If you’ve started taking antidepressants, you might have noticed that your MDMA trip feels less euphoric than before you started taking them. Some prescription medications will affect how you experience recreational drugs.
Taking SSRIs and MDMA together dampens MDMA’s effect. The SSRI prevents all the serotonin the MDMA’s released from being absorbed. If you take a low dose of MDMA while on SSRIs your risks will be fairly minor – you might feel a bit disappointed on the way up and have a harder comedown. If you take a moderate to high dose of MDMA, or if you have a bump because you’re not as high as you want to be, you increase the risk of flooding your body with too much of a good thing: serotonin.
Serotonin syndrome symptoms
Serotonin syndrome happens when your body can’t cope with how much serotonin’s in your system. Symptoms of serotonin syndrome will tend to appear less than 24 hours after taking drugs. The best way to decrease your risk is to limit anything you take on top of what you’ve been prescribed.
Get help immediately if someone
- falls unconscious, or if they
- have a seizure, high fever, or
- have an irregular heartbeat.
Early warning signs to look out for, taken from Medsafe’swebsite:
- Involuntary muscle spasms (clonus)
- Excessive sweating
- Vomiting and diarrhea
- Agitation and restlessness
- Increases in body temperature, heart rate, and blood pressure
If you’re out partying and notice someone experiencing any of these, the best thing to do is get medical help immediately and keep them as cool as possible. If the body temperature of someone with serotonin syndrome gets too high (over 40C), they’re more likely to die, so keep them cool.
Don’t physically restrain someone with serotonin syndrome symptoms. It will stress them out further. This will in turn increase the stress on their heart and can cause a cardiac event.
So why the less intense experience?
MDMA and SSRIs both act on the serotonin system. This system helps control your mood, temperature, sex drive, sleep, digestive system and cardiovascular system. When MDMA binds to the serotonin receptors, it makes you feel more euphoric. However, it appears that SSRIs are better at getting to the serotonin receptors than MDMA, dulling its emotional effect. The stimulant effects might remain while on SSRIs as MDMA binds to dopamine receptors too, which SSRIs have no impact on.
This also means if you’re dual-wielding your meds and MDMA you’re putting the stimulant load on your cardiovascular system. Your heart and lungs are going to be under an extra amount of stress and you increase your risk of overamping.
Taking a break from your meds is not recommended
At the risk of sounding like your nan, this is something you want to think really seriously about before doing for the following reasons:
- It can take anywhere up to 5 weeks for the SSRIs to clear your system to the point where you’ll feel any positive effects from the MDMA, depending on which SSRI you’re on and how long you’ve been taking them for
- The reasons you went on the medication in the first place are still going to be there. Your symptoms may feel more acute while you’re waiting for the SSRI to clear, and there may be withdrawal symptoms to contend with
- When you go back on your meds you’ll have to deal with the bedding in period again. Depending on which SSRI you’re on, this can be brutal and last for weeks.
Generally, any up from the MDMA isn’t going to be worth all the down.
SSRIs and other recreational drugs
What about other drugs?
Psilocybin
Psilocybin acts on serotonin receptors too, so you may experience a dampened high when mixing psilocybin and SSRIs.
A study by Gukasyan et al. found a small risk of serotonin syndrome when mixing mushrooms and SSRIs, however, the data was self-reported so it’s hard to know whether participants got a diagnosis (not to mention the stigma of getting diagnosed for a thing related to drugs you took). They also found that you might need to be off antidepressants for six months to not experience dampened effects of shrooms.
To make matters even more confusing, common psychedelic effects are similar to mild serotonin toxicity (another name for serotonin syndrome), Malcolm and Thomas report in their study on psychedelics and SSRIs. The easiest way to not get confused on whether you’re having a time on shrooms or mild serotonin syndrome is to not take shrooms. Sorry 🙁
LSD
Acid’s effects can be dampened if you’re taking SSRIs at the same time. There was a study done on people who had previously taken acid and then were prescribed SSRIs. When they took these SSRIs, they experienced slight psychedelic effects like LSD’s, (Goldman et al, 2007). So mixing LSD and SSRIs is unpredictable.
Ketamine
Ketamine, at therapeutic doses when used with other antidepressants, has been found to be relatively low risk . Keep in mind that there isn’t much information on what happens when you mix a recreational dose of ket and SSRIs.
More research is definitely needed
You might’ve noticed a whole bunch of “welll, we don’t really know” in this section. Not many people are studying drugs, and there’s limited funding so there’s not much peer-reviewed work we can draw from (not to mention the ethical dilemmas of just…giving people a random cocktail of drugs to see what happens. FOR SCIENCE!).
Other prescription drugs and MDMA
MAOI antidepressants are very risky to mix with MDMA, and most other drugs. MAOIs prevent the extra serotonin from being broken down. This means you risk flooding your body with serotonin right away, on a single MDMA dose. This can put you at risk of severe serotonin syndrome.
Tricyclic antidepressants also have an effect on how you experience recreational drugs. They were found to have a similar risk profile to SSRIs when mixed with MDMA, but we struggled to find more information than that, so we’d suggest that you proceed with caution.
Methylphenidate delays the onset of MDMA, so if you’re mixing the two, make sure you wait a bit longer for the MDMA to kick in. Dexamphetamine and Vyvanse are both in the amphetamine family, so have a risk of overamping if you mix them with MDMA.
Saint John’s wort also acts on the serotonin system, but we don’t know exactly how it would affect your trip.
If you can’t remember all the different interactions, all good! Our new mixing chart has condensed the risks of mixing different drugs with MDMA, MAOIs and SSRIs. And it’s important to remember that mixing any kind of drugs together comes with an element of risk, and potentially unpredictable effects. risk,potentially unpredictable effects.
