Can Psychedelics Trigger Psychosis?

 In Mental & Emotional Health, Psychedelics

Chaos consciousness ain’t for all of us.

Dan is beaming as he declares, “Dang, you’re so beautiful! It’s such a coincidence – but there are no coincidences! – that I should see you today and that you’re wearing a purple sweater.” It’s the middle of winter, but Dan’s wearing a t-shirt, shorts, and flip-flops. He’s talking fast and gesticulating wildly as he tells me about his new discoveries in sacred geometry and how purple is by far the “most spiritually attuned” color.

I’ve only met Dan once before, at a conference. Our interaction at the time was both professional and brief, so I’m somewhat taken aback by his intimate and engaged style with me now. As a healthcare provider, however, I also understand what’s going on.

Dan is showing signs of mania, a state characterized by elevated mood, hyperactivity, extreme confidence, and a reduced need for sleep. Mania is commonly seen in people with Bipolar 1 Disorder (formerly known as manic depression), though manic states can also occur in those without the condition.

Extended periods of sleep deprivation, major stressors (like the death of a loved one), and childbirth in women can all trigger manic states. Drugs can also bring on mania. This includes both pharmaceutical medications, like some anti-depressant drugs, as well as psychedelic substances. People with a personal history or a strong family history of Bipolar 1 or psychosis (like schizophrenia) are therefore advised to avoid using psychedelic altogether or, at least from a harm reduction standpoint, to use substances like LSD, psilocybin, and ayahuasca with extreme caution.

Shortly after bumping into Dan, I called a mutual friend of ours, Todd. Todd explained to me that he was worried about Dan. Dan had been drinking ayahuasca on an almost weekly basis, despite several friends asking him to take a break.

Dan ended up in the psychiatric ward of the hospital a few days later. I found myself feeling very angry, but not with this bright-eyed, cavalier young man who was trying to get a handle on his early childhood trauma. I was angry with the medicine carrier that kept serving him ayahuasca week after week, even after Dan began showing signs of mania and asked him to take a break.

Now, having a manic episode or even psychotic break can be a powerful, meaningful experience for some people, but it is by no means the only path to spiritual elevation, nor the ideal one. There are a myriad of safer ways to learn, grow, and awaken without having to end up in the hospital or seriously freak out one’s friends and family. I think most people would agree that Dan’s story is an unfortunate one.

Why psychosis and psychedelics don’t always mix well

Part of how psychedelics work is by increasing the amount of entropy, or chaos, in the brain. In fact, in a paper titled, “The Entropic Brain: A Theory of Conscious States Informed by Neuroimaging Research with Psychedelic Drugs,” neuropsychopharmacologist Dr. Robin Carhart-Harris and his co-authors explore this very nature of psychedelics [1]. They hypothesize that problems like depression, obsessive-compulsive disorder (OCD), and addiction result from too much order / rigidity in certain parts of the brain. They argue that psychedelics may help treat these conditions by temporarily creating more “chaos” in the brain to disrupt that rigidity, much like shaking a snow globe.

Psychedelics appear to disorganize the neural patterns in which rigid patterns of thought and behavior – such as those seen in depression, OCD, and addiction – are rooted. The accompanying graphic, which I’ve adapted from a similar image found in Carhart-Harris’ paper, depicts how some people are on the rigid / low chaos end of the consciousness spectrum and others are more on the entropic / high chaos end.

Image by Dr. Erica Zelfand

Thinking of psychosis and mania as high chaos states, it’s clear that chaos-increasing medicines like LSD might just push someone with a propensity towards mania or psychosis over the edge. When a person’s brain is already a blizzard, they don’t need their metaphorical snow globe shaken. Dr. Carhart-Harris and his team have also performed studies in which the brain scans of people on psychedelics were compared to baseline images [2]. These images reveal that psychedelics enhance neural crosstalk – the mechanism by which new connections are made between parts of the brain that don’t usually communicate with one another.

The following is a simplified illustration of the neural connections observed in the brains of study participants after they took placebo medication (a) vs. psilocybin (b). The participants who received psilocybin were observed to have significantly more neural connections than those who received placebo [3].

Image Courtesy of the Beckley/Imperial Research Programme [3]

Someone with depression and whose thoughts are focused on a very tight loop of negative, self-denigrating sentiments may very well benefit from a little increased neural cross talk. More neural connections may allow them to realize that there are more solutions to their problems, to feel motivated to make more beauty in their lives, and to understand that life can be pretty wonderful, if you look at it right. They may realize that it’s not so terrifying after all to take the risk of asking somebody out on a date, to read more about a topic that interests them, or to spend a little money on a haircut or new pair of shoes.

Someone in a manic or psychotic state, however, doesn’t need a nudge in the direction of new connections. In fact, they’re already at high risk of seeing synchronicity (sacred coincidence) where there might not actually be any, being overly familiar with people (as Dan was with me), becoming obsessed with fractals (or whatever has caught their interest), and piling up credit card debt in the pursuit of whimsies. Most if not all of the studies on psychedelic medicine exclude those with a personal history of Bipolar 1 or psychosis from enrolling – likely for these reasons.

The right medicine for the right condition, at the right time

We are all hopefully able to stay aware of our connection with reality and give our bodies and brains the support they need. When that fails, however, that’s where friends, families, and mental health professionals can be our lifelines. It’s time for medicine carriers to become more aware of these issues and have frank conversations with their guests, connect them with mental health resources, and refuse to serve them more medicine when they start showing signs of losing touch with reality.

When psychedelic users go days without sleeping and show signs of mania or psychosis, the answer isn’t more chaos-inducing medicine. The answer, more often than not, is rest, sobriety (including a break from sacred medicines like rapé), re-grounding, integration therapy, community support, and/or self-reflection.

If we think of psychedelics as medicines, then it’s easy to see that – as with all medicines – psychedelics are not appropriate for every person or situation. Antibiotics, for example, have saved countless lives due to their ability to combat bacterial invasion. But, as they can only fight bacteria, they are completely useless in the milieu of viral or fungal infections. Antibiotics also come with risks, such as disruption of the microbiome and can breed antibiotic-resistant “superbugs.” Antibiotics are not the appropriate solution to every kind of infection. So why, then, would we think that psychedelics could be the right medicine for every kind of mental/emotional ailment? Every medicine has its indications, and every therapy comes with its risks.

When people start losing touch with reality, it’s usually a sign to take a break from psychedelic use. It’s also likely time to work with a therapist or integration counselor to make sense of what occurred and find any wisdom to be gleaned, to cut back on work and social obligations, to rest, to connect with loved ones, to spend time in nature, and to get both feet firmly rooted – both physically and psychologically – back here on Earth.

There many medicines, many therapies, and many pathways to insight, growth, and healing. Psychedelics might be the “superhighway,” but they are by no means the only route to wisdom and healing.

References

  1. Carhart-Harris, Robin Lester, Robert Leech, Peter John Hellyer, Murray Shanahan, Amanda Feilding, Enzo Tagliazucchi, Dante R. Chialvo, and David Nutt. “The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs.” Frontiers in human neuroscience 8 (2014): 20.
  2. Carhart-Harris, Robin L., Suresh Muthukumaraswamy, Leor Roseman, Mendel Kaelen, Wouter Droog, Kevin Murphy, Enzo Tagliazucchi et al. “Neural correlates of the LSD experience revealed by multimodal neuroimaging.” Proceedings of the National Academy of Sciences 113, no. 17 (2016): 4853-4858.
  3. Petri, Giovanni, Paul Expert, Federico Turkheimer, Robin Carhart-Harris, David Nutt, Peter J. Hellyer, and Francesco Vaccarino. “Homological scaffolds of brain functional networks.” Journal of The Royal Society Interface 11, no. 101 (2014): 20140873.

Photo by Jake Davies on Unsplash

A similar article written by Dr. Zelfand first appeared on January 29, 2019 at Psychedelic.Support

 

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