine: understanding the K-Hole



Ketamine: understanding the K-Hole
Photo by Gary Meulemans on Unsplash

Ketamine is an FDA-approved medical anesthetic and recently a prescription nasal spray version of ketamine called esketamine (Spravato) was approved for treatment-resistant depression.

Ketamine is an interesting drug because it can exist in three different forms, R-ketamine (the aesthetic version), S-ketamine (the psychedelic version), and a mixture of the two (racemic ketamine).

Ketamine is typically used to put you under before surgery, however, lighter doses that don’t put you to sleep are being used to treat depression, pain, and other mental health and substance use disorders.

These “off-label” uses have led to the popularization of the therapeutic use of ketamine. This has given rise to ketamine clinics where one can pay out-of-pocket for a dose administered by a doctor in a luxuriously curated “set-and-setting” (more on ketamine therapy in Nina’s Notes #18).

The patented, FDA-approved formulation of S-ketamine, Spravato, is estimated to generate $1 billion in revenue in 2023.

In addition to the rise in ketamine use for mental health, and despite its legality, the recreational use of ketamine is rising in popularity and has quite a history of illegal recreational use.

A term frequently used with the recreational use of ketamine is “k-hole”. People use it by saying things like, they are “stuck in a k-hole” or they could have “fallen into a k-hole.”

What is a k-hole?

A k-hole is the term referring to the dissociated, trance-like state that sometimes follows acute, excessive use of ketamine.

K-holes most often occur in recreational settings, like a nightclub or house party.

The dissociative effects of ketamine are dose-dependent, meaning the more you administer the greater the felt effects.

Receiving a ketamine treatment at a ketamine clinic will likely not result in a k-hole. The dose for the therapeutic experience is finely measured for the client, is administered in a safe clinical setting, and a physician can closely monitor the medicine’s effect.

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When in a k-hole, one may be unable to interact with surroundings, control motor functions or maintain awareness of their external reality. An individual may temporarily be unable to speak, walk properly or maintain their balance. They may even find themselves feeling temporarily “paralyzed” or physically inhibited.

These motor-control symptoms are often paired with a strong internal experience, visions or visuals and an altered state of consciousness.

Experientially, it can feel like “falling into a hole” which is where the term k-hole comes from. K-holes can last as long as 5 minutes or up to roughly 30 minutes.

For some, experiencing a k-hole can be highly transformative and powerful, for others it may be a frightening experience.

Why does it happen?

Ketamine is a dose-dependent drug, the larger the dose, the bigger the effects.

While entering a k-hole is rarely the aim of a ketamine user, it can easily happen in a party setting where people may be taking multiple doses within a short period of time.

Ketamine is a white powder, similar to cocaine, which many users ingest through snorting. If a ketamine user has a history of cocaine use, they may use the drug at the same frequency due to previous habits, which can sometimes lead to k-holing.

Why is that? It’s because the half-lives of cocaine and ketamine are both short, but very different.

The half-life of ketamine

Half-life is the time it takes for the total amount of a drug in the body to be reduced by 50%. The half-life of ketamine is about 2.5 hours.

This means that it takes 150 minutes for a dose of ketamine to become a half dose in your body. Meanwhile, the ketamine high lasts about 30-45 minutes. In comparison, the half-life of cocaine is 40-90 minutes, and the high is about 15-25 minutes. Cocaine is metabolized very quickly and the high lasts about a third of the half-life of the drug.

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So half of the drug is cleared from the body at close to the same rate as the user feels the effects. Drug gone = effects end.

Because the half-life of Ketamine is about 150 minutes and the high is about 1/5th of that, a user could be going for a second, third or even fourth dose before half of the first dose is metabolized by the body.

So, with repeating doses, the total amount of ketamine in your body builds over time. A user may not feel the strong effects of ketamine anymore, but they still have more than half of a dose still in their body. When they take another dose, they risk falling into a k-hole.

What happens in a k-hole?

A k-hole can lead to intense feelings of dissociation causing feelings of being disconnected from or unable to control one’s own body.

It may also affect the ability to speak and move easily. One way to think about a k-hole is a state between intoxication and a coma. Some refer to a k-hole as an out-of-body or near-death experience. A k-hole can be frightening and induce strong feelings of powerlessness. This can be especially intense if the ability to speak is affected.

Others might not notice someone in a k-hole. They might just look immobile and intoxicated, but their mind is far from quiet. They may be experiencing vivid, dream-like hallucinations and distortions of time and space. Other k-hole symptoms include confusion, unexplainable experiences and floating sensations.

While some people find the psychedelic experience enjoyable, others find it terrifying. Some describe falling into a k-hole like a bad LSD trip. Keep in mind the whole experience may last from 10 minutes to an hour.

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Signs of a ketamine overdose

Know the signs of a ketamine overdose so that if someone at a party is exhibiting symptoms, you can get them immediate medical attention.

Although the risk of an overdose from ketamine is low, it can increase outside of a clinical setting. The overdose risks are higher when ketamine is mixed with other substances such as alcohol, opioids or other recreational drugs.

Overdose symptoms can include anxiety, chest pain, elevated blood pressure, hallucinations, loss of consciousness, nausea or vomiting, rapid or irregular heart rate, and seizures.

A k-hole, however, is a common experience due to excessive use of ketamine over a short period of time. It is not a ketamine overdose.

Though a k-hole is a temporary experience, there are several long-term side effects with extended recreational ketamine use, such as bladder problems, cognitive effects, heart problems, and seizures.

While there is no way to guarantee a perfectly safe experience with ketamine, using it outside of doctor supervision, its effects can be extremely unpredictable compared to other drugs.

With the rising popularity of ketamine in both medical and recreational spheres, this calls for a balanced perspective, appreciating the therapeutic potential of ketamine while being acutely aware of its potent effects and the dangers of excessive use.

This article was first published on Nina’s Notes and is republished on Psychedelic Health with permission.

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Beyond Psilocybin: the fascinating world of functional mushrooms



Beyond Psilocybin: the fascinating world of functional mushrooms

I typically write about psilocybin, the hallucinogenic compound in mushrooms. But mushrooms have many more interesting properties than just psilocybin.

There are well over 14,000 species of mushroom-producing fungi that have been identified so far. It is believed that many more exist and have yet to be discovered. In 2017, an article in Microbiology Spectrum estimates that there are between 2.2 and 3.8 million different species of fungi.

Functional mushrooms are a category of mushrooms that have been traditionally used for their health benefits.

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They have been incorporated into Eastern medicine for thousands of years, especially in Asian cultures. These mushrooms are not your typical culinary mushrooms. They are often found in supplements, teas or other preparations to be used for health-enhancing benefits.

Popular Functional Mushrooms

Reishi (Ganoderma lucidum)

Known as the “mushroom of immortality,” reishi mushrooms are often used for immune support and to promote relaxation.

Reishi mushrooms may positively affect white blood cells, a critical part of your immune system. A 2006 study found that ingesting reishi could increase the number of white blood cells in those with colorectal cancer.

They were also shown to improve the function of lymphocytes in athletes when they are exposed to stressful conditions.

Reishi mushrooms may also reduce fatigue and depression.

Lion’s Mane (Hericium erinaceus)

This pom-pom shaped mushroom is native to North America, Asia and Europe.

It is recognized for its potential neuroprotective effects, protecting nerves from disease or decline.

Lion’s mane has also been studied for its effect on neurons, and has gained the title “the smart mushroom” due to its potential to boost cognitive function and minimize brain fog.

It may also have potential benefits in addressing the cognitive decline associated with conditions like Alzheimer’s and Parkinson’s diseases. The bioactive compounds in Lion’s mane, hericenones and erinacines, may promote the production of growth factors and protect against brain damage.

Chaga (Inonotus obliquus)

Chaga is a black, parasitic mushroom, which looks like a lump of burnt coal.

It’s high in fiber, low in calories, but rich in minerals and vitamins.

Chaga has been used to treat diabetes, parasites, tuberculosis, and inflammation.

The oldest reference to the use of chaga mushrooms as a medicine comes from Hippocrates in his Corpus Hippocraticum, in which chaga is used to wash wounds.

For medical treatment, chaga is usually ground to a fine powder and made into a tea for its antioxidant properties and immune support.

Cordyceps (Cordyceps sinensis)

Fortunately, not the Cordyceps that infect the brains of mankind in the popular The Last of Us series.

Though creepy to look at, Cordyceps is a fungus that lives on certain caterpillars in the high mountain regions of China.

It is traditionally used to boost energy and improve athletic performance.

Cordyceps is believed to increase the flow of oxygenated blood throughout the body, boost metabolic rates, increase stamina and help muscle recovery.

Turkey Tail (Trametes versicolor)

Turkey tail is valued for its immune-boosting properties, specifically its medicinal properties as an antitumor, antimicrobial, immunostimulant and antioxidant.

It is also believed to improve bone strength and regulate blood glucose.

And some report that turkey tail can prevent urinary tract infections (UTIs) and protect against age-related cognitive decline.

Shiitake (Lentinula edodes)

Apart from being a popular culinary mushroom, shiitake is also known for its immune-modulating effects.

Traditional Chinese medicine considered shiitake a food that enhances vital energy. It is a great source of nutrients, high in protein, low in fat, and contains iron, calcium, zinc, along with vitamins B, E and D.

Easily accessible at any grocery store or market, shiitake mushrooms can be prepared to eat, or taken as a supplement for its functional properties.

What are some popular functional mushroom products?

You may have seen Ultimate Shrooms in your local health store. It’s a product that contains Cordyceps, Reishi, Chaga, Lion’s mane, Turkey Tail, Maitake, Shiitake and Oyster mushrooms.

Live Ultimate, the brand behind Ultimate Schrooms recommend adding two tablespoons with a full glass of water, juice or smoothie in the morning on an empty stomach.

Mushroom Coffee is also gaining popularity, like the product Four Sigmatic which contains Chaga and Lion’s Mane.

Some functional mushrooms, like Reishi, are less appetizing when eaten in their natural form. Thus people have begun consuming them in a power form, adding them to smoothies, teas and coffee, to improve the taste.

Functional mushrooms can offer a wide range of health benefits, though it’s essential to purchase mushrooms from a reputable source, and understand their proper preparation. Not all claims for health benefits have been substantiated by clinical trials.

It is also important to consult a healthcare professional before incorporating functional mushrooms into your diet and routine, especially for those with pre-existing medical conditions.

This article was first published on Nina’s Notes and is republished on Psychedelic Health with permission.

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