After the record-breaking turnout at our TalkBD live episode on Psychedelics & Bipolar Disorder, expert Dr. Josh Woolley is back to answer the top 10 most popular questions on the use of psychedelics, psilocybin, and bipolar disorder.
If you haven’t already, watch the full TalkBD episode below to find more Q&A not covered in this list:
1. What is the most promising psychedelic for bipolar disorder?
If you consider ketamine a psychedelic, then it has by far the most evidence that it can help depression associated with bipolar. There are several studies of ketamine in bipolar showing promising effects. However, this should be taken with a grain of salt, because these studies administer ketamine in a clinical research setting that is very different from how people in the community typically use or administer ketamine. For example, they have not paired ketamine with therapy or considered set and setting. In other words, these positive trials do not suggest that people with bipolar should use ketamine on their own in non-clinical settings.
2. Do psychedelics mainly treat depression (and not mania) in bipolar disorder?
Excellent question! Given that there have been no clinical trials of a psychedelic for any aspect of bipolar, it is hard to say. However, given the positive effects of psilocybin on non-bipolar depression, we and others think that psilocybin might be a treatment for the depressive symptoms in bipolar disorder. However, we and others are also worried about the potential that psilocybin and other classic psychedelics could cause mania or make mania worse. We think this is possible because of stories of people having a manic episode after using a classic psychedelic. However, these stories are rare. Also, we hope that giving the psychedelic in a controlled clinical setting with close followup can decrease the risk for worsening mania.
Although it is theoretically possible, we do not expect psilocybin to decrease mania. Using psychedelics frequently can definitely be risky especially for people with bipolar disorder.
3. Do psychedelics help or trigger hypomania/mania?
See my answers above. It is hard to say exactly what the probability of inducing a manic episode after taking a psychedelic is. However, it definitely can happen. We are not sure what specific risk factors increase the chances of this happening, but I suspect all of the things we know increase risk for a manic episode would still apply. For example, lack of good sleep, stress, lack of routines, lack of engagement with mental health care, etc…
4. Do psychedelics help with psychosis/psychotic disorders?
It is an interesting idea but you hit on the reason no one has studied it. They might help negative symptoms* but they might make the positive symptoms** worse.
*Negative symptoms: the absence of a typical behaviour or experience in psychotic disorders. This includes lack of facial expression, monotone voice, and finding it hard to move or speak.
**Positive symptoms: the presence of an atypical behaviour or experience in psychotic disorders. This includes hallucinations, delusions, and ‘disorganized behaviours,’ such as dressing in shorts in winter.
5. Will medication for bipolar disorder block effects from mushrooms?
We do not have good data on this. I can say that lithium should not be combined with psychedelics due to seizure risks. Antipsychotics very likely block the psychedelic effects. I am not sure about lamictal. We used to think that SSRI’s also blunted the psychedelic effects of these medicines but more recent data has brought that into question. We will have to wait for more data to help inform how best to navigate this.
6. What is the most beneficial dosage and usage frequency for psilocybin for most people?
The biggest problem is that there is a lot of variability in how much psilocybin is in a particular mushroom. This means people can easily under or overdose if they are not careful. Taking too much without proper support seems to be one of the biggest risks for bad outcomes.
I cannot offer any guidance about whether infrequent high doses or frequent low doses are better. What I can say is that almost all of the clinical trials in say non-bipolar depression have used a single dose model so we know more about that. However, keep in mind that in these trials, there is lots of professional support and follow-up which likely strongly contributed to the good outcomes in those studies. Using psychedelics on your own especially without adequate support definitely can increase risks.
7. What amounts qualify as “microdosing” for psilocybin?
There is no formal definition of this. Some people define this as a dose that does not cause noticeable psychedelic effects.
8. Are there non-psychedelic mushrooms that can help with bipolar disorder?
Interesting question. I have no idea.
9. How does psilocybin differ from ketamine as treatment for bipolar disorder?
People’s experiences on these two drugs are often different but there are some overlaps. The biggest difference is that ketamine can increase dissociation or out of body experiences. This is one of the reasons it is often used as an anesthetic. Psilocybin does not seem to induce this particular experience. On the other hand, psilocybin seems to have more “psychedelic” effects including visual alterations and experiences of unity and connection.
10. How do I join your clinical trial? What does participation involve?
We are conducting a small clinical trial in San Francisco that will include about 10 people.
There are other trials starting up across the United States and Canada. You can review clinicaltrials.gov for more information about these studies.
For our study, yes, people will have to be off most psychiatric medications and there are many other inclusion and exclusion criteria that could mean someone is not a good fit for our study. In our trial, people will receive 10-25mg of psilocybin. To be in a trial, you typically respond to an ad by calling or emailing a study coordinator. They will speak with you to see if you are a potential fit and tell you more about the study.