A systemic review of evidence has shown a lack of scientific research describing the interactions between widely used psychiatric medications and psychedelics like psilocybin and MDMA.
Carried out by researchers from Oregon Health & Science University, the review has demonstrated a scarcity of data on how psychedelics interact with psychiatric medications.
The researchers say this is problematic for people believed to benefit most from psychedelics, specifically, those with mental health conditions such as depression, anxiety and post-traumatic stress disorder.
The review has been published in Psychopharmacology.
Lead author Aryan Sarparast, M.D., assistant professor of psychiatry in the OHSU School of Medicine, commented: “There’s a huge deficit in the scientific literature. There’s a major incongruence between the public enthusiasm and exuberance with psychedelic substances for mental health issues — and what happens when they combine with the existing mental health treatments that we have now.”
In the review, the researchers found a total of 40 studies dating back to 1958, including 26 from randomised controlled studies, 11 case reports and three epidemiological studies.
They discovered that only one study examined how psilocybin interacts with antidepressant medications.
Sarparast noted that all of the clinical trials were conducted with healthy volunteers who were administered a psychiatric medication and a psychedelic at the same time — a clear sign of the need for further research on the clinical outcomes of combining pharmaceutical medications with psilocybin.
This lack of evidence will lead many providers to direct patients to taper off existing medications before being offered clinical psilocybin therapy, said Sarparast.
The review has been carried out in light of developments in Oregon, where regulators are currently in the process of developing rules to permit the clinical use of psilocybin products and services from January 2023.
Although patients with mental health conditions may well benefit from psilocybin therapy, Sarparast said he is concerned about the implications of stopping existing psychiatric treatment in order to receive psilocybin services.
This may force vulnerable people into choosing between their existing medical treatment or psilocybin services.
Co-author Christopher Stauffer, M.D., assistant professor of psychiatry in the OHSU School of Medicine and a physician-scientist at the VA Portland Health Care System added that there is a considerable amount of important data not captured in a literature review related to real-world use.
Stauffer commented: “Psilocybin has been around in Western society since the late 1950s, before many of our psychiatric medications have existed. Nonetheless, people attempting to navigate Oregon’s psilocybin services in the context of ongoing psychiatric treatment should work closely with knowledgeable professionals.”
Co-authors of the review include Kelan Thomas, Pharm.D., associate professor of clinical sciences at Touro University California, and Benjamin Malcolm, Pharm.D., M.P.H., a psychiatric pharmacist with Awake Movement LLC.
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