LabRat74
Greenlighter
- Joined
- Nov 2, 2019
- Messages
- 37
This needs some work and formatting but its a guide i wrote for those considering taking drugs on antidepressant medications a bit back, its mostly focussed around ssris admittedly.
This post is by no means exhaustive, just a way-in to seeing what sort of things to look out for.
Antidepressant - drug interactions
Ok so first off, there are many different types of antidepressant. SSRIs are one of the most common but some also inhibit norepinephrene and/or dopamine, these are called SNRIs/SNDRIs/SDRIs/NDRIs. Tricyclic antidepressants such as amitryptaline have been gradually replaced by SSRIs as antidepressants, but some people still get prescribed them and they are in circulation medicinally for other uses too. There are tetracyclics too such as mirtazipine. Also MAOIs are prescribed, albeit less commonly.
There is a common misconception with regards to one of the most queried interactions: MDMA+SSRI. MDMA requires the serotonin transport (SERT) to achieve effects, SSRIs work by occupying SERT thus stopping MDMA from taking full action. This, on paper, makes MDMA+SSRI less likely to cause serotonin syndrome than the same dose of MDMA with no SSRI. However, this doesnt mean dose higher to compensate. The noradrenergic and dopaminergic aspects of MDMA do not get truncated by SSRI and thus when you up the dose youre not really adding the euphoria youre looking for, just a more edgy/stimmy experience, relatively speaking to mdma unhindered, it becomes a more compulsive substance.
NEVER UNDER ANY CIRCUMSTANCES COMBINE A SUBSTANCE THAT ALTERS 5HT (serotonin) LEVELS WITH AN MAOI. Pharmaceutical MAOIs are particularly dangerous on account of being non reversible, whereas caapi (ayahuasca vine) and such are known as RIMAs which are slightly more forgiving (but still dangerous to mix). MAOI will inhibit the bodys ability to metabolise serotonin and thus adding things like MDMA will cause the drug to have a much more potent effect and last longer, markedly increasing the chance of serotonin syndrome as your metabolism isnt clearing the synapse of excess 5HT.
Also, any drug which has MAOI properties innately should never be mixed with an SSRI (or any drug that changes 5HT levels as detailed above) unless under medical guidance. Some examples would be aMT (MAOI), 2C-t-x (MRI), ayahuasca/changa (RIMA).
Psychedelics which do not utilise serotonin (aka 5ht partial agonists like psilocybin or LSD) will not cause serotonin syndrome in any case, let alone in combination with SSRI. So if you are on an SSRI, its *physically* fairly safe to smoke DMT, but not physically safe to smoke it infused as changa, or consume Ayahuasca as it contains MAOI in the mix. If you are on a pharma MAOI, it may uncomfortably potentiate a psychedelic.
You should not mix DXM with any of the above discussed antidepressants. DXM is a potent nonselective reuptake inhibitor. a medicinal dose of SSRI + a recreational dose of DXM has been shown to cause ser syndrome.
Tricyclics and tetracyclics- I have been operation under the notion that if they inhibit reuptake at SERT then they presumably block effects of drugs that wish to bind there, like amitryptline is an example of this. Or in the case of mirtazipine its mostly postsynaptic binding at lower thresholds and wouldnt cause SS. But its best to research all your meds on a case by case basis regardless as these families are varied and complex in their effects.
Another thing to remember is your enzymes. A lot of drugs are metabolised by what we refer to as the P450 enzymes, an example is amphetamines or opiates being primarily broken down by CYP2D6 or CYP3A4 iirc. If your psyche med is utilising one of these enzymes (some SSRIs do) this causes competition and inhibition of the enzyme will result in an increase in blood-plasma concentration of the ingested substance as its getting broken down slower. Also for e.g. if you are on prozac and ingest an inhibitor of that enzyme (grapefruit juice is one!), you will increase the amount of prozac in your blood and thus should be avoided (prozac has actually been shown to cause SS on its own). In the case of chemicals which would otherwise not physically harm you, it can still result in an unpleasant or overstimulating experience.
Now finally, you may notice iv only touched on what is *physically* safer or less safe so far (my list of examples is by no means exhaustive, its just as a guide to what to look for when doing your own research). This does not infer psychological/mental safety by any regard. When on any psychiatric drug, you are attuning to a new neural balance. SSRI for e.g. "train" your brain into working a certain way and this effect persists after discontinuing meds, its not just a case of being on the substance.
For this reason, you must NEVER SKIP A DOSE of your SSRI to facilitate drug use. You wont even notice much increase in effects and it can throw you into early withdrawls, adding a massive hiccup in progress. Now lets say you dont skip the dose and decide to take it anyway, youre still potentially throwing a spanner in the works. MDMA causes a dump of 5HT and although itll be less than usual, you will still experience a comedown, and thats ill advised when in a mentally vulnerable state. As for psychedelics its more of a grey area but again causing an intense experience or amplifying emotional response at a time when your brain is adjusting to something else is ill advised. In any circumstance always wait until youre adjusted to the meds, ideally until youre off them.
Please do extensive research when considering taking drugs on psyche meds and although preaching abstinence isnt what we aim to do, its definitely best to avoid altogether on account of not being worth the mental health risk.
This post is by no means exhaustive, just a way-in to seeing what sort of things to look out for.
Antidepressant - drug interactions
Ok so first off, there are many different types of antidepressant. SSRIs are one of the most common but some also inhibit norepinephrene and/or dopamine, these are called SNRIs/SNDRIs/SDRIs/NDRIs. Tricyclic antidepressants such as amitryptaline have been gradually replaced by SSRIs as antidepressants, but some people still get prescribed them and they are in circulation medicinally for other uses too. There are tetracyclics too such as mirtazipine. Also MAOIs are prescribed, albeit less commonly.
There is a common misconception with regards to one of the most queried interactions: MDMA+SSRI. MDMA requires the serotonin transport (SERT) to achieve effects, SSRIs work by occupying SERT thus stopping MDMA from taking full action. This, on paper, makes MDMA+SSRI less likely to cause serotonin syndrome than the same dose of MDMA with no SSRI. However, this doesnt mean dose higher to compensate. The noradrenergic and dopaminergic aspects of MDMA do not get truncated by SSRI and thus when you up the dose youre not really adding the euphoria youre looking for, just a more edgy/stimmy experience, relatively speaking to mdma unhindered, it becomes a more compulsive substance.
NEVER UNDER ANY CIRCUMSTANCES COMBINE A SUBSTANCE THAT ALTERS 5HT (serotonin) LEVELS WITH AN MAOI. Pharmaceutical MAOIs are particularly dangerous on account of being non reversible, whereas caapi (ayahuasca vine) and such are known as RIMAs which are slightly more forgiving (but still dangerous to mix). MAOI will inhibit the bodys ability to metabolise serotonin and thus adding things like MDMA will cause the drug to have a much more potent effect and last longer, markedly increasing the chance of serotonin syndrome as your metabolism isnt clearing the synapse of excess 5HT.
Also, any drug which has MAOI properties innately should never be mixed with an SSRI (or any drug that changes 5HT levels as detailed above) unless under medical guidance. Some examples would be aMT (MAOI), 2C-t-x (MRI), ayahuasca/changa (RIMA).
Psychedelics which do not utilise serotonin (aka 5ht partial agonists like psilocybin or LSD) will not cause serotonin syndrome in any case, let alone in combination with SSRI. So if you are on an SSRI, its *physically* fairly safe to smoke DMT, but not physically safe to smoke it infused as changa, or consume Ayahuasca as it contains MAOI in the mix. If you are on a pharma MAOI, it may uncomfortably potentiate a psychedelic.
You should not mix DXM with any of the above discussed antidepressants. DXM is a potent nonselective reuptake inhibitor. a medicinal dose of SSRI + a recreational dose of DXM has been shown to cause ser syndrome.
Tricyclics and tetracyclics- I have been operation under the notion that if they inhibit reuptake at SERT then they presumably block effects of drugs that wish to bind there, like amitryptline is an example of this. Or in the case of mirtazipine its mostly postsynaptic binding at lower thresholds and wouldnt cause SS. But its best to research all your meds on a case by case basis regardless as these families are varied and complex in their effects.
Another thing to remember is your enzymes. A lot of drugs are metabolised by what we refer to as the P450 enzymes, an example is amphetamines or opiates being primarily broken down by CYP2D6 or CYP3A4 iirc. If your psyche med is utilising one of these enzymes (some SSRIs do) this causes competition and inhibition of the enzyme will result in an increase in blood-plasma concentration of the ingested substance as its getting broken down slower. Also for e.g. if you are on prozac and ingest an inhibitor of that enzyme (grapefruit juice is one!), you will increase the amount of prozac in your blood and thus should be avoided (prozac has actually been shown to cause SS on its own). In the case of chemicals which would otherwise not physically harm you, it can still result in an unpleasant or overstimulating experience.
Now finally, you may notice iv only touched on what is *physically* safer or less safe so far (my list of examples is by no means exhaustive, its just as a guide to what to look for when doing your own research). This does not infer psychological/mental safety by any regard. When on any psychiatric drug, you are attuning to a new neural balance. SSRI for e.g. "train" your brain into working a certain way and this effect persists after discontinuing meds, its not just a case of being on the substance.
For this reason, you must NEVER SKIP A DOSE of your SSRI to facilitate drug use. You wont even notice much increase in effects and it can throw you into early withdrawls, adding a massive hiccup in progress. Now lets say you dont skip the dose and decide to take it anyway, youre still potentially throwing a spanner in the works. MDMA causes a dump of 5HT and although itll be less than usual, you will still experience a comedown, and thats ill advised when in a mentally vulnerable state. As for psychedelics its more of a grey area but again causing an intense experience or amplifying emotional response at a time when your brain is adjusting to something else is ill advised. In any circumstance always wait until youre adjusted to the meds, ideally until youre off them.
Please do extensive research when considering taking drugs on psyche meds and although preaching abstinence isnt what we aim to do, its definitely best to avoid altogether on account of not being worth the mental health risk.