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Functional Medicine

The transforming magic of psychedelic mushrooms

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 “We saw unfold in our patients in 6 hours (on magic mushrooms) what we would often only see in 6 years of (traditional) therapy”
 
 

This article will go into depth on :

  • How Psilocybin, the principal component of magic mushrooms, significantly improves symptoms of depression, anxiety and addictive behaviour from a single dose.
  • The age of prohibition of psychedelics is over. Research is picking up again on psychedelics.
  • The architecture of perception and the neurology of belief.
  • The neurology of how Psilocybin alters perception and rigid belief patterns, thereby enhancing creativity, memory and abstraction ability.
  • Risks of psychedelic substances and how to mitigate them.
  • Goal-dependant dosages and drug interactions.
  • A philosophical framework to determine whether you should give psychedelics a try

 

If you like to listing to me reading this article to you, you can listen to the podcast here :
 
 
“Taking psychedelics was one of the two or three most important things I have done in my life. There are things about me that people who have not tried psychedelics – even people who know me well, including my wife – could never understand” Steve Jobs
 
 
LEGAL DISCLAIMER : 
This is not medical advice. I am in no doctor-patient relationship with my readers. I am NOT advocating for or against psychedelic substances. I am strictly against breaking any federal or state laws and I do not suggest any reader should even ponder breaking a law. All direct or indirect considerations on the use of psychedelic substances only apply for readers in countries where the use of such is not prohibited by any laws. 
 
 
I believe Magic Mushrooms, or their principal component Psilocybin, have the potential to greatly improve health and performance in a wide variety of circumstances. It can be a treatment in depression, mood disorders, anxiety, addiction and can improve performance via enhancing awareness, creativity, memory and abstraction ability.
 
 
But let us start from the beginning. Like most people I started out having a big mental drawer labeled “bad drugs”, and that is where I tossed in all substances which were prohibited, either by federal law or by the sporting organization. Drugs are bad for us, they are illegal and nobody should do them. Right? There must be a good reason behind them being prohibited. Right?
 
So there they were for most of my life. Hidden in that dusty and dark mental drawer. I think the first time I heard of magic mushrooms was when I was around 15 years old. A big old Irish friend of mine told this story of him going to Amsterdam taking them and never returning to normal life since.According to him a doctor even diagnosed “holes in his brain” years after he took them. See, thats enough to scare a 15 year old boy away from ever taking that shit.
And I think most people have a friend who has a friend who took mushrooms and never returned from that parallel universe. But are these stories rooted in reality?
 
So magic mushrooms never entered my rational mind again until when I was maybe 29. At that time I was heavily into performance optimisation via legal herbal or synthetic substances. At the same time every now and then somebody told me of their experiences with magic mushrooms. They were telling me how it “changed their perspectives”, how it helped them get rid of depression or addiction, and how it helped them to be more compassionate towards others. 
So I looked into some of the serious medical research on Psilocybin. The research actually confirms these anecdotal results. It dawned on me that the psychedelic components of magic mushrooms might provide a fast track to very similar outcomes “treatment” modalities like cognitive behavioural therapy (CBT) or meditation might provide.
 
As Rosalind Watts, clinical psychologist from Imperial College London put it : “We saw unfold in our patients in 6 hours (on magic mushrooms) what we would often only see in 6 years of (traditional) therapy”
 
In the past 10 years I have had many confrontations with clinical and subclinical forms of depression, obsessive behaviour, addiction and anxiety. Not only in the many patients who I met, but even more so in the professional athletes, who I closely work with. While clinical forms of addiction and depression are a severe illness, even the subclinical (mild) forms are powerful enough to keep you from performing at your optimum. Disease is always on a spectrum. 
 
 
Helping people to help themselves get out of the psychological vice of (even subclinical) anxiety, depression or addiction is an uphill battle. It is incredible fulfilling to make progress, but also incredibly painful when everything you are trying seems to pale in effectiveness to the rigid mental patterns that drive our daily habits and behaviour.
 
Sometimes everything you are trying to battle the vice of depression, anxiety and addiction seems to pale in effectiveness to the rigid mental patterns that drive our daily habits and behaviour.
 
Thats why it is a very emotional topic for myself to write about possible cures to dysfunctional mental patterns to either cure from the illness of clinical anxiety, addiction, or depression, or from the performance-limiting effects of subclinical rigid mental patterns. I have to say I am not surprised to find that one of the possible cures has been right within our reach for centuries and even millenia. It has been part of our human existence for the better part of the existence of our species. Only recently have we turned our backs on it. It is an exciting journey for me to shed a little light on the controversial topic of psychedelic drugs.
 
 

Research into Psychedelics

Pioneering Research Era (1947-1971)

 
Psilocybin has first been isolated from the Psilocybe Mexicana mushrooms by the swiss chemist Albert Hofmann. Thats the same guy who synthesised LSD for the first time. 
 
Between 1950 and 1965 around 40.000 patients have been prescribed Psilocybin and LSD (which is a chemically close relative to Psilocybin) as treatments for schizophrenia, neurosis, anxiety and depression. During that time over 1000 scientific studies had been published on LSD and Psilocybin and six international conferences were being held. It was described as the “next big thing” in psychotherapy and psychiatry.
 
In all fairness, that was also the time, when Walter Freeman drove around the United States in his “Lobomobil” and performed up to 10 lobotomies per day for 25$ a pop. It was a widely accepted treatment for several mental disorders. He basically put the patient to sleep with three heavy  electric shocks, then fiddled a small icepick up the patients eye socket and stirred it around the patients pre-frontal cortex.

 

The Lobomobile

 
This left the patient (if he survived) smiling, happy and intellectually “limited”. He called this “surgically induced childhood” and it freed the patients of all difficulties of adulthood…and any form of intelligence. It is not difficult to imagine that the advent of selective psychiatric drug-based therapy was highly welcomed.
  
Interest in psychedelics as medicine expanded to the US mainstream in the 1960s with the Harvard Psylocibin Research project under Dr. Timothy Leary and Dr. Richard Alpert. During that time LSD and Psylocibin were completely legal substances.
 

The results of most of these studies were incredible. One one time administration helped rock-bottom alcoholics never touch alcohol again, it helped patients with depression recover within days and people with anxiety and neurotic disabilities were completely free of any symptoms even months after a one time treatment with psychedelics. Granted, the studies which were done at that time did not have nearly the necessary scientific standards to warrant widespread therapeutic use of psychedelics nowadays. 

 
The main drawback of almost all studies done in the 1950’s and 1960’s is a lack of control groups and inadequate follow-ups. 
 
Nonetheless the results were promising enough to at least do further research. But that came to an abrupt end.
 
 

The scientific dark ages (1972- ca. 2006)

 
In 1972 US president Richard Nixon launched the widespread “War on Drugs”. This was rather politically motivated than scientifically. Nixon ran for president in 1968 and became president between 1969 and 1974. Those were the high times of the hippie movement, the left student protests and the african-american civil rights movement.
 
John Ehrlichman was Nixons adviser for national security during that time and belonged to his inner circle. When he was interviewed by journalist Dan Baum in 1994 about the motivations of the “War on Drugs” he said :
 
“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana (and psychedelics) and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”
 
Thats heavy content, but…I am not surprised.
 
Scientifically some studies from that time postulated that psychedelic drugs (specifically LSD) can alter genetic information in white blood cells and can have mutilating effects on the fetus when taken during pregnancy. This came at a time when the Contergan scandal was still in everybody’s mouths and therefore understandably lead to a big media outrage that was the wind in the sails of the “war on drugs” with regards to psychedelics.
The old studies that postulated the genetic modification of psychedelics have since been reviewed and replicated several times and modern research came to the conclusion that psychedelic drugs do not have any modulating effect on genetic material. 
 
Also the public concern of psychedelics inducing lasting states of psychoses could not be confirmed. A recent large-scale study came to the conclusion that use of psychedelics is not correlated to an increased development of psychoses compared to non-drug users.
 
“The Medical History of Psychedelic drugs”, published by the University of Cambridge, which can be found the Homepage of the Multidisciplinary Association for Psychedelic Studies (MAPS), gives a great scientific overview of all the evidence that led up the point where we are now.
 
After a recent thorough review of all the evidence psychedelic drugs are nowadays being considered as a very safe drug and the research on psychedelic drugs was picked up again in the beginning of the 2000’s.
 
 

Recent Research

 
The Johns Hopkins Psilocybin Research Project has been studying the effects of psilocybin in various people for the past 15 years. Since then it has only published positive outcomes with only mild adverse side affects so far.
 
In one of their first publications they have studied the effects of Psilocybin on healthy adults. Out of the participants of that study 80% reported the Psilcyibin trip to be one of the top 5 personal meaningful and spiritually significant events of their life! About 50% reported it to be the MOST significant event of their life in a positive way, rating it more significant than the birth of their first child or the day of their marriage. 90% reported increased life satisfaction, positive behavioural change, increased positive mood and improved social relationships. The Johns Hopkins team conducted structured interviews of friends and family and they confirmed the positive impact Psilocybin had on their loved one. These effects all lasted for at least 14 months. They took 5, 10, 20 and 30mg Psilocybin in either ascending or descending dosage (randomised trial) every 4 weeks. 
 
When you look back on your life so far, what single event comes to mind, that had a lasting positive effect on you? It is incredible to think of a 6 hour experience of lying on a couch (the research subjects took Psilocybin and then rested on a couch for 6 hours) having a lasting positive effect on your mood and social behaviour. 
 
The Johns Hopkins Research Team went a step further and looked at the effect of Psilocybin on addictive behaviour in otherwise healthy individuals. They gave 15 heavy smokers (six failed cessation attempts, 1 pack/day for >30 years) a single dose of 30mg of Psilocybin. They looked at urinary cotinine (drugtest for smokers, as cotinine is a metabolite of nicotine) to validate their results. After 6-months 80% of them reliably stopped smoking. 80% is an incredible success rate. The most efficient smoking-cessation programs available to us today have a success rate not exceeding around 30%! 
 
When they administered Psilocybin to terminally ill cancer patients that suffered from depression and end-of-life anxiety in a randomised double-blind clinical trial 92% of the patients showed clinically significant improvements 5 weeks after taking a single dose and 78% still showed significant improvements at 6 months after taking a single dose of either 20 or 30mg Psilocybin.
 
Just in 2016 an English study from Imperial College London, reported an about 50% reduction of symptoms at 3-months follow up inpatients with treatment resistant depression. Thats after taking only a single dose! No other drug I know of has this effect. 
 
Up to this point all other pharmacological treatments for depression consist of daily administration of powerful drugs like SSRI’s, which have severe and debilitating side effects. These include insomnia, sexual dysfunction, And taking SSRI’s is not a cure. It is a palliative treatment. You stop taking SSRI’s and the depression comes creeping back.
 
Most of these studies on Psilocybin were pilot studies that warrant further investigations.
 
Craig D. Blinderman, director of the adult-palliative-care service at Columbia University Medical Center/New York-Presbyterian Hospital and an associate professor there, explains the stakes:
 
If these findings are confirmed, or other therapeutic effects are demonstrated, in large, powered, randomized controlled studies in a diverse population of patients, then the classification of psilocybin as a Schedule 1 drug should be challenged, for this would represent a treatment modality unlike anything in psychiatry: a rapid and sustained reduction in depression and anxiety with a single dose of a psychoactive compound (combined with guided psychotherapy).
 
 
 

The Physiology of Psilocybin

 
Psilocybin belongs to the class of the classical hallucinogens, sometimes also called psychedelics (revealer of the mind), psychotomimetics (psychosis-mimicking), or entheogens (inducer of mystical experience). The classical hallucinogens consist of two subgroups of alkaloids. The three tryptamines (lets call them TRIP-tamines) LSD, Psilocybin and DMT, and the phenethylamines, including mescaline (the principal component of the peyote cactus),
 
For our discussion we will focus on the TRIP-tamines, primarily Psilocybin. LSD and DMT have a very similar chemical structure and physiological effect albeit in different doses and forms of application. 
 
The target of the TRIP-tamines is the 5-HT2a receptor. 5-HT is short for serotonine (5-hydroxytryptamine). So Psilocybin and its friends (LSD and DMT) connect to one of the main serotonine receptors in our brain. This releases the neuronal inhibitor GABA, which leads to reduced activity in several neuronal areas including the thalamus and prefrontal cortex.
 
Understanding the role of the thalamus and the prefrontal cortex holds the key to our understanding what Psilocybin does with our brain biochemistry, and ultimately our psyche. Psilocybin basically puts these areas to sleep for a couple of hours, as several fMRI studies have confirmed. This leads to a state of “unconstrained cognition”, as the researchers put it.
 
Understanding the functional roles of the thalamus and the prefrontal cortex will help us understand why Psilocybin has the ability to help us transcend our engrained patterns of belief and help us gain true insight about ourselves and our environment.
 
 

Thalamus – Gate of Consciousness

 
The thalamus has a crucial role in connecting our subconscious with our conscious. This is already implied by its anatomical position.
  
Our brain is basically made up of three different layers. The reptilian layer (our instincts), the paläomammalian layer (our emotions), and the neomammalian layer (our cognition). In each evolutionary “stage” a new layer was added.
 
 
 
The reptilian layer is made up of our spinal cord and the brain stem. The information of most our bodies senses (except smell) enter the brain stem first. There the most relevant information for immediate survival is processed (temperature regulation, breathing and cardiac oscillations, primitive reflexes like patella reflex or sucking and grasping reflex, some gait reflexes). Reptiles only have this part of the nervous system. They lack any higher layers of brain development. And we inherited that part from reptiles. Thats why its called the reptilian brain.
 
 
In later evolutionary stages (early mammals) social structures and the motivation for feeding and caring for other mammals of the same species evolved. Thats what the paläomammalian layer, also call the limbic system, is for. It would act as a gateway and would only let sensory information that is emotionally relevant to us enter higher levels.
 
In a way the limbic system is the master regulator of bottom-up (coming from our senses) information. And thats exactly where the thalamus is located. It is just between the reptilian brain and the higher layers of limbic system and neocortex.
 
The thalamus is the master hub of information.
 
Below the thalamus sits the sensory information and above sits the prefrontal lobe. When thalamic activity is reduced all sensory information can enter our conscious at once. Imagine you see, hear and feel everything at once. What if we were looking through the key-hole most of our lifes, and now we open the whole door?
 
The following picture is a piece of art inspired by a psychedelic experience.
Is this what the world REALLY looks like without the thalamus keeping 90% of information from us??
 
 
 
 

 

The Architecture of Perception

We do not see the world for what it is. We see the world the way we interpret it. We see the world the way our thalamus wants us to see the world. In a way our emotions form the way we see the world via selective filtering and data manipulation by the thalamus. In technical terms this is called predictive processing.
 
Predictive processing forms our reality via the combination of two pathways. The first is taking in only the information of our senses and forming a picture of reality. This is called bottom-up processing. The other is looking at our internal state, our emotional state, our past experiences, our beliefs, out fears, our hopes, and from that it forms predictions about reality. This is called top-down processing. Both processes are combined and through bayesian modelling form a hierarchy of whats most likely to be true. This is our reality.
 
 
 
 
 
 
Your brain does not create your “reality” with only the unfiltered information of all your senses. That would be mayhem (thats called autism). Your brain selectively filters bits of information and combines it with your past experiences and your beliefs to create a reality that is very relevant to you. It creates a very limited but very practical reality for you. A reality that is optimised for your survival and fitness.
 
To get idea of the limitation of our individual reality here are some numbers. Our retina can perceive around 10 million bits of information per second. The bit rate of our other senses (hearing, feeling, smelling) can only be estimated, but easily exceeds another 1 million bits per second. From several experiments it has been deduced that our brain is only able to process around 200 bits per second. That is only 0,0018% of what our senses are perceiving. Our human interface with reality is just a tiny bottleneck.
 
 
The incredible part is that our final conscious reality is obviously not only 200 bits per second. That would be terrible. Remember the old 56k modems? They had 56.000 bits per second and it took them 20 seconds to load a regular text-based homepage. Our reality is far more complex than that. Our beliefs, past experiences and expectations about reality blow our reality up to the complex thing we perceive it at, with the sole purpose of increasing evolutionary fitness to survive. So we have this super complex perception of reality with everything we feel, see, hear and smell, but only a fraction of it is comprised from objective data. The rest is a supplemental simulation.
 
Our idea of the world is like a map. It helps us navigate. It is a representation of the world. But it is not the world.
 
 
Answering the question of why this simulated reality is useful for humans, Donald Hoffmann, cognitive scientist at UC-Irvine says :
 
There’s a metaphor that’s only been available to us in the past 30 or 40 years, and that’s the desktop interface. Suppose there’s a blue rectangular icon on the lower right corner of your computer’s desktop — does that mean that the file itself is blue and rectangular and lives in the lower right corner of your computer? Of course not. But those are the only things that can be asserted about anything on the desktop — it has color, position, and shape. Those are the only categories available to you, and yet none of them are true about the file itself or anything in the computer. They couldn’t possibly be true. That’s an interesting thing. You could not form a true description of the innards of the computer if your entire view of reality was confined to the desktop. And yet the desktop is useful. That blue rectangular icon guides my behavior, and it hides a complex reality that I don’t need to know. That’s the key idea. Evolution has shaped us with perceptions that allow us to survive. They guide adaptive behaviors. But part of that involves hiding from us the stuff we don’t need to know. And that’s pretty much all of reality, whatever reality might be. If you had to spend all that time figuring it out, the tiger would eat you.
 
If our reality is just a desktop interface, a simplified representation of the super complex objective reality, it is easy to understand why it is useful. But is also easy to understand where it could mess up. Imagine you want to start Internet Explorer on your Desktop. You click on the IE icon but your computer launches your system settings. Everytime you click on the Internet Explorer Icon your computer opens system settings. That sucks. This mismatch makes it hard for you to live a normal life. It would be great now if you had contact to the objective reality to really launch Internet Explorer. But you only have that narrow and incomplete desktop interface. And thats messed up right now. We should be able to fix that, should we?
 
Maybe psychedelic drugs give us the ability to look past that interface for a short period of time to find out where the connection went wrong. Maybe it gives us the ability to debug dysfunctional connections, dysfunctional personal beliefs about reality. Maybe Psilocybin turns off the firewall for a couple of hours and lets us see and the feel the world for what it really is, and not just what our thalamus’ interpretation of the world is?
 
 
 
 

Prefrontal Cortex and the Default Mode Network – The Creation of “Self”

 
The thalamus is only one part of the “firewall”, the filtering bottleneck layer that sits between us and objective reality. The second part of the neuronal basis for this interface with reality is the Prefrontal Cortex (PFC) and the Default Mode Network (DMN).
 
The main role of the prefrontal cortex is executive function. Executive functioning the combination of all cognitive processes that help us navigate the world via planning and problem solving. The basis of planning is our ability to delay gratification. When we are offered a single dollar NOW or twenty dollars tomorrow, our prefrontal cortex is able to make the decision to take the twenty dollars tomorrow. The prefrontal cortex has learned that we exist not only in this moment, but also tomorrow and long after that. With that knowledge delaying some gratifications makes perfect sense. Delayed gratification is something reptilians and amphibians are not capable of. And even in humans this is a learned behaviour that is not present from birth. Performing the same experiment with cookies a small kid will always want to have one cookie NOW instead of 5 cookies in ten minutes.
 
The neurology, benefits and pitfalls of delayed gratification for a fulfilling, healthy and valuable life are an article in itself I might want to write at a later point.
 
The prefrontal cortex (PFC) and the default mode network (DMN) also model beliefs about the world from all the experiences we collected. It creates patterns and mental sets. When you are a new born you see faces sitting on top of a T-Shirt. Really weird. Than you see somebody take of that T-Shirt for the first time and realize “Oh that is a human body wearing a T-Shirt”. Got it. Downloaded. From that point on you can always assume that there is a body under that T-Shirt even if you don’t see it. It is a fair assumption to make and it makes your life a lot easier. As you grow through life you learn many patterns and assumptions. On your first encounter with a vacuum you were scared to death. But then you learned that your mother controls the vacuum and not vice versa. You made the assumption that all vacuums are in our control and safe. And that makes your life a lot easier. You learned that a green light generally means that you can cross the street, that a smile means “Friend” and a raised fist means “Enemy”, and you learned the patterns of language and that the combination of sounds that makes the sentence “This is hot, do not touch it” should have you avoid touching the stove. All these assumptions and beliefs about the world are stored and retrieved with the help of your prefrontal cortex and Default Mode Network (DMN).
 
 The combination of these stored patterns forms your beliefs and mental sets about YOURSELF, OTHERS and THE FUTURE.
 
 
Your experience and learned patterns are different from the experiences and learned patterns of others. The unique combination of patterns of belief makes us individuals and different from each other. Our varying believes and experiences make interacting with each other worthwhile. If everybody had the same patterns of thought, belief and behaviour communication would be very dull.
 
Our patterns of belief shape our thoughts about the world. They shape our behaviour in the world.  According to the self model theory of subjectivity (SMT) the unique pattern of experienced belief is what makes you an individual, it is the basis for your “ego”. The prefrontal cortex and the DMN are therefore the primary home of our sense of self. It is our “ego”, our interface with the world, that sits -like a protective layer-, like a firewall, around our subconscious being. And this firewall is largely created by patterns, mental sets and assumptions that we created from our experiences.
 
Psychedelics show you what’s in and on your mind, those subconscious thoughts and feelings that are are hidden, covered up, forgotten, out of sight, maybe even completely unexpected, but nevertheless imminently present. Rick Strassman (MD and psychedelic researcher at UC-San Diego)
 
 
I think it is not a coincidence that people suffering from depression describe it as being “like locked up”, “in prison”, “distanced from others”. Maybe they are describing the firewall of their PFC and DMN. This firewall became so strong to protect them from emotional harm that it locked them away in a cage. It prevented them from emotional harm, but it ultimately also prevents them from feeling anything or interacting with others and the world.
 
 “Its not the mushroom that unlocks the patients from depression. Its the patient. The mushroom just shows them they key.” – Rosalind Watts-
 

A psychedelic experience is a journey to new realms of consciousness. The scope and content of the experience is limitless, but its characteristic features are the transcendence of verbal concepts, of spacetime dimensions, and of the ego or identity. Of course, the drug does not produce the transcendent experience. It merely acts as a chemical key — it opens the mind, frees the nervous system of its ordinary patterns and structures. – Timothy Leary
 
 
To summarise Psilocybin has the combined effect of reducing our sense of self (Ego), our need to categorise things in good vs. Bad, reducing our thalamus’ filtering mechanism, bringing down our firewall, turning off the desktop interface to see and feel the world for what it really is, letting go of all preconception and expectations about the world, others and ourselves and resetting our set beliefs about others, the world and ourselves. It gives us the chance to re-evaluate all assumptions and patterns we created from our experiences.
 
The influence of Psilocybin on communicative pathways of the human brain
 
 
Psilocybin reduces and regulates the activity of the Prefrontal Cortex and the DMN. When we trip, our default mode network slows down. Our brain then lets go of all “normal” paths of communication and brain areas become connected which are normally not in communication with each other. With our ego out of commission, the boundaries between self and world, subject and object dissolve. We are freed of our rigid mental sets and are given the chance of true insight. This sounds beautiful but also scary at the same time!
 
Lets look at the possible dangers.
 
 
 

Possible dangers of Psilocybin (and how to manage them)

 
Psilocybin is a powerful substance. Like all substances that have a relevant effect on our physiology it carries risks. These risks are mostly associated with irresponsible use or not knowing of interactions with other drugs.
Overall Psilocybin is considered to be one of the safest recreational drugs. Results from the global drug survey conducted in 2017 showed that only 0,2% of the 28.000 people who reported the use of magic mushrooms had to seek medical attention. Mostly only for transient psychosis which did not last longer than 48 hours. This was only a survey and does not take into account any psychological problems these substance users might have experienced long after the initial dose.
 
 
 
Dr. Griffiths, the director of the Johns Hopkins Psilocybin Project, states that in 15 years there was not one case where a patient was in a critical physiological or psychological condition when they administered Psilocybin to patients. Some patients report mild transient headaches, nauseau, and anxiety when the first hallucinations set in. But nothing of serious concern ever happened.
 

Physiological Toxicity

The direct effects of Psilocybin on our non-psychological physiology are very well studied. In short, they are almost non-existent.
 
The physiological symptoms that may occur are transient dizziness, weakness, tremors, nausea, drowsiness, paraesthesia, blurred vision, dilated pupils and increased tendon reflexes.
 
Pulse rate and diastolic and systolic blood pressure may also rise (possibly psychosomatically triggered).
If you suffer from hypertension (systolic >140mmHg and/or diastolic >90mmHg) you should make sure that you manage your hypertension first, by addressing your nutrition and your daily movement. The lazy and not so optimal route to reducing hypertension can also be to take anti-hypertensive drugs. Consult with your physician to manage your blood pressure before taking Psilocybin if you want to take the pharmacological route.
 
Overall “the physiological effects are relatively unimpressive even at doses yielding powerful psychologic effects” (excerpt from Human Hallucinogen Research : Guidelines for Safety)
 
The physiological toxicity is not comparable to that of other substances like MDMA, or Ecstasy, which have a powerful (and possibly harmful) effect on cardiac rhythm, the sympathetic nervous system, blood coagulation and hydration status.
There are no such toxic effects occurring with the use of Psilocybin. Almost all physiological effects mentioned before are attributed to the powerful sensual effects of Psilocybin.
 
There is also no risk of dependence. There are no withdrawal symptoms and no post-trip crash as there is with many other drugs. Users of magic mushrooms even tend to only use the drug only very occasionally (once a year to once a month).
 
“If you get the message, hang up the phone.” – Alan Watts on the non-addictive nature of psychedelics.
 

 

Drug Interactions

While Psilocybin is relatively harmless on its own it can have severe drug interactions with other drugs. Since Psilocybin is a powerful agonist at the 5-HT receptor group, all other drugs that directly or indirectly interact with that same receptor-system pose a serious threat when taken simultaneously with Psilocybin.
 
 
 
SSRIs & SSNRIs
Fluoxetine (Prozac), Fluvoxamine (Luvox) , Escitalopram (Lexapro), Paroxetine (Pexeva), Citalopram (Celexa), Sertraline (Zoloft), Venlafaxin (Effexor), Duloxetin (Cymbalta)
 
 
The first group of drugs that should be avoided when taking Psilocybin are the SSRI (selective serotonin re-uptake inhibitors) group of anti-depressants. When taking SSRIs and Psilocybin simultaneously (within 5 days) the serotonine system can get overloaded which can lead to serotonine toxicity syndrome. This is a serious medical condition of increased agitation, body tremors, profuse sweating, increased core temperature, accelerated heart rate and can result in seizures and even cardiac arrest. It is highly advisable to not take SSRIs and Psilocybin within the same time frame of 5 days. When you are taking SSRIs consult your psychiatrist before tapering off SSRIs as it can be dangerous to just stop taking them. It can result in serious withdrawal symptoms for weeks. SSRIs are crazy drugs and you should not mess with them unless you have to and always consult an expert beforehand.
Chronic use of SSRIs can decrease your sensitivity to Psilocybin. So even if you taper off to take Psilocybin, the SSRIs still mess with your trip. Many people who are on regular SSRIs report little to no effects when taking magic mushrooms even weeks after tapering completely off of SSRIs. It is not advisable to just increase the dose of magic mushrooms to cross the “threshold”. When you are off of SSRIs for 6 months your serotonin system should be re-sensitised and you can experience a full Psilocybin trip with a regular dose of mushrooms.
 
 
 
Tricyclic Anti-Depressants and Lithium
Clomipramine (Anafranil), Imipramine (Tofranil), Trimipramine (Surmontil), Amitritpyliine (Elavil)
 
 
These prescription anti-depressants are not being used so much anymore. They have mostly been replaced by the SSRIs and SSNRIs. But in case you are on Tricyclic Anti-Depressants or Lithium it is important to know the the chronic use can increase the effect of Psilocybin to dangerous levels. You should not be taking magic mushrooms when you have taken Lithium or Tricyclic Anti-Depressants in the last 6 months.
 
 
 
Monoamine oxidase inhibitors (MAOIs)
Selegiline (Zelapar, Eldepryl, Emsam), isocarboxazid (Marplan), tranylcypromine (Parnate), Phenelzine (Nardil)
 
 
This class of drugs inhibits the breakdown of serotonine. Chronic use of MAOIs decreases the effect of magic mushrooms, while acute use of MAOIs with magic mushrooms poses a serious health threat.
MAOIs are not only found in anti-depressants, they are also one of the two principal components of Ayahuasca, the “drink of the gods”. The active ingredient in Ayahuasca is DMT, but since DMT is not orally active it is combined in combination with MAOIs, which inhibit the enzyme that would normally break down DMT in our stomach and small intestine.
Therefore you should not combine Ayahuasca with Psilocybin. If you are taking MAOIs, make sure you are tapering off of them before taking Psilcybin.
 
 
 
Antipsychotic medication
Haloperidol (Haldol)
 
 
Some sources recommend using the anti-psychotic Haloperidol to stop a “bad” trip. This totally not recommendable as Haloperidol can increase the effects of Psilocybin.
 
 
 
 
Recreational drugs 
MDMA, Ecstasy, Mescaline, Alcohol, Marijuana, Cocaine, Ritaline,…
 
 
It is not recommended to combine Psilocybin with any other recreational drugs. Some recreational drugs (especially MDMA, Ecstasy and Mescaline) act on the serotonine receptors, which can lead to serious complications when combined with Psilocybin, while other recreational drugs just dilute the clear messages that Psilocybin can send.
 
 
 
 
Nutritional supplements
St.Johns wort, 5-HT, Ginseng, Resveratrol, Gingko, Garlic
 
 
Nutritional supplements which have a strong interaction with monoamine-oxidase inhibition, CYP450 enzymes or serotonine should not be consumed with psychedelic drugs.
 
 
 
 

Psychological Toxicity

The psychological toxicity of Psilocybin is a lot harder to define. To clearly define a toxic psychological effect one would need clear standards of what a healthy psyche is like. Psychiatric definitions of illness and health are not without controversy, but for this discussion we should stick to general psychiatric definitions when it comes to illnesses.  While we have established some boundaries left and right of what an ill psychological environment is like, the wiggle room in the healthy middle is large. I think we can all agree on not wanting to be at the left or right extremes of psychiatric sickness (be it mania, psychosis, schizophrenia, depression).
 
 
But what about the area in the middle? Everybody has his spot somewhere. Do you see other individuals on that spectrum that may be healthy by definition, but you might think they are ill? What does a CEO of a Forbes500 company think about the mental well-being of a nomadic street musician or vice-versa? What do you think of the mental well-being of Russell Brand, David Bowie, Bob Dylan, Steve Jobs, Donald Trump, Tom Cruise, Justin Bieber, Taylor Swift, Elon Musk, your father, your mother? While they might all be completely healthy by medical psychiatric definition they are on completely different spots of the “healthy” spectrum.
 
For example :
Psilocybin increases the personality trait of “openness” with effects lasting well over a year. This has been shown by a study from Johns Hopkins University in 2011. This is really fascinating because previous research has indicated that personality traits are fixed by age 30. After you turn 30 your personality is supposedly completed and you don’t change much is what was previously believed. Also the general flexibility of personality is highly debated.
 
Now Psilocybin has the power to change what was previously considered to be rigid. It increases openness. Openness includes a relatively broad range of intercorrelated traits covering aesthetic appreciation and sensitivity, fantasy and imagination, awareness of feelings in self and others, and intellectual engagement. People with high levels of Openness are “permeable to new ideas and experiences” and “motivated to enlarge their experience into novel territory”. Openness is strongly associated with creativity, and some of its facets (Ideas, Values) are correlated with general fluid intelligence and cognitive ability.
 
Fluidity in personality does sound like a great thing, and I think in general it is. It helps people to be more true to their authentic identity, but it can have its drawbacks in some cases. While openness improves performance in some types of jobs, it is not optimal in other types of jobs or situations. 
 
What I am saying here is that being healthy is a wide definition and all psychiatric and psychological interventions have the potential to change the location of a person on that healthy spectrum. This in itself can be considered a relative psychological risk. What if you are the manager of a Forbes500 company with a wife and three kids, and all of a sudden your beliefs switch to that of a nomadic street musician. Or vice-versa. What do you do? You are not sick, but your life while be upside down.
 
Aside from that relative risk, I think there are two major risks to be considered when it comes to psychological safety while, or after taking Psilocybin.
 
1. Self-Harm because of hallucination
2. Unleashing the demon
 
 

Self-Harm during hallucination 

The hallucinations associated with Psilocybin are by definition pseudo-hallucinations, because you are at all times aware that you are still rooted in reality. In a real hallucination you are 100% certain that you see spiders on your arms. In pseudo-hallucinations you see spiders on your arm, but you know it is a hallucination. When you are able to acknowledge it to be a hallucination it becomes a pseudo-hallucination. Yeah, you have noticed it is very blurry line between those two. But a very important one. A pseudo hallucination of you walking on clouds can be an incredible experience, while a sincere hallucination of you walking on clouds can cause you to jump out of your window.
 
Fortunately this risk can be easily mitigated by always having at lease one “sitter” with you when you take Psilocybin. Sitters are people that you fully trust and feel comfortable with who accompany you on your psychedelic experience, while staying completely sober themselves. The role of the sitters is to keep you from harming yourself.
 
While the risk of you doing something that could harm you while on Psilocybin is in itself very low, a sitter is reliable safety net, whose role it also is to assure you to accept and surrender to all images and messages of the mushrooms instead of trying to fight anything. So when you see a monster you don’t want to run away from it, but you want to welcome it and ask it why it is there. What is it afraid of? A good sitter can assure you that the monster cannot hurt you, so you might as well treat it with curiosity. You might find out something life-changing.
 
To optimize a psychedelic experience you should stick to the 6 S model of psychedelic use. The Johns Hopkins research team also stuck to that model. That is why their research lab looks more like a comfortable living room.
 
The psychedelic research lab of Johns Hopkins University
 
 

 

Unleashing the demon

 
Imagine your subconscious as a huge basement with many different rooms. Some are clean and brightly lid, some are nicely arranged, because you have been down there recently and cleaned up some old shit. Some rooms are still messy, but you are determined to clean those up in the next months. There are some rooms where the light is broken, some are chaotic, in some you store the stuff that you have no place for in other rooms.  You have some rooms without doors that you regularly walk in to, because there you store some stuff you need in your daily life. But there are also some rooms that haven’t been in in years. Some rooms have doors to which you have somehow lost the keys. And there are some rooms which you locked on purpose. Some are even locked by massive wooden planks and protected by guards with heavy weaponry.
 
Taking high doses of psychedelics basically opens all these doors for several hours. Depending on whats hidden in these rooms this can be a terrifying experience. There can be incredible trauma locked behind these doors. I don’t suggest taking psychedelics if you haven’t undertaken other measures of cleaning up those individual rooms.
 
Whats down in that basement? Maybe its time to clean up and install some lights?
 
 
Meditation can be a great way of addressing one room after the other. It equips you with strategies to enter these rooms with curiosity instead of fear or aggression. Meditation can bring some light into these rooms and prepare you for a psychedelic experience. I highly suggest you do at least 100 hours of some form of meditation before indulging in psychedelics. A good start can be to download an app like “Headspace” and run through their 30 introductory and guided meditative sessions.
 
Going into a psychedelic experience without having the right tools to handle different encounters can result in negative experiences ranging from “bad” trips to lasting psychoses. Its like parachuting into the jungle without a knife and a firestarter.
 
A previously mentioned large-scale study concluded that Psilocybin does not significantly increase the onset of a lasting Psychosis, but I still want to address this issue.
 
The main effect of Psilocybin is that it induces a 4-6 hour transient psychosis. Thats what it does. Thats where its therapeutic power lies. A transient psychosis is a lot different from a lasting psychosis, though.
Psychosis is by definition an abnormal condition of the mind that involves a “loss of contact with reality“. People experiencing psychosis may exhibit personality changes and thought disorder.
This thought disorder and loss of reality is where the magic of Psilocybin lies as we discussed in previous pages. But the key is that it only lasts for 4-6 hours and then we are completely back in reality. We do not want this state of psychosis to be lasting any longer.
 
Now what might be possible risk factors of a psychosis lasting longer because of Psilocybin?
 
One established risk factor is a genetic predisposition to schizophrenia. Consumption of psychedelic drugs is associated with earlier onset of schizophrenia in genetically predisposed individuals. For people with first or second degree relatives with schizophrenia or bipolar disorder it is not recommended to take psychedelics. The risks are very low even in these people, but it has to be carefully evaluated if the cost/benefit ratio is worth it in this case.
 
 
Another risk factor for a “bad” trip or rating the overall Psilocybin experience as negative is a low score in the personality traits of “Openness” (and a high score in “neuroticism”). This is based on the Big Five Personality test. You can easily do that test online in 30 minutes. 
 
 
Now this is a double-edged sword for me, as on one side Psilocybin has been shown to increase openness, on the other hand it has been shown that reduced openness can be a predictor of a bad trip. Maybe it is like strength training. Strength Training is good for weak muscles, because it makes them stronger. But also the weaker the muscle is, the more it will be sore after strength training. The key might be to find the minimum effective dose. 
 

Dosage

In general there are three approaches to consuming Mushrooms, or Psilocybin. The first approach, Microdosing, is being used to increase creativity, abstraction, memory and empathy while still being able to go about a normal (business) day. The recreational dose creates pseudo-hallucinations without loss of reality, “ego death”or mystical experiences. The therapeutic dose is in the range being used by clinical studies to break conventional patterns of thought and gaining new insight to liberate parts of you that have been locked. Lastly, the heroic dose is being used to have deep spiritual and mystical encounters.

 

 

Microdosing

Many people have successfully used Microdosing to treat their depression or addiction. In the entrepreneurial scene Microdosing is also a widely spread practice, because of its ability to free you from rigid patterns of thought and find new solutions to old problems. Take for example this exercise :

 

I want you to draw a square with three straight lines.

 

There are at least two solutions to this simple problem. If you have already found both solutions right away you might not need microdosing to improve your creativity. If you haven’t, there might be some learned boundaries that hold you back from creating solutions.

 

Solution #1 : “with” vs. “by”

The exercise asked for a square WITH three straight lines. Not BY using three lines. Just as in “I go to the coffee shop with Lindsey”. Me and Lindsey go together. I do not use Lindsey to get to the coffee shop. When you have been asked similar things in the past it was implied that “with” means “by” in that certain case. Your brain did what it does best. It created a pattern. It induced a general rule from this specific case. But while these general rules might be true in 90% of cases in this specific case it was not true. A pattern that made life easier 90% of the time was holding you back in just this case.

 

 

 

 

Solution #2 : No one said “only”

No one said “only”. You can use as many lines as you want. Four is probably the weapon of choice to draw a square. Same thing here. You assumed that the exercise meant “only” three straight lines. Your brain is great at assuming. Again, these patterns make life easy. But you know what they say about the word ASSUME. When you ASS-U-ME you might make an ASS out of U and ME. This learned pattern of assumption helps us 90% of the time and holds us back in these instances where creativity is necessary. One could argue that creativity is nothing more than looking past our learned patterns of thought.

 

 

 

Solution #3 : Let the mushrooms guide you

I do not have a third solution. But maybe there is one. I am just too rigid to find it or know it. Do you have one?

 

With Microdosing the effect of enhanced creativity, memory and empathy last for around 6 hours, but consumers report and “afterglow” effect that can last for around 48 hours. They usually take small amounts on Day 1, but feel even better on Day 2. Most “Microdosers” are on a 1 ON, 2 OFF protocol. They take mushrooms one day, have another day of afterglow and then one day off of mushrooms before they start again. One reason for that is that Psilocybin itself is not the drug that makes you high. It is your bodies own serotonine which gets released by ingesting Psilocybin. Serotonine has to be re-synthesised in the body before Psilocybin can have its effect again.

A typical dose for Microdosing is 0.2g – 0.5g of dried mushrooms. The amount of Psilocybin in the mushrooms varies greatly. More so by the amount of nutrients and humidity in the soil than by the various strains of Psilocybe mushroom. So you shouldn’t rely on knowing the strain to exactly gage the effect it will have on you. It is recommended to start with 0.2g and increase by 0.1g every fourth day until you feel the heightened awareness and creativity.

 

 

Recreational Dose 

A common dose for healthy individuals to experience psychedelic effects without having any specific therapeutic goal is in the range of 6-20mg of pure Psilocybin. This is equal to roughly 1,5g – 3g of dried mushrooms. Again, it is advisable to start on the low end and slowly increase the dosage. Most people recommend doing a psychedelic sessions once a month. One could start with 1,5g and increase by 1g every 4 weeks.

 

 

Therapeutic Dose

In most of the studies done on the effect of Psilocybin on depression and addiction, dosages of 20mg – 30mg of pure Psilocybin have been used. This is equal to roughly 3-6g of dried Psilocybe cubensis mushrooms. You should definitely have at least on “sitter” that takes care of you during the session and respect the 6 “S” of psychedelic use.

 

 

Heroic Dose

Terence McKenna, an ethnobiologist who popularised a lot of the recreational and spiritual use of psychedelic mushrooms in the industrial nations, recommended to take a “Heroic Dose” for deeply mystical and spiritual experiences. A heroic dose would be north of 6g of dried mushrooms. In general this NOT recommended as a recreational dose for people without very sensible spiritual goals and a lot of previous psychedelic experience. 

 

 

The Apple of truth : Should you eat the forbidden fruit?

When Adam and Eve were in the garden of Eden they were supposedly in paradise. They were naked and lived in a state of innocent obedience to god. They could do almost everything they wanted. The only thing they were not allowed to do is to eat from the tree of knowledge. God told Adam and Eve that if they were to eat the fruit from the tree of knowledge they would die.
 
A snake approached Adam and Eve. Seemingly this snake know something about the forbidden fruit. The snake convinced Eve to bite in the apple of truth. It said : “When you bite in the fruit you will not die. Your eyes will be opened. You will be like gods yourselves, knowing the truth of good and evil (everything)”
 
Adam declined, but Eve was intrigued. She bit in the apple and convinced Adam to taste the fruit as well.
What happened next? Did they drop dead biting the Apple of Truth? No they did not. Their eyes were opened just as the snake predicted. All of a sudden their nakedness appeared to them. They quickly started to grab fig leaves to cover themselves up, as they felt embarrassed by their own naked nature.
 
The Canturbury Psalter, Adam and Eve and the Mushroom of Knowledge, 1147 CE
Was the forbidden fruit a psychedelic mushroom?
 
 
God lied to them. God told them they would die. But what actually happened is that they found truth! The snake was right. And God tried to deceive them.
 
But what is God’s side of the story? God said that the snake deceived them. God punished the snake for “deceiving” Adam and Eve into biting the fruit. And then God punished Adam and Eve for their “sins”. Even today all of Christianity feels guilty for that “original sin”
 
But when we really think about it, who should be trusted? God? Well he deceived us! The snake spoke the truth. God lied.
 
But maybe God only deceived us, because he knew that in the long run the truth would lead to endless suffering. So he deceived us to save us?!
 
Or maybe we should trust the snake. Afterall the snake did not deceive us. It told us the truth! This truth had us expelled from the innocent obedience of paradise.
 
Who is right? Is truth more valuable than innocent obedience in paradise? Will truth eventually lead to endless suffering? What should we do?
 

“Part of what psychedelics do is they de condition you from cultural values. This is what makes it such a political hot potato. Since all culture is a kind of con game, the most dangerous candy you can hand out is one which causes people to start questioning the rules of the game. Terence McKenna

 
Everybody can decide for themselves in what state of consciousness he wants to live in. Either in a state of constant search for the truth, or in a state of innocent obedience.
 
I think the first step is to realise that we do have a choice. We can decide ourselves what we value more. This is an omnipresent dilemma. Much of the peaceful and not so peaceful discourse between youth vs. old, left vs. right, science vs. religion, west and east and capitalism vs. Marxism is based in majors parts on this dilemma.
 
Now what does that have to with the risks of consuming magic mushrooms? If you think this interpretation of the events that took place in paradise is complete bogus and obviously god did the right thing, then you should not eat from the forbidden fruit. It might open your eyes. It might make you embarrassed of your naked nature. It might shaken your foundation that you were so certain of. It might cause havoc in your real life, because it might force you to change major portions of your life. Truth can be awfully painful. Or is a life with incongruence, inauthenticity and some form of innocent obedience even more painful?
 
This is not about Christianity. The story of paradise, the snake, the apple of truth and the original sin is present in different shapes in every world religion. In Eastern spirituality you can exchange paradise with Tao, and Good and Evil with the dualism of Yin and Yang and you have the same story. In greek mythology the apple of truth from the tree of knowledge is the box of Pandora. It is present in every day life. It is present in political discourse, in philosophy, in sports, in marriage and in business.
 
In sports, business and your personal life you are constantly being confronted with finding your spot on the spectrum between tradition and truth. Sometimes tradition is truth. Sometimes it is not.
 
 
 
Gerrit Keferstein, MD

Gerrit Keferstein is a Medical Doctor specialised in Performance & Functional Medicine. He is most known for his work on the optimisation of recovery and adaptation in elite athletes.

Tags : psychedelicsmushroomspsilocybinlsddepressionanxietyaddictionneurologypsychotherapypsychologyperformance docperformance medicine

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