Lithium-Related Concerns

Urgent help first

A seizure is a medical emergency. In the US, call 911. For a possible poisoning, US Poison Help is 1-800-222-1222. If you take lithium, do not stop or change it because of this page; lithium is a prescribed medicine, and decisions about it belong with the prescriber. This page is education only.

What lithium is and why it comes up

Lithium is a mood-stabilizing medicine used mainly in bipolar disorder. People with bipolar disorder have been excluded from recent psychedelic trials, which means there is little controlled information about psychedelics in people taking mood stabilizers. [1] NIDA also notes that modern research excludes people with previously diagnosed psychosis or bipolar disorder, and sometimes other mental illnesses, as a precaution. [2] For the mood-related side, see mania and bipolar-related concerns.

Evidence labels used on this page: insufficient evidence, evidence of harm (as a signal in reports only) and preclinical where noted. See how we label evidence.

What the reports show

Online experience reports (2021). A research team that included staff of the Erowid Center, which runs one of the websites, analyzed reports of classic psychedelics taken with mood stabilizers, posted on three websites (Erowid, Shroomery and Reddit). Of 62 lithium-plus-psychedelic reports, 47% involved seizures, another 18% were described as bad trips, and 39% involved medical attention. None of 34 lamotrigine reports involved seizures. The authors provisionally concluded that psychedelic use may pose a significant seizure risk for patients taking lithium, and said further research is needed. [1]

The systematic review of drug interactions (2022). A review of psychiatric medicine interactions with MDMA and psilocybin summarized the same dataset. For psilocybin specifically, 2 of 6 reports of lithium plus psilocybin involved seizures, and none of 10 reports of lamotrigine plus psilocybin did. The review quoted the original authors acknowledging low-quality evidence due to lack of standardization, selection bias and lack of clinical verification. [3] Most reports in that analysis involved LSD, not psilocybin. [3]

A scoping review of seizures (2024). A scoping review found 16 human publications and 11 animal ones. Overall the results were heterogeneous but suggested psychedelics may not increase seizure risk in healthy individuals or animals in the absence of other drugs, while taking other substances, such as kambo or lithium, could increase the risk. The authors cautioned that the data lack sufficient external validity. [4]

How to read these findings

• Source type. The numbers come from people who chose to write up their own experience online, not from a study that followed everyone who took the combination. The review of these reports flagged selection bias, so the percentages cannot be read as the chance that a seizure will occur. [3]
• No confirmation. The reports are not clinically verified, as the review noted. [3]
• What is unknown. The product, the amount, other substances taken and whether the person had other risk factors are not reliably known.
• A signal, not a measurement. The result is consistent across a few sources, so it deserves caution. Label: insufficient evidence for a rate, with a safety signal that is concerning.

Proper evidence not found for controlled human studies of lithium given with LSD or psilocybin. We searched PubMed for lithium with psilocybin, LSD and classic psychedelics and found the three sources above and a trial protocol on ketamine in bipolar depression that is not about classic psychedelics.

Other substances and combinations

The reports compared lithium with lamotrigine (a different type of mood stabilizer). This comparison should not be read as a statement that any other medicine is safe with psychedelics. Other mood stabilizers and antiseizure medicines have not been shown safe in the sources we read.

Ayahuasca, MDMA, ketamine and other substances have their own interaction profiles. Proper evidence not found in this session's sources for lithium combined with them. For an overview see psychedelic drug interactions and toxicology and serotonergic medicines.

Who should talk to a professional first

• Anyone taking lithium or another mood stabilizer.
• Anyone with epilepsy or a past seizure. The 2024 scoping review notes that psychedelic studies tend to exclude patients with a past history of epilepsy. [4]
• Anyone with bipolar disorder or a family history of it.

A pharmacist or prescriber can review the whole medicine list. See talking with a health professional.

What the evidence cannot say

• How common seizures are with the combination.
• Whether other doses of lithium or other mood-stabilizing medicines change the risk.
• Whether psychedelic-assisted therapy under supervision would be safer; no trial has tested this combination in the sources we read.