Prescription medication and party drugs

Before we get into this article, we STRONGLY recommend that you talk with your doctor candidly about taking recreational drugs with your medication.

It’s late autumn and winter is on the horizon. Winter’s lack of vitamin D-giving sunlight can be a challenge. The seasonal affective disorder struggle is real, and a lot of people with anxiety and depression feel their symptoms a lot worse in the colder, darker months. This can lead to folk being prescribed medication to help make life more tolerable.

Recreational drugs and your meds: What you need to know

If you’re taking medication for anxiety or depression there’s a chance that they’re not going to go well with recreational drugs. Your medication can affect the intensity of the recreational drug experience, and make coming down more of a shit time than usual.

What happens when you take MDMA with prescription medication?

MDMA releases large amounts of serotonin in your brain in a flood. If you’re not on medication that affects your serotonin levels, your brain can compensate to deal with the new levels of serotonin and process it. Unless you’ve taken a dangerously large amount of MDMA (please don’t) the risk of harm is relatively low. Your risk of harm goes up if you’re on medication for anxiety or depression.

Medication for depressive disorders, but particularly SSRIs, will dampen the effects you feel from taking MDMA. This means you might want to take a stronger dose, which is where you get into trouble.

Many antidepressants work by slowing down how fast your brain can get rid of serotonin after it’s released. If your brain isn’t able to clear serotonin quickly and you add MDMA, the flood of serotonin can keep building up with nowhere to go and cause a serotonin overload.

Your medication reduces how quickly your brain deals with serotonin. If your body suddenly has more serotonin than your meds can handle you run the risk of serotonin syndrome.

What’s serotonin syndrome?

Serotonin is responsible for mood, digestion, heart rate and blood flow, and breathing. If there’s more serotonin in your body than it can handle, all of these systems will go into overdrive.

Mild symptoms include:

  • Agitation or restlessness
  • Confusion
  • Rapid heart rate and high blood pressure
  • Loss of muscle coordination or twitching muscles
  • Muscle stiffness
  • Heavy sweating
  • Diarrhea
  • Headache
  • Shivering
  • Goose bumps

Severe serotonin syndrome has put people in hospital, and can kill in extreme cases.
Call an ambulance or get to A&E as soon as possible if you or someone you’re trip-sitting have

  • High fever
  • Seizures
  • Irregular heartbeat
  • Unconsciousness

What about psychedelics?

There’s no empirical data on whether or not psychedelics like LSD or psilocybin cause serotonin syndrome.

BUT

Psychedelics work by activating serotonin receptors so It might not be a great idea to take them with anything that’s already affecting serotonin.

Anti-anxiety medications also blunt psychedelic effects. Your trip might be less intense and your visuals might not be as strong. This might lead folk to take a higher dose than usual.

With LSD there’s a lower risk of doing yourself any lasting physical damage if you take a strong dose. If you’re eating mushrooms or drinking mushroom tea the likelihood of stomach cramps and nausea goes up the more you take. Psilocybe species contain high levels of a substance called chitin which is what can make you feel sick. The more of it you ingest, the worse you’re likely to feel and the more likely you are to vomit and/or have diarrhea.

Read more about the interaction between psychedelics and antidepressants on the Mind Foundation site
Read more about how mushrooms interact with your digestive system at the Psychidelic Science Review site

Ok but ketamine tho?

There’s still not a lot of study published around ketamine’s effects on your serotonin system. A lot of new research is being done at the moment that we’re watching with interest. But the results for the haven’t been released yet. We always urge you to be cautious when you’re messing with your brain chemistry.

Read the article about ketamine’s effect on serotonin receptors in SSRI-resistant patients on the Nature website

What if I stop taking my meds for a bit?

We definitely don’t recommend doing this.

It’ll take up to five weeks to get your brain back to factory settings and ready for recreational drugs. Five weeks with no medication means you get five weeks of the symptoms you started taking the prescription meds for in the first place. This will definitely have an effect on how you feel when you take your recreational drugs and can influence the vibe you experience.

And then there’s going back on the meds once you’ve come all the way down after your adventure and recalibrated. The two-to-three week bedding in period for psych meds can make the symptoms you experience far worse before the medication starts to do its job.

What does sunlight have to do with your brain chemistry?

You have special receptors in your skin that turn UV B rays from the sun into vitamin D3. Vitamin D3 is one of the regulators for tryptophan, which is one of the building blocks for serotonin. Basically, if you don’t get enough vitamin D in your skin, you can’t make enough serotonin.

This is your brain. This is your brain on serotonin and dopamine

Serotonin is the hormone produced in your gut and other tissues that controls depression and anxiety, among other things. One of serotonin’s jobs is to put the brakes on the chemical reactions in your body that cause these feelings. So, the more serotonin you produce and the more chances it has to bind to the right receptors, the less anxious and/or depressed you feel.

Serotonin also works with dopamine. Dopamine is the hormone your body uses to tell when something that you really need to pay attention to is about to happen. It’s the chemical that ties major emotional and psychological events to triggers.

For example, you get a dopamine spike when you see your favourite food or drink. Your brain knows that something delicious is about to happen because the information from your tastebuds and your belly have previously confirmed that yes, this is a tasty thing, and tasty things are good. Your body kicks up dopamine production and you get excited and have that feeling of anticipation for the tasty thing.

It also works for bad things, like if you eat something that gave you food poisoning or tasted completely gross. You’ll see the bad thing that done you wrong, and your dopamine will spike. This will make your body remember what happened last time you ate this particular thing and you’ll nope out.

So when an event happens, serotonin adjusts your levels of anxiety and depression to Good or Bad, and dopamine puts a chemical ‘marker’ on the event so that you remember it on a physical level. It’s what kept our stone age ancestors from eating toxic things and trying to cuddle sabre-tooth tigers.

Read more about Seasonal Affective Disorder (SAD) at the Springer Online site
Read more about vitamin D deficiency and mental illness at the BMC Psychiatry site
Read more about what serotonin does on the Wikipedia page
Read more about what dopamine does on Wikipedia

If you can’t make your own neurotransmitters, store-bought is fine

There’s a buttload of stigma around anti-anxiety and antidepressant medication.

Fuck stigma. It’s stupid.

Anti-anxiety and antidepressant medication is the psychological version of having to wear glasses or having your arm in a cast when you break it. You should feel free and happy to do what you need to in order to get by in the swirling clusterfuck that the world’s in right now.

Image, diagram of the serotonin system with effects of MAOIs and SSRIs shown
This is your brain doing serotonin. The bits of the neuron where MAOIs and SSRIs do their job are labelled.

These are the three main types of prescription drugs that are used to help people with anxiety and depression in New Zealand.

SSRIs (Selective Serotonin Reuptake Inhibitors)

SSRIs work by slowing down how quickly your brain can recycle serotonin so it hangs around for longer. This means that it has more time to activate receptors and send messages before it gets sucked back up again.

SSRIs only block serotonin recycling and not dopamine or norepinephrine.

Common SSRIs are:

  • Citalopram (Celexa)
  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Escitalopram (Lexapro)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)

MAOIs (Monoamine oxidase inhibitors)

Monoamine oxidase enzymes A & B play a major part in breaking down dopamine, norepinephrine, and serotonin into other chemicals which is important for things like mood regulation.

MAO inhibitors (MAOIs) block the activity of one or both of these enzymes.
This slows down the breakdown of dopamine, norepinephrine and serotonin in your brain so they can hang around longer and send more signals.

Because they affect serotonin, dopamine and norepinephrine, MAOIs have potentially dangerous interactions with many other drugs so extreme caution is advised.

Common MAOIs are:

  • Moclobemide (Amira, Aurorix)
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)

Tricyclics

Tricyclics aren’t used so much in treatment of depression or anxiety disorders any more, but they are still used to treat chronic pain.

Tricyclics work by blocking serotonin transporters and norepinephrine transporters. This means that both of these hormones have more time to build up in your brain’s synapses and make stronger signals for your brain to use.

Common tricyclics are:

  • Amitriptyline (Elavil)
  • Nortriptyline (Pamelor, Noritren)
  • Clomipramine (Anafranil, Clomicalm)
  • Imipramine (Tofranil, Tofranil-PM)
  • Doxepin (Sinequan, Quitaxon, Aponal)

Special thanks to Matija Miletec for helping translate the neuroscience

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