Important Notes on "Mushroom" Therapy -- Part 2-- 02/14/02

...continued

When it comes to interactions with other medications, we are faced with a significant challenge. Virtually all clinical research into the effects of psilocybin and LSD ceased in the early 1970's, when they were criminalized in the United States. In theory it is still possible to obtain a research license allowing experimentation with these and other Schedule 1 compounds, but in practice the complexity and inertia of the governmental approval process is so overwhelming that very few researchers have the stamina to see it through to the end. As a result, there are few studies to refer to regarding interaction with drugs in existence before 1971, and no clinical information at all on drugs developed since then.

However, there are some medications which are known to reduce or eliminate entirely the effectiveness of psilocybin (and LSD).

  1. All ergot compounds, such as ergotamine, Sansert (methysergide), cafergot, DHE 45 (di-hydro ergotamine), methergine, to name the ones most commonly used in treating CH.
  2. First-generation anti-psychotics such as Thorazine.
  3. Opiates and synthetic opiates, such as codeine, oxycontin, heroin, morphine, tramadol, methadone, demerol, laudanum, opium, and others. It is still unclear whether these compounds will reduce the effectiveness of psilocybin in treating cluster headaches, but it is well known that opiate addicts get less "high" on mushrooms and LSD than non-addicts will.

There are also medications that will increase the effects of psilocybin (and LSD):

  1. A class of compounds known as MAOIs (monoamine oxydase inhibitors). There are few MAOIs being prescribed today. Most have been replaced by newer-generation compounds, but there are still a few in use, mainly for psychiatric conditions.
  2. Lithium. Lithium has the same effect as an MAOI. It has been reported by several "recreational" users of psilocybin and LSD that Lithium will roughly double the psychoactive effects of a given dose of psilocybin (or LSD). It is unclear whether it will also double the CH-fighting properties, but we have one report from a clusterhead who deliberately took some Lithium immediately before ingesting mushrooms and had a much more intense experience for a few hours than he had bargained for. In his case, the psilocybin also killed the headaches, but it is probable that he would have achieved the same relief with less stress.
  3. Dissociative anesthetics such as ketamine, PCP (phencyclidine) and DXM (dextromethorphan).

There are medications that we suspect will interfere with the action of psilocybin (or LSD):

  1. Any of the triptans, such as Imitrex, Amerge, Zomig, Maxalt. These compounds are chemically quite similar to psilocybin. For example, Imitrex (sumatriptan) is basically sulfonated DMT (di-methyl tryptamine) while psilocybin is phosphorylated DMT.
  2. Any of various serotonergic medications classified as SSRIs (selective serotonin re-uptake inhibitors) and Tri-Cyclic antidepressants. This covers a number of medications sometimes used to treat CH: amitryptaline and nortryptaline, Zyprexa (olanzapine), Depakote (divalproex sodium), to name a few

There are some medications which may interfere with psilocybin (and LSD):

  1. anti-convulsants or anti-epileptic medications such as Neurontin (gabapentin) and Topamax (topiramate). The exact mechanism by which topiramate works, for example, is still unknown, so it is impossible to even guess whether or not it will interfere with psilocybin.
  2. medications which are either synthetic analogs of certain hormones or which regulate hormone production: Prednisone and Synthroid, for example. There is no direct evidence to suggest that these drugs will interact with psilocybin, but hormones have a very complex and inter-related effect on numerous body systems. We have seen a few reports on this message board suggesting that thyroid levels play a part in cluster headaches.
  3. tranquilizers and mood-altering medications such as Xanax, Valium, Prozac and Wellbutrin.

There are medications which will probably not interfere with the actions of psilocybin:

  1. antibiotics
  2. NSAIDs (non-steroidal anti-inflammatory drugs) such as tylenol (acetaminophen), aspirin, ibuprofen, Vioxx (rofecoxib), etc.
  3. antacids and anti-ulcer medications
  4. asthma medications
  5. insulin

It must be noted that the above category reflects my personal opinions. I have seen no reports of interactions with these medications, and I suspect that the mechanisms by which these medications act is too different from the action by which psilocybin and LSD work for there to be any significant interaction, but I wouldn't want to bet my life's savings on it.

Finally, there are the Calcium Channel Blockers. The most popular CCB used by clusterheads is verapamil. We have received reports of clusterheads achieving complete success with psilocybin while taking verapamil. I have also seen reports from chronics whose only medication at the time of their psilocybin trials was verapamil, who failed to get any significant relief. Was this lack of success due to interaction with verapamil? I don't know. I am open to argument on this one.

Verapamil does act on a certain subgroup of serotonin receptors, but it appears not to be the same subgroup that psilocybin and LSD act on. For the moment, I will tentatively classify the CCBs as a category of medications that may not completely block the action of psilocybin, at least for some individuals. I reserve the right to change that opinion as more data becomes available.

There is one more interaction that must be taken into consideration... the self-limiting factor of psilocybin and LSD themselves. This well-documented but still unexplained property of these substances is the reason why consecutive doses must be taken at well-spaced intervals, rather than day after day. It is also why psilocybin and LSD are classified as "counter-addictive". Flash calls this self-limiting process "shutting the door".

One of the first things that a molecule of psilocin (psilocybin is converted into psilocin as soon as it enters the bloodstream. It is actually psilocin that produces the effect, not psilocybin) will do when it nestles snuggly into its chosen synaptic cleft is to trigger a reaction in the receptor site that "shuts the door" behind it. Not only does the door shut on the sites that contain psilocin molecules already, but on all other sites anywhere in the brain that are capable of accepting similar molecules. This process is not instantaneous, but it does take place fairly rapidly... maybe over twenty minutes or half an hour or so.

This is why dosing with mushrooms or LSD is an "all or nothing" thing. With alcohol or marijuana, if you think you are not yet where you want to be, you can have another beer or another joint, and another and another. But psilocybin and LSD take time to produce their full effect... sometimes as much as an hour or even longer from the time you take them till the time they start to work. By the time you discover that you have underdosed, it is too late to do anything about it. You will have to wait until next time around to adjust the dose. If you take some more immediately, it is a complete waste of medicine, since by the time the new batch of molecules make it to your brain, all the doors are firmly shut.

These doors remain shut until all the molecules of psilocin or LSD have broken down (around 12 to 20 hours) and then the doors gradually start to re-open. This is why veteran "acidheads" back in the 1960s would only dose once a week or so. Some individuals can dose with only a three day break, others need as much as week. A good compromise for clusterheads is about five days.

This door-shutting mechanism precludes the use of any other hallucinogen for that given period of time. That is to say, if you take some mushrooms Friday night, then take some LSD on Saturday night, the LSD will have no effect at all. Methysergide (Sansert) and other ergot compounds such as ergotamine and di-hydro ergotamine (DHE) will also shut the door. Due to the marked similarity between the various triptans (Imitrex, Amerge, etc.) and psilocybin, it is likely that they will also shut the door for at least as long as they remain in the body, and probably for some period of time after that.

Bottom line... it is essential to wait 4 or 5 days between mushroom doses, and to avoid all other known "blocking" medications during that time as well.

In conclusion, I would like to point out that although psilocybin has by far the highest reported success rate of any preventative medication we currently know of, we do still get reports of occasional failures. Since we are unlikely to see any clinical study of psilocybin and cluster headaches in the near future, our only source of data is from the reports of those who have tried it.

I urge everyone who has tried this therapy, successfully or not, whether with psilocybin or LSD or some other psychoactive substance, to post their stories here, giving as much detail as possible, particularly in regards to other medications being used at the same time. If you wish to retain your anonymity, post under a different name, or send your report directly to me so I can repost it as an "anonymous" report from "Patient X". I have no doubt that once we have a better grasp of which medications do in fact reduce the effects of these substances, the success rate will be even higher.

For all those who have tried this therapy and reported their experiences, especially Flash, the man who got the ball rolling with his first post back in 1998, and Ueli, who painstakingly compiled all these reports from the CH.com message board and archived them here (see "Message Board Archives")...

...my sincerest thanks. Thanks as well to all those who created and contributed to the page linked above. And, to all those who have read this series of posts from start to finish, I thank you for your patience.

pinky

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