Thank you all for doing this AMA. You three have done incredible things for the world of psychedelics. Michael—I loved How to Change Your Mind and I’m looking forward to getting my hands on This is Your Mind on Plants when it comes out. Tim—I love your podcast and have been listening to it almost daily for the past two months. Dr. Johnson—your podcast with Lex Fridman was incredible.
The question:
What are your thoughts on someone with Bipolar 1 taking psychedelics for non-therapeutic purposes? Assuming the person is on proper medication and has been very stable for several years, would it be relatively safe for them to take a psychedelic (psilocybin and to a lesser degree LSD in particular)? The intention would be an attempt at occasioning a mystical/spiritual experience, exploration of the self and mind, and as Bob Jesse put it, the “betterment of a well person.” You can also assume the individual has done significant research on the impact of set and setting, dosage, and read about the experiences of other people on these compounds. Would it be a good idea to start with 1-2 grams of mushrooms to gauge the experience? Would it be better to find an experienced guide like Michael did in How to Change Your Mind ? Do you think they would work with someone someone who has well managed Bipolar?å
Tim—You have mentioned you dealt with Bipolar (type 2) in the past and I’m wondering if could shed some light on whether or not you think the potential benefits outweigh the risks?
Dr. Johnson—What does the risk profile look like for someone with well-managed Bipolar 1 when taking a psychedelic? I know the occasioning of a manic episode and to a lesser extent a psychotic break are the main risk factors, but how much of the risk would be mitigated by proper medication and years of stability? Have you ever met anyone with bipolar 1 who has taken psychedelics?
(The medications are lamotrigine and bupropion—both of which have no known interactions with psychedelics).
Michael—Given your work with experienced guides, do you think any of the underground professionals would accept someone with well-managed bipolar? Do you think working with a guide would help mitigate risk in this scenario?
TLDR: What are your thoughts on someone with well managed Bipolar 1 taking psychedelics (psilocybin and to a lesser extent LSD in particular)? If the person is on the proper medication and has been very stable (0 episodes in either direction) for several years, would the level of risk be reduced to a level that taking a psychedelic would be acceptable? The goal of the trip would be the exploration of the mind and the “betterment of a well person,” as Bob Jesse says—not treatment for Bipolar disorder. Would underground professionals work with someone who has well-managed Bipolar? If not, would trying a relatively low dose of 1-2 grams of mushrooms to gauge the experience without a professional guide be a good idea?
I’ll start out saying I never encourage anyone to use psychedelics, and I don’t give individual medical advice. As you know and as Michael stated, modern studies exclude such folks. That said, there are those with anecdotal reports of psychedelics helping with bipolar disorder ( e.g., https://icpr2020.net/poster-presenters/benjamin-mudge/ ). Also, all else being equal, having another competent and sober person present is going to be less risky, relatively speaking, than being by oneself. And all else being equal, lower doses will be less risky than higher doses. I’ll end by saying there is definitely some risk that a psychedelic experience can exacerbate mania, and some of the anecdotal reports of prolonged adverse reactions look like mania rather than psychotic episodes.
Long comment; TLDR at the bottom.
Thank you all for doing this AMA. You three have done incredible things for the world of psychedelics. Michael—I loved How to Change Your Mind and I’m looking forward to getting my hands on This is Your Mind on Plants when it comes out. Tim—I love your podcast and have been listening to it almost daily for the past two months. Dr. Johnson—your podcast with Lex Fridman was incredible.
The question:
What are your thoughts on someone with Bipolar 1 taking psychedelics for non-therapeutic purposes? Assuming the person is on proper medication and has been very stable for several years, would it be relatively safe for them to take a psychedelic (psilocybin and to a lesser degree LSD in particular)? The intention would be an attempt at occasioning a mystical/spiritual experience, exploration of the self and mind, and as Bob Jesse put it, the “betterment of a well person.” You can also assume the individual has done significant research on the impact of set and setting, dosage, and read about the experiences of other people on these compounds. Would it be a good idea to start with 1-2 grams of mushrooms to gauge the experience? Would it be better to find an experienced guide like Michael did in How to Change Your Mind ? Do you think they would work with someone someone who has well managed Bipolar?å
Tim—You have mentioned you dealt with Bipolar (type 2) in the past and I’m wondering if could shed some light on whether or not you think the potential benefits outweigh the risks?
Dr. Johnson—What does the risk profile look like for someone with well-managed Bipolar 1 when taking a psychedelic? I know the occasioning of a manic episode and to a lesser extent a psychotic break are the main risk factors, but how much of the risk would be mitigated by proper medication and years of stability? Have you ever met anyone with bipolar 1 who has taken psychedelics?
(The medications are lamotrigine and bupropion—both of which have no known interactions with psychedelics).
Michael—Given your work with experienced guides, do you think any of the underground professionals would accept someone with well-managed bipolar? Do you think working with a guide would help mitigate risk in this scenario?
TLDR: What are your thoughts on someone with well managed Bipolar 1 taking psychedelics (psilocybin and to a lesser extent LSD in particular)? If the person is on the proper medication and has been very stable (0 episodes in either direction) for several years, would the level of risk be reduced to a level that taking a psychedelic would be acceptable? The goal of the trip would be the exploration of the mind and the “betterment of a well person,” as Bob Jesse says—not treatment for Bipolar disorder. Would underground professionals work with someone who has well-managed Bipolar? If not, would trying a relatively low dose of 1-2 grams of mushrooms to gauge the experience without a professional guide be a good idea?
I’ll start out saying I never encourage anyone to use psychedelics, and I don’t give individual medical advice. As you know and as Michael stated, modern studies exclude such folks. That said, there are those with anecdotal reports of psychedelics helping with bipolar disorder ( e.g., https://icpr2020.net/poster-presenters/benjamin-mudge/ ). Also, all else being equal, having another competent and sober person present is going to be less risky, relatively speaking, than being by oneself. And all else being equal, lower doses will be less risky than higher doses. I’ll end by saying there is definitely some risk that a psychedelic experience can exacerbate mania, and some of the anecdotal reports of prolonged adverse reactions look like mania rather than psychotic episodes.
I’m not qualified to offer advice. In general people with bi-polar are excluded from the current trials.