Are There Risks to Using Psychedelics If You Have Certain Mental Illnesses? 

I would like to try psychedelics, but I have a diagnosed bipolar disorder. Are there risks to combining psychedelics with certain mental illnesses?

A great question, and one that I can only answer to the best of my current knowledge. Let the record show that this is not medical advice and that you should verify it with mental health professionals who are involved in carrying out studies on this topic. 

Here’s my take, based on what I’ve been told by some researchers and therapists who work with psychedelics: Mood and psychotic disorders, such as bipolar (with or without psychosis) and schizophrenia, are prone to flare-ups when you go through periods of stress. People who have dormant mood or psychotic disorders, either from familial inheritance or just their personal chemistry, may experience their first onset of symptoms after experiencing acute or chronic stress. 

Stress looks different for everyone, but some pretty universal stressors include sleep deprivation (72 hours of wakefulness is enough to trigger acute psychosis in the average person), traumatic events (like losing your home, breakups, injury, or other kinds of fear/pain/loss), chronic distress (such as a difficult living situation, financial hardship, or difficulties with mental health), and physical and/or mental exertion (intense exercise or emotions; strong physical responses to emotions). 

From what I understand at the moment, it’s not so much that psychedelic experiences are necessarily any more or less powerful as stressors than these other things, it’s that psychedelic experiences are more prone to producing intense experiences in general. Having a trip where, say, you get it in your head that you’ve died and you’re in purgatory, can be very traumatic. Alternatively, you might have a trip where your connection to The Oneness is so strong it carries over into your daily life. 

If you have a personal or family history of mood or psychotic disorders – especially if your immediate family, like your parents (or you yourself) have mood or psychotic disorders – it becomes extra important for you to weigh the opportunity cost of doing psychedelics and to baby proof your environment as much as possible. Indeed, the risk of entering into a manic or psychotic state during/after a trip does exist (I’ve personally witnessed it, several times). Sometimes this leads to a diagnosis, and other times it’s an isolated incident. Because of this, there’s usually a bit of a waiting game for a few days to see if things ebb or the person returns to baseline. 

Ultimately, my advice is fairly simple: If you have a mood or psychotic disorder, you are indeed at higher risk when doing psychedelics. That doesn’t mean that you absolutely shouldn’t do them, necessarily, or that they’re guaranteed to worsen your symptoms, but you need to know that it can (and does) happen. 

If you decide you want to try a psychedelic substance, I advise starting with a true microdose (0.1 g of mushrooms or 5 µg of LSD) and very slowly and gradually increasing the dose, only consuming in environments/with people that are calm and safe. More frantic activity, sensory overload, and conflicting social cues can lead to more distressing and chaotic trips, which increases your risk of having many stressors at play. You can also just stick with microdosing, which is definitely the lowest-risk practice. Avoid taking any psychedelic on a daily basis. 

I strongly recommend discussing your plans with your mental health provider if you have one, and your support system if you don’t. Having other people on your team who can help you monitor your response to psychedelics from the outside can be invaluable.

Does microdosing LSD have a different effect than microdosing psilocybin and if so, how is it different?

Actually, yes! LSD has a different pharmacological profile than psilocin (the active component of psilocybin). Psilocin is very serotonin-oriented, and its action is almost – if not completely – entirely focused on serotonin receptors. LSD, on the other hand, also influences dopamine and possibly norepinephrine, and it lasts about twice as long as psilocin does. 

For a refresher, serotonin is a neurotransmitter that’s involved in things like sleep, social behavior, and appetite, and mood. There are multiple different kinds of serotonin receptors – little buckets that serotonin molecules stick themselves into to produce some sort of response in the brain – and each of them has different effects. 

The 5-HT2A receptor, specifically, is the receptor responsible for producing the effects that we traditionally affiliate with psychedelics, although not every hallucinogen activates it. Salvia, for example, is actually an opioid agonist, which means that even though it’s hallucinogenic it’s not typically classified as a psychedelic. Psychedelics are drugs that act on the 5-HT2A receptor, and hallucinogen is a broader class. Note: This definition isn’t completely universal.

Dopamine, on the other hand, is involved in reward and motor control, and norepinephrine is your body’s fight-or-flight neurotransmitter, so it’s involved in arousal. We’re still learning how norepinephrine might be involved here, but there seems to be a general consensus that dopamine is affected by LSD. 

What does all this mean? For one thing, many people find LSD to be much more stimulating than mushrooms. It’s common for people to take a microdose as a bit of an energy boost, but fewer people find that mushroom microdoses are explicitly energizing (but it does happen). LSD also lasts twice as long (8-12 hours), which may or may not be ideal if you’re looking for something for the evening hours. 

There’s also just the general “these are different drugs” bit. Mushrooms are often (but not always!) taken with different intentions than LSD, which tends to be more party-oriented. The activity that you plan on doing might be heavily impacted by your microdose – a corporate event, for instance, might not play too well with mushrooms, and lying on the beach watching the sunset might merit something a bit calmer and more introspective than LSD. What it comes down to at the end of the day is preference. 

Is ketamine like alcohol where you can build a tolerance to it? The more often I use it, the more ketamine it takes to feel an effect. Is there a point where you can take too much like alcohol poisoning?

To the first: Yes, definitely. For many people ketamine produces “diminishing returns” where subsequent doses are less enjoyable after a certain point. This can also happen when you’ve been doing it frequently. Here’s a good time to note that doing ketamine frequently can and does produce bladder/liver toxicity! 

Most drugs build tolerance when you’re using them often. Doing ketamine every few weeks consistently will eventually build a tolerance, for example, as well as doing it for many hours straight. This is the difference between a chronic and acute tolerance. Chronic tolerance is established over time, while acute tolerance builds over the course of a session. Having a higher acute tolerance, followed by higher chronic tolerance, increases the risks of ketamine toxicity significantly. Proceed with extreme caution. 

In regards to the alcohol poisoning bit, not exactly. If you take way too much ketamine in one night you might be causing acute stress to your organs, but after a certain point you’re more likely to just anesthetize yourself and enter a catatonic state for two hours. This being said, doing tons of ket in a sitting can disrupt your thermoregulation (body temperature regulation), which may be dangerous.,You’re also at high risk of vomiting and choking on it if you’re on your back or not being watched. 

It’s highly ill-advised to try and reach an anesthetized state on ketamine without the support of a medical professional. If you really get to that point, you’ll probably need an IV drip and vitals monitoring. Either way, ketamine can be a bit of a slippery one since it’s so easy to start doing it more often – first at festivals, then at raves, then at weekend parties, then at home with friends, then alone in bed for fun. None of these environments is inherently bad, BUT it’s not uncommon for people to find themselves suddenly using ketamine all the time. 

This is happening increasingly because of ket’s spike in popularity as an antidepressant administered by therapists or as part of clinical services. If you’re using ketamine often enough to develop a tolerance and diminishing returns, I strongly suggest taking a nice long break and establishing longer pauses if/when you pick it back up. My personal recommendation is to not use ketamine more than once a month, and if you cheat, take an even longer break. 

I recognize that this advice is not in alignment with 1) ketamine infusion therapy regimens provided in clinical settings and 2) prescription lozenge/nasal spray ketamine regimens prescribed by mental health professionals, so I’ll explain: Part of the issue here is that people tend to use ket in settings that are not supervised by medical professions on an ongoing schedule, like every 3-4 weeks for multiple years. This can make it difficult to take longer breaks due to the baked-in routine of it. 

Regular exposure, especially if it’s high-grade (large quantities), can cause gradual bladder toxicity that eventually leads to painful urination or other related issues. If you ever feel anything related to bladder or kidney pain and you’re doing ketamine frequently, try to halt your use immediately. 

Ketamine therapies, on the other hand, are often administered to people who have never used ketamine before and don’t have access to it on a recreational basis. The quantity of ketamine that’s given through an IV/IM is much lower than the amount that an average person would snort in a night. The typical IV infusion is 0.5 mg/kg, which amounts to just about 25-50 mg of ketamine over the course of an hour. Even if you’re treating chronic pain, which uses much longer IV/IM sessions, the total amount consumed is usually nowhere near the half-to-full grams that many people go through in a night or weekend. 

Additionally, these sessions are usually administered in a “burst” of frequent infusions followed by maintenance infusions on a less regular basis. 

All this to say that I advise responding to a tolerance or diminishing returns by stopping your use for a tolerance break and reevaluating the schedule on which you’re consuming ketamine. 

About Your Psychedelic Auntie

When we have questions about psychedelics, we often consult our Auntie. An Auntie can be a person of any gender who offers wise advice about psychedelic substances and how to effectively use them. Lucid News is asking a collection of well-informed people to step in as Auntie and answer your questions about psychedelics. Some of the best peer-based, accurate information about psychedelic substances and harm reduction comes from DanceSafe, a nonprofit educational organization founded in 1998. DanceSafe provides health and safety services at festivals and events. This month, our Psychedelic Auntie is DanceSafe Programs and Communications Coordinator Rachel Clark. Send your questions to the Psychedelic Auntie via the Lucid News contact page and watch this space for the answers.