Interactions between classic psychedelics and serotonergic antidepressants: Effects on the acute psychedelic subjective experience, well-being and depressive symptoms from a prospective survey study

Abstract

Background: There is growing evidence for the therapeutic effects of psychedelics. However, it is still uncertain how these drugs interact with serotonergic antidepressants (serotonin reuptake inhibitors (SRIs)). Objective: This study explores the interaction between psychedelics and SRIs in terms of therapeutic effects. The objective is to compare acute psychedelic effects and subsequent changes in well-being and depressive symptoms among ‘SRI −’ individuals (not on psychiatric medication) and ‘SRI +’ individuals (undergoing SRI treatment). Methods: Using prospective survey data, the study employs multivariate analysis of covariance (MANCOVA) and linear mixed effect models to analyse subjective differences and changes in well-being and depressive symptoms pre- and post-psychedelic experiences. Results: Results indicate that ‘SRI −’ participants experience significantly more intense subjective effects compared to ‘SRI +’ participants ( F = 3.200, p = 0.016) in MANCOVA analysis. Further analysis reveals ‘SRI –’ individuals report stronger mystical (18.2% higher, p = 0.048), challenging (50.9% higher, p = 0.001) and emotional breakthrough experiences (31.9% higher, p = 0.02) than ‘SRI +’ individuals. No differences are observed in drug-induced visual effects ( p = 0.19). Both groups exhibited similar improvements in well-being and depressive symptoms after the psychedelic experience. Conclusion: Individuals presumed to be on serotonergic antidepressants during psychedelic use display reduced subjective effects but similar antidepressant effects compared to those not undergoing SRI treatment. Further controlled research is needed to comprehend the interplay between serotonergic antidepressants and psychedelics, illuminating potential therapeutic benefits and limitations in clinical contexts.