Lithium and psychedelics: the seizure signal
People with bipolar disorder are excluded from psilocybin trials, so some try it alone. In 62 online reports of psychedelics taken with lithium, nearly half described a seizure. In 34 with lamotrigine, none did.
The claim
“Psychedelics are fine if you’re on a mood stabiliser.”
Contradicted With lithium, 47% of the reports described a seizure. With lamotrigine, none did.
- Study
- Analysis of online trip reports
- Sample
- 96 reports
- Peer review
- No, preprint
- Funding
- Academic
Nayak SM, Gukasyan N, Barrett FS, Erowid E, Erowid F, Griffiths RR. Classic psychedelic coadministration with lithium, but not lamotrigine, is associated with seizures: an analysis of online psychedelic experience reports. Preprint, February 2021. Johns Hopkins University School of Medicine and the Erowid Center.Funded by the Johns Hopkins Center for Psychedelic and Consciousness Research. This is the preprint; check for the peer-reviewed version before citing elsewhere.
What kind of paper this is
A content analysis of anonymous trip reports from Erowid, Shroomery and Reddit in which someone described taking a classic psychedelic (such as psilocybin or LSD) while on lithium or lamotrigine. Each report was coded for seizures, bad trips, medical attention and whether the stabiliser seemed to change the experience.
What it found
Of 62 lithium reports, 47% involved a seizure, a further 18% a bad trip, and 39% involved medical attention. Of 34 lamotrigine reports, none involved a seizure, and 65% were judged to show no effect on the psychedelic experience, against 8% of lithium reports. Other drugs taken at the same time, most often SSRIs, did not change the pattern. The authors provisionally conclude that lithium should be considered a contraindication to psychedelic use.
Table view
| Measure | Value |
|---|---|
| Seizure | 47% |
| Medical attention | 39% |
| Bad trip, no seizure | 18% |
| No effect on the trip | 8% |
Table view
| Measure | Value |
|---|---|
| Seizure | 0% |
| No effect on the trip | 65% |
What it did not find
These are self-selected anonymous internet reports, not a trial: no verified doses, no confirmed diagnoses, no denominator of people who took both and wrote nothing. Dramatic experiences are more likely to be written up, so the 47% is not a risk estimate for any individual. It does not show lamotrigine is safe with psychedelics; it shows the reports did not describe seizures. The authors acknowledge these limits themselves.
What you would change on Monday
If you take lithium, this is the strongest signal available and it points one way: the combination has been followed by seizures often enough that the researchers call it a contraindication. If you are considering psychedelics, the conversation to have is with your prescriber, before, and it belongs on your Psych Visit Brief. Do not stop or change lithium on your own to make room; that carries its own relapse risk. This note is harm reduction, not encouragement.
Where it sits in the tools
Corrections
None. To challenge a claim, email [email protected] with the specific line.
One paper, read for what it can carry. Not clinical advice; the editorial policy and medical disclaimer apply.