Safety and medications

Medications and psilocybin

Each row is a cited finding, checked 26 October 2026. A medicine that is not listed has no cited evidence either way; ask the prescriber.

Conditions centres screen for

• Lithium: seizure risk. An analysis of online reports found that 47% of 62 reports of lithium taken with a classic psychedelic (such as psilocybin or LSD) involved seizures and 39% involved medical attention, while none of 34 lamotrigine reports did. The authors provisionally concluded psychedelic use may pose a significant seizure risk for people on lithium. [Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports, Pharmacopsychiatry, 2021]
• Oregon bars recent lithium users. Oregon's required Client Information Form asks whether the client has taken lithium in the last 30 days; a yes answer means the client may not participate in an administration session. [Client Information Form (Oregon Psilocybin Services, updated 1.1.26), Oregon Health Authority, Public Health Division, 2026]
• Tricyclic antidepressants and lithium may intensify effects. A small retrospective questionnaire study (10 people using LSD, not psilocybin) found chronic tricyclic antidepressant or lithium use was associated with subjectively stronger physical, hallucinatory and psychological responses, while chronic MAOI use was associated with weaker responses. [Alterations in responses to LSD in humans associated with chronic administration of tricyclic antidepressants, monoamine oxidase inhibitors or lithium, Behavioural Brain Research, 1996]
• SSRIs and SNRIs can blunt effects. In a survey of 611 reports of taking mushrooms with an antidepressant, the probability of weaker than expected effects was 0.47 for SSRIs, 0.55 for SNRIs and 0.29 for bupropion, and reduced effects may persist up to 3 months after stopping an SSRI or SNRI. An older study found 28 of 32 people (88%) on serotonin reuptake-inhibiting antidepressants for over 3 weeks reported decreased or virtually eliminated LSD effects. [Attenuation of psilocybin mushroom effects during and after SSRI/SNRI antidepressant use, Journal of Psychopharmacology, 2023] [Chronic administration of serotonergic antidepressants attenuates the subjective effects of LSD in humans, Neuropsychopharmacology, 1996]
• Antidepressant interactions: serotonin syndrome risk is lower than with ayahuasca. A review of serotonin toxicity concluded that serotonergic psychotropics without MAOIs are low risk in combination with psychedelics that also do not contain MAOIs, such as psilocybin; the main danger arises when an MAOI is involved. [Serotonin toxicity of serotonergic psychedelics, Psychopharmacology (Berl), 2022]
• Psychosis and severe psychiatric history. Published research safety guidelines recommend excluding volunteers with a personal or family history of psychotic disorders or other severe psychiatric disorders, and note prolonged psychoses triggered by hallucinogens are less common than acute distress. Oregon's Client Information Form bars anyone who has ever been diagnosed with or treated for active psychosis. [Human hallucinogen research: guidelines for safety, Journal of Psychopharmacology, 2008] [Client Information Form (Oregon Psilocybin Services, updated 1.1.26), Oregon Health Authority, Public Health Division, 2026]
• Bipolar disorder. In an international survey of 541 people with self-reported bipolar disorder who had used psilocybin, 32.2% described new or increasing symptoms after trips, prominently manic symptoms, sleep problems and anxiety; 3.3% used emergency medical services. The authors say bipolar symptoms may emerge or intensify after psilocybin use. [Risks and benefits of psilocybin use in people with bipolar disorder: An international web-based survey on experiences of 'magic mushroom' consumption, Journal of Psychopharmacology, 2023]
• Blood pressure and heart rate. NIDA states that psilocybin typically raises blood pressure and heart rate, which may be dangerous for people with heart conditions. A 2024 meta-analysis of psychedelic trials found an increased risk of elevated heart rate and systolic and diastolic blood pressure at all dose ranges during the acute phase. [Psilocybin (Magic Mushrooms), National Institute on Drug Abuse (NIH)] [Safety and risk assessment of psychedelic psychotherapy: A meta-analysis and systematic review, Psychiatry Research, 2024] [Hallucinogenic mushrooms drug profile (archived copy of emcdda.europa.eu page), EMCDDA (now EUDA), via Internet Archive snapshot 2024-06-18]
• Challenging experiences outside supervised settings. In a survey of 1,993 people describing their worst psilocybin mushroom experience, 11% put themselves or others at risk of physical harm, 2.6% behaved aggressively or violently, 2.7% received medical help, and 7.6% of those whose experience was over a year earlier sought treatment for enduring psychological symptoms. Risk rose with dose and with absence of physical comfort and social support. [Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences, Journal of Psychopharmacology, 2016]
• Unsupervised use and risky behaviour. NIDA notes that health risks are greater when psilocybin is taken unsupervised and outside clinical supervision, including dangerous behaviour such as driving or walking in traffic while impaired. [Psilocybin (Magic Mushrooms), National Institute on Drug Abuse (NIH)]
• Adverse events in the COMP360 phase 2b trial. In the NEJM phase 2 trial of a single dose of COMPASS's synthetic psilocybin for treatment-resistant depression (233 participants), adverse events occurred in 179 participants (77%), including headache, nausea and dizziness, and suicidal ideation or behaviour or self-injury occurred in all dose groups. [Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression, New England Journal of Medicine, 2022]
• Oregon's mandatory client screening questions. Before any Oregon administration session, the client must complete a Client Information Form with a facilitator, answering yes/no questions on lithium use, current treatment for medical or mental health conditions, mushroom allergy, medications, thoughts or history of harming self or others, active psychosis and pregnancy or breastfeeding. Current thoughts of harming self or others, lithium in the last 30 days, or a history of active psychosis rule out a session; clients who are pregnant or breastfeeding must be told the risks are unknown. [Client Information Form (Oregon Psilocybin Services, updated 1.1.26), Oregon Health Authority, Public Health Division, 2026]

Truffles in the Netherlands

• Strength varies between packs. DRUGSinfo notes that smartshop staff can advise on truffle strength, but the strength of truffles is known to vary from pack to pack. [Wat is het verschil tussen paddo's en truffels?, DRUGSinfo (Drugs Infolijn), Trimbos-instituut]
• No quality control of truffle ceremonies. The Trimbos Institute's DRUGSinfo warns that nobody checks the quality of truffle or mushroom ceremonies, including intake, aftercare or the number of sober people present, and that a truffle ceremony can be dangerous for people who take medication or have psychological complaints. [Paddo's: Risico's, DRUGSinfo (Drugs Infolijn), Trimbos-instituut]
• Ceremonies are not therapy. DRUGSinfo states that advertising ceremonies as treatment for mental health problems is not allowed and not correct, that evidence is far too limited, and that many people have more complaints after a ceremony. [Paddo's: Risico's, DRUGSinfo (Drugs Infolijn), Trimbos-instituut]
• Psychosis risk. DRUGSinfo states that mushrooms and truffles can trigger or worsen psychosis, mainly in people who are susceptible, for example because it runs in the family or they have had a psychosis before. [Paddo's: Risico's, DRUGSinfo (Drugs Infolijn), Trimbos-instituut]

If you need help now

• 988 Suicide & Crisis Lifeline: Call or text 988, or chat at 988lifeline.org. Anyone in the US facing mental health struggles, emotional distress, alcohol or drug use concerns, or who just needs someone to talk to. 24/7, free and confidential. 988 Suicide & Crisis Lifeline
• Veterans Crisis Line: Dial 988 then press 1, text 838255, or chat at veteranscrisisline.net. Veterans, service members, National Guard and Reserve members, and those who support them. You do not have to be enrolled in VA benefits or health care. 24/7, free and confidential. U.S. Department of Veterans Affairs
• SAMHSA National Helpline: 1-800-662-HELP (4357); TTY 1-800-487-4889. Individuals and families facing mental and/or substance use disorders: treatment referral and information, in English and Spanish. 24/7, 365 days a year, free and confidential. Substance Abuse and Mental Health Services Administration
• FindTreatment.gov: findtreatment.gov. SAMHSA's confidential and anonymous locator for treatment of substance use disorders (such as opioid or alcohol use disorder) and mental disorders in the US and its territories. . Substance Abuse and Mental Health Services Administration

Outside the US, call your local emergency number.