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Content analysis of Reddit posts about coadministration of selective serotonin reuptake inhibitors and psilocybin mushrooms

  • Original Investigation
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Abstract

Rationale

Treatments with the serotonergic psychedelic psilocybin are being investigated for multiple neuropsychiatric disorders. Because many patients with these disorders use selective serotonin reuptake inhibitors (SSRIs), understanding interactions between psilocybin and SSRIs is critical for evaluating the safety, efficacy, and scalability of psilocybin-based treatments. Current knowledge about these interactions is limited, as most clinical psilocybin research has prohibited concomittant SSRI use.

Objectives

We aimed to explore potential interactions between psilocybin and SSRIs by characterizing peoples’ real-world experiences using psilocybin mushrooms and SSRIs together.

Methods

We conducted a systematic search of Reddit for posts describing psilocybin mushroom and SSRI coadministration. We identified 443 eligible posts and applied qualitative content analysis to each.

Results

8% of posts reported negative physical or psychological effects resulting from coadministration. These included 13 reports that may reflect serotonin toxicity, and 1 concerning for a psychotic/manic episode. 54% of posts described reduced intensity of the acute psilocybin experience, but 39% reported unchanged intensity with SSRI coadministration.

Conclusions

Psilocybin’s interactions with SSRIs are likely complex and may depend on multiple factors. Prospective studies are needed to evaluate whether psilocybin treatments are reliably safe and effective in the setting of SSRI use.

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Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. Vortioxetine has multimodal actions and is not technically considered an SSRI (Alvarez et al. 2014). We included it because of its similar SERT-inhibiting activity and affinity for multiple serotonin receptor subtypes.

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Author notes

  1. Kimberly Sakai and Ellen R. Bradley contributed equally.

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, 94143, USA

    Kimberly Sakai, Ellen R. Bradley, Joseph A. Zamaria, Gabrielle Agin-Liebes, D. Parker Kelley, Alexander Fish, Valeria Martini, Aoife O’Donovan & Joshua D. Woolley

  2. San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA

    Kimberly Sakai, Ellen R. Bradley, D. Parker Kelley, Aoife O’Donovan & Joshua D. Woolley

  3. School of Education, University of California, Berkeley, Berkeley, CA, 94720, USA

    Joseph A. Zamaria

  4. Psychology Department, Palo Alto University, Palo Alto, CA, 94304, USA

    Valeria Martini & Michelle C. Ferris

  5. Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 2A1, Canada

    Emma Morton & Erin E. Michalak

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  1. Kimberly Sakai
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Corresponding author

Correspondence to Ellen R. Bradley.

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Conflicts of interest

Joshua D. Woolley, MD/PhD is a compensated consultant of Alexander Shulgin Research Institute and Gilgamesh Pharmaceuticals, has received research support from Filament Health, and previously conducted research sponsored by the Usona Institute.

Aoife O’Donovan had received research support from SILO Inc.

Erin E Michalak holds educational grants from Ostuka-Lundbeck.

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Sakai, K., Bradley, E.R., Zamaria, J.A. et al. Content analysis of Reddit posts about coadministration of selective serotonin reuptake inhibitors and psilocybin mushrooms. Psychopharmacology (2024). https://doi.org/10.1007/s00213-024-06585-x

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