Ask an Expert: Psilocybin, Psychedelics & Bipolar Disorder

on January 6, 2022 7 comments
Ask an Expert: Psilocybin, Psychedelics & Bipolar Disorder

After the record-breaking turnout at our talkBD: Psychedelics & Bipolar Disorder episode, expert Dr. Josh Woolley is back to answer the top 10 most popular questions on the use of psychedelics, psilocybin, and bipolar disorder. Watch the complete episode below to find more Q&A’s!

 
Watch on YouTube


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…

Do Psychedelics Trigger Mania or Bipolar Disorder? 🍄


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.

Is It Safe to Use Psychedelics With Medications? – Lithium, SSRIs, Lamotrigine 💊


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.

Does Microdosing Psychedelics Help Bipolar Disorder?


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.


Dr. Josh Woolley standing indoors with a houseplant in the background. He is Caucasian with blue eyes, short salt-and-pepper hair, and squarish glasses. He is smiling with a closed mouth.

Josh Woolley, MD, PhD

Associate Professor, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
crestbd.ca/josh / @thebandlab
Dr. Josh Woolley is currently the principal investigator and director of UCSF’s Bonding and Attunement in Neuropsychiatric Disorders (BAND) Laboratory. The lab’s mission is to understand mechanisms of social connection among individuals with mental illness and to test new treatments. The BAND Lab studies psychedelics as novel therapeutics for multiple conditions, including bipolar disorder. He’s also the director of the translational psychedelic research program at UCSF.


Watch our talkBD episode on psilocybin & bipolar disorder, featuring Dr. David Gard.

Watch on YouTube


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7 Comments on “Ask an Expert: Psilocybin, Psychedelics & Bipolar Disorder”

  1. Will Lamictal keep me from experiencing mushrooms, acid and MDMA? I’ve carefully titration off two antidepressants so I can experience these drugs fully. Now I’m worried that Lamicatal, Wellbutrin and trazadone might interfere.

    Thank you,
    Sue

  2. I suffer from bipolar type 1 disorder and have been unmedicated most of my life. (26 now) I tried medications for a brief time and could not follow through. I would say my biggest struggle with it all is staying in a “manic” state majority of the time. I’m almost always in this state since learning about the disability and monitoring my actions and feelings. Recently I have decided to start micro dosing psylocibin mushrooms to help stabilize my manic state of always being energized with spurts of anger and rage or aggravation, and short spells of extreme sadness or depression over a certain issue before I move on being manic again. What I have noticed when I micro dose magic mushrooms at about .25 to .5 of a gram. (A quarter to half a gram) is it slows my brain down so much so I can just focus on one thing. My mind usually goes 15 places at once while I’m performing a task, talking to my wife, observing my surroundings and thinking of several other things in my head alone. It really just slows me down enough to focus one thing at a time and maybe carry a conversation. As for the random spurts of aggravation and rage they have tended to go away if it’s over a smaller concern that would usually infuriate me. If I’ve dosed a small amount of mushrooms they don’t get under my skin as bad I tell myself not to worry about it as hard and just move forward with dealing with the situation a bit calmer. It’s still going to take time with what I’ve committed to doing to really figure out how to use this as my tool to help navigate my life. My main goal is to use it as a mood stabilizer and potentially even not have to use it all the time like traditional bi polar medicines. I have been taking a day off here and there while experimenting with dosages and I have felt great. It hasn’t been magic or perfect, there was one day where I still got bent out of shape and went through a fit but I got out of it by bumping up from .3 to another .2 later and then drinking some green tea and reading a book to get my mind in something else. I would also like to note that I don’t see myself doing large doses as I don’t think they would help my bi polar disorder. I don’t care if I get the stronger effects of the mushroom anyways as long as it helps keep my mood stable. From what I’ve noticed with a dose around 2 grams though is that it made me feel a bit anxious and messed with my heart a bit, I’m dealing with some minor heart problems now though so this could have a lot to do with it obviously. I just like to look at that experience and think that others like me though might not benefit from a large does as it could cause them worry, extra energy and excitement, or just with a larger dose you feel a lot different and if your trying to get your mind stable and under control you don’t want your mind and body altered too terribly much by the medicine! Micro dosing these magic mushrooms is the first medication I have found helpful in anyway in my life and the first one I will stick to trying to help with my life. I truly hope it works out and I’m happy to see studies everywhere about bipolar and mushrooms starting to be done if these medicines are used in small amounts they can totally help us out as they might help another situation out in a different amount.

    • Hello John Allen,
      Thank you kindly for your posted message. My brother, Rick has Bipolar 1. He is having manic episodes and small depressive ones. Mostly manic. Unfortunately, in his case, he also suffers mental slowness and has the age of a child even though he is almost 60.
      I’m writing to you because I was wondering if you have heard of Amanita Muscaria Mushroom??
      I am soon to be learning more and how it works in a few weeks in person with a woman who took herself off benzodiazapines. She had almost committed suicide.
      Would like to get your contact if you are interested. Perhaps I can share more and you could also share with me so I can better help my brother Rick.
      Sincerely,
      Laura Garza
      lsgroot777@gmail.com

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