Hallucinogen Persisting Perception Disorder, or HPPD, is among the more mysterious, debilitating, and under-researched possibilities of psychedelic drug-taking. As enthusiasm around psychedelics and their possible benefits continues to grow, it’s imperative that researchers, user populations, and clinicians look closely at HPPD and other possible hazards.

HPPD is little-known among clinicians, and many reporting these experiences have trouble finding informed help. Treatments – pharmacological, psychotherapeutic, and somatic – are out there, and by reports, have proven useful for some, but no controlled trials have been performed to gauge their true effectiveness. 

In this article – intended as an exercise in harm reduction, raising awareness, and ensuring true informed consent before people ingest psychedelics – we’ll outline the current knowledge base around HPPD, including indications of the gaps and where future research may prove useful. This article’s tips, advice, and analysis (and more) is also featured in an in-depth HPPD Information Guide, which can be freely downloaded from the Perception Restoration Foundation’s website, where a more direct guide for those struggling with HPPD is also hosted.

The HPPD Basics: What is it?

Hallucinogen Persisting Perception Disorder is a DSM-5 listed condition in which people experience lasting, distressing changes to their perception after taking psychedelic drugs. There are two types: Type-1, in which people experience episodic (usually sudden) “flashbacks,” and Type-2 (the more commonly reported), in which people’s everyday perception is altered.

These perceptual changes may be married with shifts in cognition, mood, and somatic experience, and further research is required to understand how they relate. HPPD can last anywhere from weeks and months to several years – some people live with its perceptual changes for decades. In up to 50% of HPPD patients, the changes may spontaneously remit within five years.

The perceptual changes are wide-ranging, but most constellate around a stable set of experiences also reported in other conditions: Visual Snow Syndrome (VSS), migraine with aura, manic episodes, epilepsy, anxiety disorders, brain injuries, and also as experienceable features (under the right conditions) of normal, healthy perception.

This implies that HPPD likely sits on a continuum with other disorders and ordinary perception. Further research is required to understand HPPD’s role in this continuum, the possibly unique contribution of psychedelics in affecting symptoms, and the kinds of treatments people with HPPD would benefit from versus other disorders. 

• Visual snow: When the field of vision is coated with small, grainy dots like the static of a detuned TV
• Haloes and starbusts: When objects have a bright “halo” or “aura” ring around them, or concentric colored rays around light sources
• Trails: When an object moves, a trail of faint replicated images follows it
• After-images: When the outline or silhouette of an object is seen on a surface after looking away
• Enhanced hypnagogia, or the semi-visionary state experienced between waking and sleep
• Intensified floaters: Most of us have seen “floaters,” which are the small squiggly lines and shapes that sometimes appear in our vision. With HPPD, these floaters can become more visible, disturbing, and irritating
• Blue Field Entoptic Phenomenon: The appearance of tiny bright dots moving quickly along squiggly lines in the visual field, especially when looking into bright blue light such as the sky
• Changes to size and depth perception: Things can seem smaller, at-a-distance, expanded, or possessing a two-dimensional quality
• Assorted psychedelic-style effects: Fractal kaleidoscopic and geometric patterns, faces, “breathing” walls, moving, “wavy” or shaky text, flashing and strobing lights, closed-eye visuals, enhanced phosphenes
• Complex pseudohallucinations 

Other, non-perceptual symptoms are reported, too:

• Physical effects, such as head pressure, acute neck pain, unequal pupil sizes, muscle twitches
• Tinnitus and ringing of the ears
• More intense dreams
• Auditory changes
• Confused and unclear thoughts, including brain fog, trouble processing information, memory loss, dyslexia, and the onset of stammering
• Depersonalization/Derealization Disorder (DP/DR), in which people feel detached from their bodies and the world stops feeling real
• Psychosis
• Anxiety, depression and panic 

Note, to be diagnosed with HPPD, these changes must prompt distress – which they do, in many cases. They can disrupt people’s everyday function – relationships, work, operating heavy equipment, driving, navigating the day-to-day, and beyond – and cause anxiety, panic attacks, depression, and suicidal thoughts in high numbers of clinical patients. Many report a strong degree of isolation and loneliness, and the disorder is also strongly-correlated with dissociative experiences like Depersonalization/Derealization Disorder (DP/DR). 

How Common is HPPD?

We don’t know. It seems that developing perceptual changes after taking psychedelics is not necessarily that uncommon; the distressing, intrusive kind that manifests in HPPD is likely a real but minority experience. 

A 2011 survey of 2,455 users of psychedelics (via Erowid) found that up to three-fifths of psychedelic users reported lingering changes, 25% in ways that were seemingly permanent, and 4.2% in ways so distressing that they could prompt seeking clinical help. The latter is suggestive of diagnostic HPPD. 

What Kinds of Psychedelics Are Implicated?

Practically every psychedelic, but some more than others: LSD, psilocybin, ayahuasca, 2-CB, ibogaine, etc., but also related (but not classically psychedelic) drugs like MDMA, cannabis, dextromethorphan (DXM), datura, ketamine, salvia, and diphenhydramine (DPH) have been implicated. 

In anecdotal reports and the existing literature, it seems that LSD is the leading cause of perceptual changes compared to other kinds of drugs. Whether this is because LSD has been historically the most commonly-used psychedelic or there is something special to the LSD experience or its effect on neurophysiology is unclear. Short-acting psychedelics like DMT seem to be less implicated. 

Some report that, after heavy use of classic psychedelics, their HPPD developed suddenly after the use of research chemicals like 25-i-nBOME, which is often mis-sold as LSD; HPPD is also reported in particular among users of synthetic cannabinoids. Cutting agents in street MDMA, including synthetic cathinones (“bath salts”), may make HPPD more likely.

Can Non-Psychedelic Drugs Create These Perceptual Changes?

Yes. SSRI antidepressants, antibiotics, antipsychotics, and nootropics have been described in self-reports as triggering very similar visual changes. There is also considerable overlap between HPPD/post-psychedelic perceptual changes and another drug-free condition known as Visual Snow Syndrome (VSS). 

At the same time, compared to other drug classes, it seems that psychedelics (in particular, LSD) provide a higher risk factor for developing these perceptual changes. It may also be that HPPD patients report different kinds of visuals (perhaps more psychedelic ones), or more cognitive and emotional changes (as with psychedelics’ powerful psychoactive effects), compared to non-psychedelic groups.  

Is HPPD the Same Thing as Flashbacks? Aren’t Flashbacks a Myth?

It’s complicated. The “flashback” describes a particular kind of experience in which people feel they truly re-live a prior psychedelic state: something that is real and can happen, and is what people may experience in Type-1 HPPD. Most cases of Type-2 HPPD, though, will likely not be true examples of flashbacks in this way.

To give a brief overview, the idea that psychedelic drugs could cause lasting changes in perception was noted from as early as 1954 – 15 years before the notion of the “flashback” was ever coined. A number of authors in the first wave of psychedelic research from the 1950s to the early 1960s reported patients experiencing a wide range of complications after their drug experiences – including what sounds like standard HPPD – but also states that blur more into psychosis and the experience of complex pseudohallucinations. They noted that some patients were acutely re-living their trips.

These observations continued once psychedelics became popular drugs of adult use in the mid-to-late 1960s. This was reported in popular media from, at latest, 1966. 

The “flashback” label was coined by author Mardi J. Horowitz in 1969, and used for many years afterwards, including by Dr. Henry Abraham, who first developed the psychiatric diagnosis of HPPD. Perhaps contrary to what we’d expect, authors in the “flashback” literature were at pains to emphasize the complexity, variation, and need for further research in explaining the phenomenon, as well as noting that many (some surveys suggested the majority) did not find their experiences distressing.

The Flashback Problem

Unfortunately, the idea of the flashback was later sensationalized by journalists and prohibition activists, who tied the idea to certain marked untruths: that the drug can be “stored” in the spine or fat cells, make people legally insane, or otherwise cause major brain damage.

The flashback idea also had some conceptual problems, which is perhaps to be expected from the first attempts at describing a new phenomenon. With some critical exceptions, authors were bound by a consensus that post-psychedelic visuals and flashbacks were re-experiences of the visuals glimpsed in the psychedelic state – as if the drug had not properly worn off, perhaps as a matter of lasting changes to neurological function. The notion that HPPD is a “re-experiencing” has also become one of the core criteria of the current DSM-5 diagnosis.

As noted earlier, though, identical perceptual phenomena can be experienced both through non-psychedelic drug classes, and as part of experiences in which drugs played no necessary role: other kinds of neuropsychological conditions, or otherwise as a feature of normal perception. 

In contemporary literature, some authors have noted that many patients experience visual effects that never manifested in their trips – though this isn’t the case for everyone. Those who are “reliving” their trips may be described plausibly as experiencing flashbacks.

The idea of the flashback is also not unique to psychedelics – in particular, it’s used as a descriptor for experiences of post-traumatic stress disorder (PTSD), in which people can feel “flung back” to the original trauma in quasi-visionary states. This implies that the psychedelic “flashback” may not be a distinct phenomenon for some (or most) cases: rather, that it’s an example of a psychedelic drug-induced traumatic flashback, where the real issue is trauma (not drugs per se).

How Do We Explain What’s Going On?

Since authors first noticed that psychedelics can cause lingering changes in perception, a variety of different hypotheses have been pursued to explain what’s going on. The HPPD experience will likely involve a complex, multi-factor origin that varies from patient to patient.  

Could psychedelic experiences alter neurophysiological function?

HPPD’s leading neurophysiological hypothesis, introduced by Dr. Henry Abraham, relates the condition to a “disinhibition” of the visual cortex. Drugs like LSD decrease, or “disinhibit” the filters of the brain’s visual cortex, so visual noise that would otherwise be filtered out may remain in the field of vision. HPPD occurs when these filters do not return to their pre-drug state. This may make HPPD akin to a form of “visual tinnitus” (and tinnitus is also experienced as a symptom).

This disinhibition is linked to reductions in alpha waves in the brain. A neuroimaging study by Abraham (2001) suggested that alpha wave frequency increases with HPPD patients versus controls. The role of an objective alteration to visual perception was lent support by 1982 and 1988 studies executed by Abraham, in which he found both non-HPPD LSD users and HPPD patients had decreased ability to discriminate color differences and light sensitivity during dark adaptation, with HPPD patients reporting further decreased ability.

There could be a role for neuroplasticity, or neurons’ ability to change and reform in response to experience. This may be explained in the context of a “Bayesian Brain” model, similar to the REBUS and entropic brain hypotheses introduced by UCSF’s Robin Carhart-Harris: by shaking the “snowglobe” of our nervous system’s categories of perception through a psychedelic experience (or psychoactive changes altogether), it could be that those categories do not settle as before. A neuroplasticity model may explain why, in some cases, further psychedelic experimentation can reduce or eliminate HPPD presentation. It may underlie also why teenagers are especially vulnerable, as they have more plastic, developing brains.  

LSD’s long duration may explain why the drug is so associated with HPPD – that is, with more hours of seeing abnormal visual changes, the brain is more likely to reprogram itself than with shorter-acting drugs. Smokeable DMT, for instance, isn’t particularly-associated with perceptual changes, while longer-acting ayahuasca is.

Synaptogenesis may also be involved. As described by Samuel Štancl, “Psychedelics induce strong synaptogenesis, or the creation of new synapses, resulting in high synaptic density. EEG scans show less inhibitory activity in the visual cortex both in people on psychedelics and in people with HPPD.” This means that electrical currents are being enhanced in the visual cortex by increased synaptic connection. This also underwrites why pruning excessive synapses through pharmacological treatments like lithium – or even exercise – may be useful.

What about psychological factors?

A 2018 paper by Halpern and Passie suggested that challenging drug experiences, including intense reactions of panic, dysphoria, anxiety and trauma, may be associated with a higher likelihood of developing HPPD. This is more likely for psychedelic use in uncontrolled settings. 

Recall, HPPD often co-arises with Depersonalization/Derealization, a dissociative reaction in which people feel disconnected from their bodies and immediate environments. This is suggestive of anxiety and trauma. Drug-free anxiety and depersonalization are independently-associated with similar, if not identical, perceptual changes. Somatic cognitive changes, including head pressure and brain fog, are also associated with anxiety. Challenging and traumatic drug experiences may therefore induce elevations of anxiety, which has its own uncharted pathway towards many changes, including perception.

In the historical flashback literature, there was tentative evidence that visual phenomena could be experienced as matters of attention, hypnotization, and placebo suggestion. The role of trait absorption – or a person’s tendency to become occupied by mental imagery and internal experience, including daydreaming, fantasy and hypnagogia – has also been discussed by authors as a possible personality determinant of HPPD likelihood.

What’s more, there are case reports of people altogether resolving their distress and visuals through targeted psychotherapies without pharmaceuticals: in particular, Cognitive Behavioral Therapy (CBT) to target the destructive internal beliefs people formed around their condition (“I am brain damaged,” “I’m a weirdo,” “I’m a freak,” etc.), including in combination with relaxation techniques. The sense of isolation may also be addressed through the therapist leaning into their own capacity for abnormal visual phenomena, and experiencing them with the patient – something that resolved one person’s HPPD.

Psychedelic researcher Stanislav Grof explained and resolved his patients’ cases of HPPD through psychodynamic therapies. He interpreted HPPD as a problem of the psychedelic surfacing unconscious material that needed to be re-integrated through additional encounter experiences, including with psychedelics and breathwork.

Could HPPD patients simply be noticing more stuff that previously filtered into the background?

Yes, at least for some patients. Phenomena like visual snow, after-images, tinnitus, and floaters are not necessarily uncommon, even among “normal” people. As a possibly overlapping mechanism with anxiety and fixation, it may be that some people with HPPD are noticing perceptual features that had previously been filtered into the ignorable background of their experience. Halpern and Passie found that HPPD patients were possibly more likely to have experienced visual oddities before they took drugs.

This led Krebs and Johansen to recommend re-attributing some HPPD experiences to Somatic Symptom Disorder, whereby people fixate and ruminate on normal somatic experiences and perceptions.

This is unlikely to be exhaustive, because many HPPD patients report florid and extreme visual changes that plausibly could not have been ignored before; it will also have limited applicability to those whose visuals are distinctly psychedelic and are experiencing Type-1 HPPD. It’s possible, too, that histories of such visual experiences imply a vulnerability that has been activated or catalyzed by drug experiences. 

Part 2 of this article, focusing on harm reduction, will be posted shortly!

This article’s tips, advice, analysis (and more) is also featured in a more in-depth HPPD Information Guide, which can be freely downloaded from the Perception Restoration Foundation’s website, where a more direct guide for those struggling with HPPD is also hosted. Owing to the tentative nature of our HPPD knowledge base, the PRF invites any and all comments and criticisms for the Guide at info@perception.foundation, and any worthwhile amendments will be quickly published.

By Amy Hogan

Raising children requires a lot of patience, compassion and energy, which is why parents like me turn to microdoses of LSD.

My introduction to LSD happened in 1997 at Penn State University. Phish’s Lawn Boy CD acted as the soundtrack and de facto tour guide for that trip. It was such a fantastic experience that I crammed seeing dozens of Phish concerts on psychedelics into my college curriculum. The acid ignited my senses and soothed my soul; worries about my future and body fat percentage faded and I could live in the moment; one with the music. Then late one night in 2004 atop a muddy mountain in Coventry, Vermont, Phish momentarily ended and a new era of my life began.

I met a man. We fell in love. Swept up in the fairytale romance, I was blissfully unaware that my freewheeling, psychedelically enhanced Phish festival days were being replaced with the crushing realities of juggling a job with family life and childcare concerns. For years I feared that I would never find balance without making myself—or my husband and kids—miserable. Luckily Phish and LSD still play an important role in improving my life, though in much smaller doses. So how does a modern mom—between work, cheer practice, swimming lessons, and PTA meetings—find time to start microdosing lysergic acid diethylamide?

How Does One Become a Microdosing Mom?

In 2009, I was too busy working long hours at a weekly tabloid magazine, planning my wedding, and buying a house to care that Phish reunited. During the next few years, life changed so rapidly in such a short amount of time that I lost sight of my own needs and could feel the light inside me dimming. I got married in October and was pregnant by Christmas. Those were happy days, but just a week before my daughter’s first birthday (and the day before my own birthday) my father died undergoing heart surgery.

The day after his funeral, I dropped my one-year-old off at my mother-in-law’s house in an utter haze before heading to my first day of work at a brand-new celebrity weekly magazine. Quietly sobbing in a bathroom stall during lunch and panic attacks before editorial pitch meetings became my normal routine, while everyone I loved told me that the demands of the job would be the best way for me to get through my grief. I wanted to believe them. Instead, I felt sadder and meaner to those closest to me as they reminded me that I was no different or special than any other working mother. My doctor gave me a lecture on my weight gain and a Prozac prescription.

For years, I self-medicated with too much cannabis and wine and popped Prozac. I quit it all to get pregnant again. My second daughter was delivered in distress at 31 weeks. She weighed just two pounds. I was too scared to celebrate her birth and fell deeper into depression. Today she’s a strong-willed, fearless five-year-old and I love her more than words can express. The entire NICU experience left me with severe PTSD, which I had no time to truly treat because I had to get back to my magazine job. I spent just two hours a weekday with my girls and half that time I couldn’t wait to put them to bed because I was too mentally drained and depressed to find any joy in the motherhood journey.

When I got laid off a year later, I felt relief for a brief moment before the anxiety, despair, and depression of not having a steady income crept back into my brain. Of course, there is no time to properly deal with those feelings when you’ve got a teething toddler and curious kindergartner. I desperately wanted to be a better mom, but some days all I could do was prop them up with snacks and the Disney channel and weep silently in the next room. I know I’m not the only parent that experiences this.

Could Parenting and Psychedelics Go Hand in Hand?

“When you’re a trauma survivor, you think you’ve healed and then you have children and they just push you into your shit,” Pepper Wolfe, a New York-based yoga therapist and wellness coach tells Psychedelics Today. “After my first was born I was struggling with postpartum [depression] and then my mom was diagnosed with pancreatic cancer. She died when I was six months pregnant with my second and I could not snap out of it. No amount of meditation, yoga, talk therapy, or breathwork made me feel better. I was hitting a wall, not getting better.”

While Wolfe, who is also a licensed social worker, recalls feeling short-fused and super-triggered by normal childhood things, like tantrums and messy meals, I flashback to my own experiences with my young daughters. “I fell apart and was not the mom I wanted to be,” Wolfe tells me. Her dark days could be my dark days. And then, while cleaning her basement she found a long-forgotten stash of magic mushrooms. She took them. “And it was powerfully transformative in my perspective, my reactivity, my patience, and how I felt my body,” says Wolfe. “It was like the lightness came back.”

While that was a full-on trip, Wolfe says that she has since learned how to use psychedelics “in a more disciplined, formal way,” which has helped her to be a better parent by healing her past wounds. “I found that things that I had been working on for years in talk therapies, these issues were just clearing up, these blocks were being removed, and I was having new insights.”

Curiosity got the best of me once I noticed microdosing being discussed as a sort-of-Hail-Mary-miracle in my Phish-loving parents’ social media group. I recalled the bliss of tripping at a show immersed in the sounds and lights and energy. Though I have no desire to melt my face off and then attempt to make patty melts for family dinner, I did wonder if microdosing could be the key to calming my short-fuse and lack of patience for the nitty-gritty of parenting.

Obviously, taking a do-it-yourself-at-home approach to dabbling in psychedelics is not for everyone. I’ve used cocaine in conjunction with Weight Watchers to lose 100 lbs., so I may be a little crazy, but I’m also open to experimentation for the sake of self-improvement. That’s how I ended up asking a friend to “get me some Lucy.” I skipped the shrooms and went right for the chemical because I have never been a big fan of psilocybin—it  gives me intestinal distress, that is, if I could even chock them down, which for me, is a bad way to begin a trip. Plus, I’ve always preferred the smooth climb to the peak and comedown cycle of an acid trip as opposed to the continuous up and down sensations I experience on psilocybin-containing mushrooms.

A Microdose Experiment

My friend showed up with a little, inconspicuous bottle and said, “This is such a small amount, I can’t charge you.” He left with a carton of eggs from our backyard flock. I stood, alone, in my kitchen looking at that tiny drop encased in amber glass. No one was home; I had hours alone ahead of me. I thought back to that night at Penn State and all of the Phish shows where I felt carefree. Yearning to feel some iota of that joy again, I touched the tip of the dropper to my tongue. Must be a microdose, right?

Twenty minutes later I was at the grocery store, giggling about cheese names and wandering around the glossy stacks of apples and pears in produce. I patiently waited with a smile on my face to pay for the manchego. Back home the living room curtains rippled and dewdrops glistened like chunky metallic glitter on each blade of grass in the backyard. Giggling uncontrollably, I realized this might be more than a microdose.

An acid trip can last anywhere from eight to 12 hours on average. When my husband walked in, I informed him of my microdosing misjudgment. We laughed and he promised to get the kids off the school bus and handle homework duty. I asked Alexa to “play Phish songs” and danced while dusting the house, enjoying the burst of energy. As the sun set on that evening, I began to come down but still had energy to run around the backyard helping my girls catch and release fireflies. I felt genuinely connected to them for the first time in as long as I can remember.

Brad Smith* had a similar experience. The father of two tells me that microdosing LSD “continues to bring me to a more open and understanding place in my daily life, which includes dealing with my two toddler boys. Empathizing with a struggle they are enduring that I would have considered trivial previously, has helped me to better communicate and provide for them.”

Remember, the whole point of microdosing for me was to get mentally healthy and happier without actually hallucinating. Since that day, I’ve learned 10 micrograms works best for my body—I spent a week experimenting while my daughters were on vacation at their grandma’s farmhouse. And I can honestly say that microdosing has made me a better parent by easing my depression and making me more approachable. Plus, I’m more active, aware, and available to my girls both emotionally and physically. I delight in playing games and crafting with them and even have the energy to race around the backyard playing Freeze Tag. I am still in awe of the fact that a tiny bit of LSD helps me to be the mother I’ve always imagined I’d be. I can’t say the same for Prozac.

What The Experts and Other Microdosing Parents are Saying

Much like my own experience misjudging a microdose, it’s a common occurrence. Adam Bramlage, who hosts a microdosing course for DoubleBlind Mag and is the Founder and CEO of Flow State Micro, explains to me that the very first thing a person needs to do is dial in their dosage. “It’s important to remember that a very small amount of LSD—especially in liquid or even paper form—can be very, very strong,” says Bramlage. “It is important for parents to start low and go slow—that’s somewhere between 5 or 10 micrograms. Once they find the ‘sweet spot,’ which is the dose that they feel but doesn’t have that classic psychedelic effect, they can experiment with protocols.”

Bramlage recommends microdosing a few days in a row to properly start the process. The Stamets protocol—either five days on and two days off or four days on and three days off—is a popular approach. For beginners, Bramlage usually recommends the Microdosing Institute protocol, which is one day on and one day off. He says, “There is a 48-hour effect to psychedelics, even in small doses. We call it the afterglow or the halo effect. If starting specifically with LSD, which can be considerably stronger than psilocybin in small doses, the user wants to make sure they have the right dose; having the day off will let them see how it’s affecting them.”

According to Bramlage, the Fadiman protocol, which is one day on and two days off, is “a great one for parents because again you’re getting the day off, which is the afterglow, and then the second day off, you’re getting back to baseline so you can notice a difference.”

He speaks from experience. As a single dad with shared custody of a 7-year-old daughter and a 12-year-old son, Bramlage says that microdosing LSD “helps increase my energy and stamina throughout the day. It seems to block that default grumpy old man that overreacts to the spilled milk. It puts you in a flow state and when you’re more in the moment and not thinking about other things you can be more present. It allows people to live in the moment instead of worrying about the future or ruminating over the past.” Who couldn’t benefit from that?

Wolfe says she has a lot of friends that “microdose on LSD and are having a lot of peak experiences, flow states, and great work performances. And I just kept thinking, ‘I just want to be a better parent. I want the generational trauma to stop with me. I don’t want to make my wounds their wounds.’ And for me, that’s what psychedelics did.”

Microdosing for Parents: Not a Miracle Cure for Everyone

Of course, microdosing doesn’t work for every parent. Oregon mother of five, Ashleigh Stevenson*, didn’t see any benefit from trying microdosing. “I was looking to improve my mood and allow me to be a more present parent to my crew, which includes 2-year-old twins,” she says. After getting no relief from magic mushroom capsules, she moved on to LSD. “But it still didn’t do anything for me. I knew it wouldn’t make me trip or anything like that, but it didn’t make me feel any happier or at peace with my crazy home life. I just felt more anxious, like what is wrong with me? Why won’t this work?”

She’s not alone. Washington D.C. native Leo Greene* is disappointed in his microdosing experience, too. “I’m normally a pretty happy-go-lucky guy. But the pandemic and being home with the kids nonstop for like a year really put me in a difficult place, and I struggled not to default back to yelling. Parents in my social circle were raving about finding their joy and having the energy to chase their kids around the National Zoo,” he shares. “So I tried [microdosing] a few times, and what a letdown. I felt nothing, nada, zilch.” Though Greene says, he is open to continued experimentation. “I will keep messing around with the dosage and hopefully find one that works for me. My kids are the best, and I want to be my best as a dad for them.”

Due to restrictive drug policies, placebo-controlled studies on psychedelics are few and far between. Despite that, the Imperial College of London managed to conduct the largest placebo-controlled trial on microdosing psychedelics, although it was ‘self blinded’ meaning participants did it all themselves. The results suggest that the benefits of microdosing may be the result of the ‘placebo effect’​​—or all in our minds. In other words, we might be creating our own microdosing euphoria more so than the LSD. During the study, 191 participants followed online instructions on incorporating placebo control into their microdosing routines to observe whether it can improve cognitive function and psychological well being. There was significant improvement of all psychological outcomes for the microdose group, however the placebo group—who had no idea they weren’t taking the psychedelic—also experienced nearly equal improvements.

However, that doesn’t stop many parents from having very positive effects, like Oregon native Danica Aria* who is positive that microdosing LSD makes her a better mom, too. “I don’t think it’s hindered my parenting skills but rather helps bring me more patience and calmness to many scenarios that would normally stress me out. I wish other parents would know the beneficial qualities hallucinogens can provide,” she says.

Bramlage believes that day is coming. “We have long known that LSD has been an amazing chemical and agent for change,” he says. “I believe that psychedelics and microdosing are the secret to saving our society and that all starts with re-educating people. We need to break the myths down, to tell the truth—let parents know that there are amazing potential benefits and uses for LSD.”

Until then, you can find me hanging out with my friend Lucy whether I’m at home getting crafty with my kids or at Phish shows surrendering to the flow.

*Name has been changed 

About the Author

Amy L. Hogan delights in writing about celebrities, cannabis, psychedelics and sometimes even witches for both print and digital media. In 2001, she received her Bachelor of Arts degree from The Writers Institute at Susquehanna University.  She resides on the East Coast with her husband, two daughters, three cats and a chicken named Fluffhead.

By Joe Moore & Kyle Buller

An open letter to the Psychedelics Today audience

Dear Psychedelic Community,

We know this past year has been extremely challenging and isolating. Humans are social creatures by nature, and quarantine and social distancing have been hard on all of our psyches and mental health. But as a community, we have to get real: if we really want what’s best for the collective whole of humanity, the truth is that it’s still not safe to meet up in big groups to do psychedelic work or ceremonies.  

We’ve been talking about it a lot on the podcast, especially on Solidarity Fridays, so here is a reminder in print: COVID-19 is real, psychedelics and spirituality won’t make you exempt from catching and spreading it, and therefore, it’s still too dangerous to be doing group psychedelic work.

Often, when people justify disregarding masks or social distancing measures, their line of reasoning is that they’re not a senior citizen or immunocompromised, and so the current safety precautions don’t apply to them. But this is not a zero-sum, “die or survive” game, and it’s not just about you and your healing; it’s about the people around you–employees at your local grocery store, your bus or taxi driver, the nurses, doctors, and teachers in your community–people you don’t know and don’t think about, who still might be harmed by your actions. 

And COVID-19 is not temporary. There are psychedelic community members with vagus nerve damage, permanent vocal cord damage from severe coughing, lung issues, and other serious long-term conditions. We know plenty of people in their 30s and 40s who survived COVID-19 and thought everything was fine, but their post-virus quality of life has since been severely lowered. We know folks who are still sick, struggling with chronic pain, brain fog, and low energy for over a year, who have therefore been unable to work and have become dependent on family members to support them as their recovery extends past the 13, 14, and 15-month marks.

Beyond our immediate community, a recent study published in The Lancet journal of psychiatry found that a significant portion of COVID-19 survivors were diagnosed with a neurological or psychiatric condition within 6 months of contracting COVID, many for the first time. And remember- we’re still seeing COVID variants pop up, so while many feel we’re making our way out of this dark period, we may still have a long way to go. 

And it sucks. We understand people are struggling right now. Kyle sees it every day in his therapy and coaching practice, and we all feel it. Being in isolation and lacking human connection is extremely hard, unnatural, and affecting us all. The need for healing and contact is immense and only getting bigger, and we absolutely empathize with you all. We understand that it goes against our individualistic cultural conditioning, but this is a social responsibility that is beyond individual healing or personal politics, and we have to think communally. When the community is sick, the individual is sick. And when the individual is sick, the community is sick. 

When we’ve posted about this on social media, we’ve had folks bring up suicide statistics from 2020, using the high number as an argument for encouraging much-needed psychedelic healing work. Everyone on our team has lost someone to suicide and we know how difficult that is, and also how easy it is to think that perhaps an ayahuasca or mushroom ceremony could have saved our loved ones from their afflictions. So it feels insensitive to compare numbers of deaths against each other, but since that’s something that gets brought up a lot, look into it: while the 2020 stats aren’t final and don’t take overdoses into account, the numbers are actually very similar to 2019, with the number of deaths directly attributed to COVID-19 being drastically higher. It’s uncomfortable to think about, but the numbers speak for themselves. This is beyond our emotional ties to the issue; this is for the sake of the whole community of humanity.

The fact of the matter is, psychedelic group work involves a lot of touching, being close together for 6 to 12 hours, and being in close proximity to others’ bodily fluids while we cough, purge, or cry. Cups of water, pipes, snuff tools, and tobacco cigars are often shared. People hold hands, hug, and practice bodywork with each other. These are all optimal opportunities for viruses to spread. Plus, when you are under the influence of a psychedelic medicine, the realities of social distancing and spreading germs won’t exactly be in the forefront of your mind and can easily be cast aside as “silly human problems.” And while that belief may feel freeing, it won’t protect you from catching or spreading disease.

Are there safe options for participating in psychedelic healing work? At the moment, we think the safest option for those looking for mental health relief with psychedelics is ketamine-assisted psychotherapy and infusions. Unlike underground group work or retreats abroad, ketamine clinics and practitioners are regulated by organizations like OSHA (Occupational Safety and Health Administration) in the US, meaning they have to follow governmental guidelines for safe and sterile working environments. Also, ketamine infusions, injections, lozenges, and nasal sprays are not typically done in groups, and if they are, they also follow social distancing protocols, as outlined in our recent piece on the topic. 

We understand that for many, treatment options like ketamine-assisted psychotherapy may not be accessible or appropriate, and some people will still participate in group work anyway. To those people, we encourage everyone to do everything as safely as possible by only engaging in small ceremonies that are following strict safety and social distancing protocols and have contact tracing in place. If the work can be done outside, do it there. And if you’re traveling, please quarantine in consideration of the communities you’re traveling between. But don’t forget- there are lots of virtual psychedelic community offerings to keep us all engaged too. And think about the other work you can do, from meditation, breathwork, and journaling, to creating art or just going for a walk in the woods. Not all healing comes from psychedelics and group work. 

As more people get vaccinated and the world begins to reopen, we are all feeling the excitement to move towards the sense of normalcy we all miss so much. But this is a slow process, and we encourage everyone to continue to move slowly, stay cautious, and continue engaging in safe practices and social distancing measures until we get there. 

We know that this is not what a lot of the psychedelic community wants to hear, but regardless of how unpopular putting this out might make us, we feel it’s a necessary reminder that we all have a shared responsibility to keep our communities safe.  

Thanks for your support,

Joe, Kyle, & the rest of the Psychedelics Today team

For decades the consensus of the psychedelic science community regarding bipolar disorder is that people with manic depression should avoid psychedelics as to not aggravate their condition.

They’re one of the few groups, along with those with a psychotic spectrum disorder or a heart condition, who are told sorry, psychedelics are not safe for them. In the case of those diagnosed with bipolar disorder, the fear is that the psychedelic experience can cause them to go manic, a state characterized by grandiose thinking and over-extending oneself (and often one’s bank account) that can lead to reckless, dangerous, and intrusive behavior that’s essentially out of character and can cause folks to lose control of their own lives or put themselves and possibly others in life-threatening situations.

And it’s not a myth, there are case studies, like this one from 1981, of people going manic during or after psychedelic experiences, but there haven’t been any trials controlling for things like the type of substance, set and setting, and dosage.

The Serotonergic System and Bipolar Disorder

Classic psychedelics and other medicines like MDMA work largely by affecting the brain’s serotonin system, especially the 5-HT2A receptor, says Will Barone, PsyD who’s worked in research and clinical settings with therapies involving MDMA, psilocybin, and ketamine. For most people, that’s not a huge risk. It’s not physically dangerous unless mixing different substances or taking super-high doses. But for people with bipolar disorder, the serotonergic activity may be what poses the problem – that increased activity could potentially trigger mania, or at least “increase the likelihood for mood episodes,” as Barone puts it.

Most bipolar people can’t even take SSRI anti-depressants without the risk of hypomania or a manic episode, and it’s how many of the folks I interviewed and who filled out a survey on bipolar and psychedelics I created got diagnosed in the first place. They went to their doctors feeling depressed, got prescribed an SSRI, and instead of feeling better (or nothing at all), they went manic, some even bordering or breaking through to psychosis. And so, to most in the psychedelic community that’s the end of the story. If an SSRI can cause mania, then surely it’s unsafe to give these folks psilocybin, MDMA, or ayahuasca, for example. Sorry bipolar diagnosed people, but you are excluded from the incredible and mystical insight, perspective shift and depression relief that psychedelics can grant others. But what if it’s not as open and shut as the community would make us think? 

Before I dive any deeper into what I found investigating this subject, it’s important to say that I am in no way encouraging anyone to take psychedelics or get off their prescription medications. But living with bipolar disorder can be hard. Not only can mania be dangerous but the depression is also life-threatening; people with manic depression are much more likely to attempt and commit suicide than the general population. Yet, the hypersensitivity that is sometimes a handicap can also be a gift, one that many are unwilling to give up. And traditional pharmaceutical medication often suppresses empathy, creativity, spirituality, and concentration, among a host of other natural processes. So are there other options for folks living with this condition?

The Use of Ketamine for Bipolar Disorder

“Ketamine is the primary substance I would feel comfortable working with for a bipolar client,” says Barone. “It doesn’t seem to have the same risk for inducing a mood episode as MDMA or psilocybin.” He explains that ketamine doesn’t work nearly as much on serotonin as other entheogens, that instead, its primary action is on the glutamate and NMDA receptors, which has made many researchers theorize how ketamine produces its rapid antidepressant effects. “We’re still figuring out a lot about how ketamine works,” Barone explains, but the risk of inducing a manic episode from clinical ketamine treatment seems to be very low. “That’s one of the interesting things,” he says, “so far in clinical ketamine treatment, we haven’t seen mania develop in people with bipolar disorder, even with a history of mania. I haven’t personally seen any cases.” However, it’s important to note, many bipolar clients of Ketamine assisted therapy or infusions are also staying on their medications, likely mitigating the risk. “Ketamine is one of the only medications with psychedelic properties where it is appropriate for a patient to remain on their mood-stabilizing medications,” says Barone. “This is important for patients with bipolar disorder who can be destabilized by stopping medication too abruptly.” 

In the program where Barone practices, Healing Realms Psychotherapy, clinicians sometimes utilize ketamine assisted psychotherapy (KAP) for individuals with bipolar disorder. It’s on a case by case basis, but essentially ketamine can be offered at different doses in conjunction with talk therapy, which can “use that psychedelic or altered experience to better understand your situation,” says Barone, “to have better awareness of your ego functioning and how to manage mood, in addition to the mood-stabilizing properties of ketamine.” Then, clinicians often increase the amount of follow-up sessions for bipolar clients to continue to monitor changes to mood or cognition, Barone tells me.

The Risks of Triggering Mania with Different Substances

A Ph.D. candidate at Flinders University, Benjamin Mudge, is looking into this phenomenon for his thesis and believes the type of substance plays a large role in mitigating the mania risk and providing the most balanced depression relief for those with manic depression. Mudge himself is bipolar, and at 48 has been through the wringer in attempts to treat his condition. Over a three hour Skype conversation, he tells me about being institutionalized and medicated on 17 different pharmaceuticals over 10 years with varying degrees of negative side effects, from weight gain and hair loss to losing his ability make art (a practice many thought he’d pursue professionally as a young person), capacity to make and perform music, and complete numbness to the rich world around him.

“I don’t feel suicidal, manic, or crazy [on the drugs the psychiatrists prescribed me],” Mudge explains. “But I don’t feel pleasure, fun, or arousal. I don’t feel a spiritual connection with nature. I can be sitting in a sacred ceremony, church, music festival, or forest, and everyone that’s around me is feeling something deep. But I just feel numb. And as a result of that, I then feel a sense of frustration and alienation from other people, and a sense of pointlessness.”

Eventually fed up, Mudge stopped taking pharmaceuticals cold-turkey (a practice he does not recommend to others) in search of a more natural remedy. After failed attempts with herbs like St John’s Wort, a friend asked if he had heard of ayahuasca. Now, 15 years later, Mudge drinks ayahuasca every couple of months to manage his condition (in addition to being careful with nutrition and avoiding other psychoactive substances) – and has never felt better. Even though, he tells me repeatedly throughout our conversation that this path isn’t for everyone and he in no way recommends folks stop taking their meds in favor of ayahuasca.

But his Ph.D. in psychiatry gives him the opportunity that many don’t have: he is systematically recording his moods and other reactions to ayahuasca, along with analyzing each tea he drinks in the lab to try and figure out the optimal brew for those living with manic depression. And he’s formulated a few fascinating theories that are catching the eye of psychedelic researchers around the globe.

For one, substance matters, and Mudge believes DMT might hold the most benefits for those with bipolar disorder because of its incredibly short binding time to the 5-HT2A receptor. Most psychedelics “plug into” the 2A receptor, LSD, psilocybin, and DMT included, but the length to which they stay there determines the length of a trip. So for example, (see image 1) LSD stays plugged in for the longest, which explains why it’s such a longer-lasting trip than psilocybin or simply smoking pure DMT. But Mudge theorizes the binding time also matters when determining the mania risk for the bipolar brain, that the short binding time of DMT poses less of a risk of pushing bipolar people into mania, while substances that bind for longer, like LSD, present a higher risk. 

His theory gets more complicated than this and some of his mechanical ideas are based on findings of his mother, Anne W. Mudge, a Professor of neurobiology at University College London. In 2002 she discovered the bipolar brain has a malfunction in its inositol phosphate metabolism, which is a key regulating function that helps average folks regulate their moods, speed of their thoughts, and other related actions. In a nutshell, she discovered that instead of the bipolar mind being “too high” or “too low” (aka manic or depressive), that in reality, it was functioning at speeds that were too fast or too slow because of its missing regulating mechanism, thus explaining how medication like Lithium comes in to help regulate that speed (see image 2).  

Now when we add serotonergic psychedelics or SSRI medication on top of a “dysregulated” brain, there’s a chance it could overextend itself and go too fast for too long, which could look like mania. And often, depression follows the mania in these cases, hence, the “disorderly” moods. However, this gets back to the binding time in Mudge’s theory, because what if shorter-acting psychedelics didn’t push people over the edge into mania, but rather, jump-started them out of depression and left them with more self-awareness to notice when their moods are fluctuating, giving them the ability to be more proactive in that process? 

Mudge has found that ayahuasca and DMT help him the most (in carefully curated circumstances that we’ll discuss below). It brings him depression-relief and healing from a long list of past traumas, plus incredible awareness of the internal signs of a rising manic episode and how those behaviors have affected others. “One of the most fundamentally valuable things about ayahuasca for bipolar people is that it’s helped me understand how the manic episode is damaging people around me and damaging myself,” Mudge explains. “There is a sort of heightened sense of conscience, a social conscience that comes from the psychedelic awareness. That principle is perfect for getting bipolar people to understand how problematic the mania is, even if it feels amazing at the time.”  And with the right brew of ayahuasca in a supportive container, this insight and healing come without pushing him into mania. He says after an ayahuasca ceremony he feels a “humble happiness” rather than a speedy or bordering on manic one.

Part of his research is interviewing others and collecting qualitative data of folks with bipolar disorder who use ayahuasca and DMT to try and determine what’s happening. And it’s beginning to prove his theories. For example, of the 10 bipolar people, he’s interviewed that smoke or vape pure DMT (without any MAOI inhibitor-containing plants or substances), “none of them went manic.” He says, “All of them reported the same thing, which was that it was mildly antidepressant. But it was also calming and grounding. As in, if they were on the manic end of the spectrum [which three were], it would bring them back to the center. And if they were depressed, it would bring them slightly up, but it wouldn’t keep pushing them and escalating into mania.”

This is a shocking finding, but not a surprising one. Psychedelics in the right dose and a prepared set and setting are known to give people a new perspective on their lives and behaviors, so why couldn’t they help folks increase their self-awareness around their mood? In a survey I conducted of bipolar diagnosed people who have tried psychedelics, I came to a similar finding. Of the 42 bipolar people who continue to use psychedelics like psilocybin, ayahuasca, DMT, mescaline and even LSD, 35 found the experience helped them manage their symptoms, including not only depression-relief but more awareness to ground themselves during mood shifts and ability to recognize manic behavior. 

“I am aware of my manic episodes when they are taking place. I am also able to recognize them faster after they happen. Maybe I can’t change what I did in those moments, [but] I am able to hold compassion for myself and understand that I am still learning and growing because for so many years I just numbed myself with Pharma and alcohol,” described Mary* a 31-year-old with Bipolar I who no longer takes pharmaceutical medication but has been using psilocybin in varying doses since January 2019. “The manic events are shorter and less severe. For example, instead of spending $1,000 at a store, I’ll spend $100 and then recognize it and am able to hold compassion that I am making progress. (My manic episodes tend to lean towards over-spending, over-eating, over-everything). Also, it has helped my binging and purging, and my depression. Obviously, all are related, but I am just more aware of everything and also the plant medicine helps me see where everything is stemming from so I can re-parent those sides of myself.”

Interestingly, some who reported more awareness and ability to manage manic behaviors pointed to mania being a very “ego-driven” experience, perhaps explaining how psychedelics are helping folks deal with it rather than aggravate it further. “When I am starting towards a manic episode, psychedelics kind of smack me back down to earth and help me remember that I don’t have all my shit figured out. It humbles me and relieves the burning anger and irritation with compassion and connection to the ‘other’,” explained Sarah*, a 37-year-old with Bipolar 2 who is now off pharmaceuticals and instead uses psilocybin truffles about once a month in different doses, which are legal in the Netherlands where she lives.

Admittedly, the responses to the survey I created have a bias because most folks found the Google Form through my social media where I’m very pro-psychedelic (especially psilocybin mushrooms) and so my followers are more likely to report positive experiences than negative ones. However, considering the lack of options beyond lifelong medication for the bipolar population, it’s an interesting finding in need of more investigation beyond anecdotal reports. Could one psychedelic experience every few months “ground” bipolar folks, allowing them to experience and manage their full range of feelings without heavy meds like Lithium? Even in Barone’s practice with ketamine, he tells Psychedelics Today that when appropriate, the goal is to wean some patients off their pharmaceutical medications eventually and instead, manage their moods with the help of intermittent ketamine-assisted therapy sessions and building skills to independently manage mood fluctuations.

It’s super controversial, especially considering unmedicated bipolar folks are at a much higher risk for suicide. Plus, going off psychiatric medication quickly without a doctor’s supervision is also dangerous, especially when combined with psychedelics. Barone, who’s volunteered at Burning Man’s Zendo Project for seven years and supervised for four, explains the combination of stopping medication to take psychedelics has caused numerous attendees to have a psychotic break at Black Rock City. Plus, Barone says that for some people, “It may be the intensity of the experience or having insufficient support during and after a trip that shifts mood or cognitive process beyond the effects of the substance.”

At the same time, mixing bipolar medications with psychedelics seems to be contraindicated, although getting a clear answer from doctors on this is hard. While it’s pretty common knowledge that SSRI’s shouldn’t be combined with psychedelics for several reasons, including the potential risk of Serotonin Syndrome, there’s less info out there about common bipolar medications like lamotrigine and lithium. Some doctors, like a psychiatrist Mudge, knows of in New York and those I interviewed for my book on mushrooms, seem to think lamotrigine doesn’t pose a huge risk when mixing with psilocybin or ayahuasca, however, lithium seems to be in a class of its own. I’ve personally heard of two instances where lithium mixed with LSD caused such negative reactions (including a seizure) that both people were sent to the emergency room to the despair of their tripping friends. There’s more info on mixing Lithium and LSD in this Erowid vault. 

To make matters even more complicated, even some of those who responded to my survey saying psychedelics help them reflect on their manic/hypomanic behaviors and ground themselves often also describe a singular incident where they did go manic and even psychotic or deeply paranoid after particular psychedelic journeys where they either “took too much,” had a “bad trip”, or took substances in less than ideal set and settings. Which brings us back to Mudge’s theories, that the bipolar brain is more sensitive and can’t handle certain substances or situations, like frequent psychedelic use or poly-drug mixes, without possibly heading into mania. 

And so, Mudge has created harm reduction guidelines for bipolar diagnosed people who want to drink ayahuasca, although he tells me multiple times he is not advising anyone to take ayahuasca or do anything illegal, but instead to please wait until his research and other community initiatives are completed. Yet, if people ignore his advice, the guidelines (see image 3) do provide a lot of interesting information to reduce harm and the risk of mood episodes. For instance, while the ayahuasca tradition is to partake in multiple ceremonies over a week or two, Mudge says that puts the bipolar brain at a much higher risk for mania. Instead, participating in one ceremony and getting enough sleep afterward will provide folks with a lot more benefits than continuing to drink – and stimulate their 5-HT2A receptors – night after night. 

Plus, he’s seen this high frequency of psychedelic use play out badly with other substances as well in his interview subjects, even at microdoses. For example, he tells me of a bipolar man who was microdosing psilocybin every day to manage his mood and had the worst manic episode of his life – at 40. Mudge believes it was the repeated stimulation of taking a serotonergic substance that binds for six hours that induced mania – similar to what an SSRI would do to a bipolar person.

When it comes to safe ayahuasca practices for those diagnosed with manic depression, Mudge believes mixing with other substances – even if they’re presented in ceremony as holy tools, like rapé, cannabis and even cacao or chocolate – poses a higher risk for pushing the bipolar brain into mania. I ask if there should be a specific bipolar “dieta” (a concept in the ayahuasca tradition where you adhere to a special diet in preparation for your ceremony) and he says absolutely. “This is why you’re not supposed to eat overripe bananas and soy sauce. Because it’s chemically reactive,” Mudge explains, and for bipolar folks, the dieta will have to be even more restrictive to provide the maximum benefits and the least amount of harm.

Lastly, when it comes to ayahuasca, not all brews are created equally, and Mudge also believes some brews that pose a higher risk than others based on their chemical composition. For example, ayahuasca prepared in the Amazon jungle can have a different combination of herbs and precise species of vine depending on the shaman, culture, and retreat center. While most psychedelics have a single type of molecule causing the experience, there are at least four psychoactive ingredients in ayahuasca: harmine, harmaline, tetrahydroharmine, and DMT. Therefore, brews can have different ratios of MAOI inhibitors to DMT molecules, and Mudge believes the bipolar brain responds better to a brew that has more DMT because the MAOI inhibitors can push people into mania (just like MAOI pharmaceuticals are known to do). He also says ayahuasca prepared in other parts of the world that use Syrian Rue instead of the ayahuasca vine also poses more of a risk because it has a different ratio of harmala alkaloids than the Banisteriopsis caapi vine used in genuine ayahuasca. 

Plus, lots of the ayahuasca that is consumed isn’t brewed fresh, but brewed once and is carried around for months to over a year, and in that time it begins to ferment and produce alcohol. And Mudge believes fermented ayahuasca poses a problem for the bipolar brain where a depressive hangover can follow rather than a humble afterglow. “I think it changes the qualitative experience for everybody,” he elaborates. “I think it makes the ceremony more intense, more into the shadow.” But for the bipolar brain, “which is more sensitive” it can leave people feeling agitated and depressed. He explains there is a trick to getting rid of the alcohol in aged ayahuasca, basically cooking the brew on a very low heat for 10 to 20 minutes so that it steams the alcohol off but never starts to boil or even simmer. “It should start to smell like a vegetable soup when it’s ready,” Mudge says.

And it’s not like bipolar people don’t ever go manic after drinking ayahuasca, it happens, and 17 of his 62 interview subjects experienced it. But, after investigating each situation further, it seems many, if not all, of the 17 were mixing substances, drinking fermented ayahuasca or brews with Syrian Rue and participating in multiple ceremonies in a week, and so in terms of his research, are technically false negatives. Although, these situations only further prove the need for his research and more like it.

Clinical Perspectives and Safety Concerns

But what about other psychedelic substances? If Mudge’s theory is correct, is DMT the only option that’s less likely to cause mania? What about mushrooms, LSD, or MDMA? Could they all have a place with specific safety guidelines? And what would those guidelines look like for a person diagnosed with manic depression? Cynthia*, a clinical therapist specializing in spiritual emergence and psychedelic integration who was trained in the transpersonal paradigm at the California Institute for Integral Studies (CIIS), thinks bipolar clients not only need a lot of preparation and integration support for a psychedelic experience, like with a professional therapist or spiritual guide, but they need to be able to sustain their stability without medication first, which she realizes just isn’t possible for everyone. She’s come to this belief not only as a clinician but as someone who was diagnosed with bipolar herself over 20 years ago, although she doesn’t identify very strongly with the diagnosis. 

She views bipolar, and all mental illness, through a very spiritual lens. “It’s not just our biochemistry and our diagnostic criteria, but it’s really our souls,” she says. She tells me about her only manic-psychotic episode which was brought on by SSRI medication in the late 1990s when she was only 20 years old. “It absolutely was also a very spiritual experience and very much a healing crisis.” She explains, during her episode, she had trauma from her early childhood come up and other painful material that needs resolving, but she didn’t get the support to really examine it until years later. I ask her if she thinks mania can be thought of in terms of Stanislav and Christina Grof’s idea of “Spiritual Emergence(y)”, a theory that views some non-ordinary states of consciousness as healing processes that could be supported for the most positive gain rather than suppressed with tranquilizing medication.

“I do think mine was a spiritual emergence. And I knew that at the time, but I didn’t have the language for it,” she says. “And what I’ve come to conclude is I think it’s not necessarily a completely ‘either-or’. I think there’s both, or it’s almost like two different languages used to describe a similar thing. Because, if you go through the checklist, I definitely fit the criteria for manic psychosis. And I definitely was having trouble, just at the very end, not eating and sleeping and not being able to use words, things that were dangerous. Now, if I had had sitters and 24 hours of support and a bunch of space to wander around, I probably could have rode it out and had the support to just be in that state faithfully until it ran its course. But I didn’t, and most of us don’t.” 

It’s a curious and radical idea that insight and healing can come from some natural non-ordinary states of consciousness, like mania and psychosis, if they could be “sat with” and supported as they played out, just like a psychedelic trip. And it’s not the first similarity between manic depression and the psychedelic experience that I came across researching this piece. Two other bipolar diagnosed people I spoke to pointed to mania being very much like a entheogenic journey. “So much of my mania feels like tripping,” said Pam* a 39-year-old woman with Bipolar 1 who no longer takes prescription mood stabilizers but uses different psychedelics to deal with her depression, “If the tripping will end, so will the mania.” 

However, in our society, we very much view these states as needing to be “cured” and suppressed rather than explored and supported. And in Cynthia’s case, she ended up in a psychiatric hospital and then on Lithium for five years after her episode. But during her first semester of grad school at CIIS, she began working with a holistic psychiatrist, part of the Grofs’ Spiritual Emergence Network, who helped her confront her trauma, wean off the medication, and learn to feel and manage the full range of her emotions through the use of spiritual and Eastern practices. Which admittedly, right after years of Lithium, was hard. She essentially had to relearn how to feel and it was overwhelming at first. “And then I was terrified of doing anything spiritual. I was terrified to meditate. I had a chance to do holotropic breathwork and I was like, I don’t want to rock the boat.” But she did learn and developed other spiritual practices, like yoga, which helped her understand how to regulate her own energy. And, even though she’s not currently on daily pharmaceuticals, she definitely still thinks they have a place, like to regulate mood for a shorter time and to control “breakout” symptoms of mania, such as trouble sleeping.

Implications for Future Research and Guidelines

For Cynthia, psychedelics were not part of this re-learning for 20 years. Instead, she spent that time integrating her spiritual emergence/manic episode, learning how to recognize the “edges” of hypomania and ground herself naturally. But two years ago, she finally felt ready to go back into the psychedelic space with spiritual guides, and now she manages all types of psychedelic experiences, even the ones Mudge warns against like LSD, MDMA, 2C-B and others I had to look up like 3-MMC and 2C-E. She says it’s not the psychedelics that keep her grounded like some of my survey participants reported, but since she’s learned how to ground herself, these experiences are manageable and beneficial for other healing.

“I’ve had a lot of stuff come up from around my episode, like fear of my own greatness. It’s like I’m scared to go visionary because they’re going to label me as manic. But I had to reclaim my comfort with that.” Cynthia admits, after a trip, especially with “heart medicines” like MDMA, she does have increased energy, “It’s exciting, I have this sort of energy of how wonderful everything is. I just have to make sure I’m sleeping and intentionally doing things to stay grounded.” She says there was a time recently where she was taking empathogens a little too often – once a month, sometimes more – and she started to have “more depressive dips and more anxiety.” But she was able to recognize that and back off. “Now I’m trying to keep it like once a quarter or even less than that.”

However, she says as a clinician, “I don’t feel super comfortable if I had a bipolar client doing classic psychedelics. I might, but it would be very case by case because I do think there is that potential risk.” She also believes bipolar to be a spectrum, and those with more severe cases with recurrent manic episodes might not be able to stabilize themselves like she’s learned to. But the connection between spiritual emergence and bipolar disorder, psychedelics and mania seem too close and full of such vast potential to not be investigated further. And of course, Mudge has a plan for how to proceed. 

Once Mudge figures out the ideal recipe for brewing ayahuasca “in a balanced way” that is medicinal but “not dangerous in terms of triggering mania,” his mission is to create the “Manic Depressive Community Church”. It would serve as a community for those with bipolar and those affected by the condition (like parents and spouses) where ayahuasca, served in the safest possible way by understanding facilitators who are bipolar themselves, is the sacrament. His vision is that this church would be a non-profit organization that’s local to people so they wouldn’t have to travel to the Amazon to take this medicine. And of course, being the academic that he is, he also envisions setting up a clinical trial or having the Multidisciplinary Association for Psychedelic Studies (MAPS) come in to do an observational clinical trial so the community can finally get some hard data on this population other than assumptions, anecdotes, and old case studies.

Mudge also insists that bipolar folks wait for him to accomplish this goal before they start drinking ayahuasca or taking other kinds of psychedelics. He says his safety protocol and recipe are still about two years away from being complete, and in the meantime, he encourages folks to prepare by getting their lifestyles in order. He explains that it means accepting their diagnosis and getting on medications that work, like lamotrigine and a low dose of lithium. It also means getting enough sleep and stopping other recreational or self-medicating drug use like alcohol, cannabis, or whatever else. “That’ll help you in the next year or two in a massive way,” says Mudge, “and then you’ll be ready to drink safely.”

But the weight of the bipolar community’s desire to heal shouldn’t be all up to one man. The psychedelic science community should also step up and start investigating the potential benefits and harms for this large and desperate population. “There’s a massive potential of psychedelics, but bipolar people have unique brain chemistry,” says Mudge. “They need the psychedelic experience to be chemically tailored to their brains’ needs.”

*Editor’s note: Names changed for privacy.