Important Notes on "Mushroom" Therapy -- Part 1-- 02/14/02

After reading some of the spectacular success stories that many have reported from a single small dose of psilocybin (or LSD), it is easy to lose sight of the fact that psilocybin is just another medication, and in order to successfully treat cluster headaches with psilocybin certain rules must be followed, just as is the case with all medications.

According to the reports posted on this message board, the majority of those who have had success with psilocybin mushrooms obtained complete and lasting relief from a single small dose. But that doesn't guarantee that every clusterhead on the planet will get the same results from a single dose. Some (such as Bob Wold) required more than one dose to achieve complete remission.

It is also true that many have gotten complete relief with very low amounts, barely enough to notice any effects at all, much less any psychoactive effects. But others have required larger amounts, sometimes bordering on what is considered a "recreational" dose.

A few have achieved no relief at all, regardless of the dosage and the frequency of ingestion.

Just as with any other medication, it is essential to refrain from taking medications that interfere with the action of psilocybin. This is not always easy to accomplish. Many "blocking" drugs are known and have been listed here on numerous occasions. But there are medications commonly taken by clusterheads whose interaction with psilocybin is still unknown. Some may intensify the effect, others may block it, still others may have no effect one way or the other. As more reports are received, more medications to be avoided will be identified.

Note that the above statements apply to every other preventative medication in the clusterhead arsenal. Let's use Verapamil, the "gold standard" of CH preventatives, as an example.

Verapamil can be effective in doses ranging from roughly 240 mg per day to a maximum of 960 mg per day. So, just like psilocybin, the effective dosage varies from person to person. For a few people, the effects of Verapamil are noticeable within a few days of starting treatment. For the majority, however, a week or two of daily (sometimes increasing) doses is required for the medication to start working. So again, just like psilocybin, some people require more doses than others do before the medication starts to take effect. For a sizeable percentage of people (roughly 30% according to available studies) Verapamil has no effect on their CH at all. And, just like psilocybin, there are other medications that cannot be taken while on Verapamil.

I could repeat the above paragraph many more times, substituting for Verapamil any other preventative medication currently used for treating cluster headaches.

But the most interesting thing that differentiates psilocybin (and LSD) from other CH medications is that it does not just abort a single attack (like Imitrex, Cafergot, or oxygen), and it also does not just prevent an attack from occuring as long as serum levels are high enough (like Sansert, Verapamil, Lithium, Prednisone, Depakote, Neurontin, Topamax, et al), but it actually terminates the entire CH "cycle" for an extended period of time -- long after all traces of it have vanished from the body. In the case of some chronics this period may be as short as two weeks. In the case of episodics, this period may be as long as a year.

The only other treatments I know of that will produce an actual termination of a CH cycle are prednisone (rarely), DHE injections (occasionally) and intravenous magnesium (occasionally).

In your own case, Bob P, you did everything correctly for at least the first dose of psilocybin. That first dose didn't terminate your cycle, and the attacks were getting more severe, so you (understandably) started a course of prednisone, knowing that it had helped you in the past. It is possible that the prednisone blocked the action of the subsequent doses of psilocybin. It is also possible that you are an individual for whom psilocybin is ineffective, prednisone or no prednisone, just as I am an individual for whom Verapamil is ineffective. There is no way of knowing for sure which is the case.

As more reports are received, some facts are becoming apparent:

  1. The most effective use of psilocybin is as a prophylactic. If taken before a CH cycle is due to start, the cycle will not start. This of course is an option not available to chronic clusterheads.
  2. The second most effective use of psilocybin is to take it at the very beginning of a cycle, before the cycle is firmly established, and while the individual is still free of other medications. Again, an option for episodic clusterheads only.
  3. Once a cycle is firmly established, it may be necessary to take higher initial doses, and more than one dose may be required to terminate the cycle. This is the case with many chronic clusterheads, and with some episodics. These are also the cases where the factor of interactions with other medications become problematical. It is a rare chronic indeed who is completely free of preventative medications, and any episodic who has made it to this stage of a cycle with no medication at all has my utmost respect.
  4. It is impossible to determine precisely how large the first dose of mushrooms should be for any given individual. It's not as if psilocybin is available in pill form containing a known number of milligrams... we are dealing with a natural substance that is subject to the vagaries of nature. The psilocybin content of each batch of mushrooms will vary, sometimes substantially. And, just as with Verapamil or Lithium or Topamax or any other medication, the sensitivity to psilocybin varies from one individual to another. The amount required for subsequent doses becomes much easier to determine, but for the first dose many individuals are (understandably) choosing to underdose.

Anyone who is considering this treatment must accept the possibility that two or even more doses may be required. It is also possible that some individuals may have to put up with some short-lived (a few hours) psychoactive side effects in order to achieve success.

There is an equivalent of the "Kip Scale" that is commonly accepted by "recreational" users to measure the effects of a dose of mushrooms:

Level 1
This level produces a mild "stoning" effect, with some visual enhancement (i.e. brighter colors, etc). Some short term memory anomalies. Left/right brain communication changes causing music to sound "wider".

Level 2
Brighter colors, and some subtle visual anomalies (i.e. objects appear to slightly shift position or "breathe"), some 2 dimensional patterns become apparent upon shutting eyes. Confused or reminiscent thoughts. Change of short term memory leads to distractive thought patterns. Vast increase in creativity becomes apparent as the natural brain filter is bypassed.

Level 3
Very obvious visual distortions: everything looking curved and/or warped, patterns and kaleidoscopes seen on walls, faces etc. Some mild hallucinations such as rivers flowing in wood grained or "mother of pearl" surfaces. Closed eye images become 3 dimensional. There is some confusion of the senses (i.e. seeing sounds as colors, etc). Time distortions and "moments of eternity".

Level 4
Strong hallucinations, i.e. objects morphing into other objects. Destruction or multiple splitting of the ego. (Things start talking to you, or you find that you are feeling contradictory things simultaneously). Some loss of reality. Time becomes meaningless. Out of body experiences and e.s.p. type phenomena. Blending of the senses.

Level 5
Total loss of visual connection with reality. The senses cease to function in the normal way. Total loss of ego. Merging with space, other objects, or the universe. The loss of reality becomes so severe that it defies explanation. The earlier levels are relatively easy to explain in terms of measureable changes in perception and thought patterns. This level is different in that the actual universe within which things are normally perceived ceases to exist. Satori enlightenment (and other such labels).

Most episodic clusterheads will need to achieve somewhere around a Level 1 or Level 1.5 experience in order to terminate their cycle. A few episodics have had success at even lower levels, but a few have had to reach Level 2.

Most chronic clusterheads will need to take enough to achieve a Level 1.5 or Level 2 experience. In particularly stubborn cases, even higher doses may be required. CarlD, for example, reported a few months of painfree time after reaching (from his brief description) Level 3.

Despite the fact that there is considerable variability in both mushroom potency and individual sensitivity to psilocybin, some rough guidelines have emerged that give some help in determining how large the first dose of mushrooms should be.

It should be noted that unlike alcohol, the effects of psilocybin (or LSD) seem not to be dependent on an individual's weight or percentage of body fat. This makes our task somewhat easier.

Almost all "black market" mushrooms being sold today are of the species Psilocybe cubensis. In Europe this species is sometimes called Stropharia cubensis. The main reason why they are so popular is that Psilocybe cubensis is extremely easy to cultivate indoors. Recent developments in home cultivation methods have made it something that an eight year old child could do with no difficulty. There are other species which may sometimes be encountered on the black market that are more potent than Psilocybe cubensis, but it is rare indeed that they become available. Clusterheads who grow their own are all growing Psilocybe cubensis, so I will discuss dosage levels for that species only.

Even when discussing a single species, there are many factors that determine the potency of a given batch of a mushrooms, not all of which are under the control of the cultivator, so bear in mind that the figures given below are only guidelines, and not cast in stone. Your mileage may vary.

All the doses given below are expressed by weight, in grams (1.0 gram = 1000 milligrams) because it is impossible to correctly measure a dose of Psilocybe cubensis in terms of the number of mushrooms. Individual dried mushrooms can weigh as little as 20 milligrams, and as much as 2.5 grams. The only way to accurately measure a dose is by weight. The numbers I give are also for thoroughly dried mushrooms -- "cracker-dry" is the term most often used. They should be crisp and will snap and crumble easily. If they are leathery and "bendable", they must be further dried before weighing, or the dose will be effectively smaller than it should be due to excess water content.

For the average individual who is completely free of all other medications which may interfere with the action of psilocybin, it will be necessary to take 1.0 to 1.5 grams of thoroughly dried Psilocybe cubensis of average potency in order to achieve a Level 1 experience.

For a Level 2 experience, somewhere around 1.5 to 2.5 grams is normally required. For Level 3, a dose of roughly 3.5 grams or more will be required. From the reports we have seen so far from numerous clusterheads, it does not seem that reaching levels higher than Level 3 gives any additional benefit.

I must repeat that there may be the occasional individual who is exceptionally susceptible to psilocybin who has obtained an exceptionally potent batch of mushrooms and takes 1.0 gram, yet reaches as much as a Level 2 experience. On the other hand, there may be another individual who is exceptionally resistant to psilocybin who has obtained an exceptionally weak batch of mushrooms and takes 3.5 grams, only to barely reach Level 1. Neither case is the norm, but neither case is unheard of, either, particularly the latter.

The final factor that will influence the effect of a given dose of psilocybin (or LSD) is interaction with other medications. This is an area where we are still learning, but some interactions are well-known and will be discussed next.

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