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.”
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.”
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.”
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.
