Nearly half of online reports of psychedelics taken with lithium involved seizures; none of the lamotrigine reports did
"Strikingly, 47% of 62 lithium plus psychedelic reports involved seizures, and an additional 18% resulted in bad trips while none of 34 lamotrigine reports did. Further, 39% of lithium reports involved medical attention."
Weak or heavily disputed. Treat as a question, not an answer. how we score evidence
Caveat on this rating: Self-selected online reports with no denominator; the percentages are of reports, not of users, and severe events are over-represented. The lithium versus lamotrigine contrast within the same sources is the finding, not the 47 percent itself.
People with bipolar disorder were excluded from the psychedelic trials. Some are trying the drugs anyway, on their mood stabiliser. This is the only systematic look at what happened.
Significant findings
Nayak and colleagues (Pharmacopsychiatry, 2021) analysed reports of classic psychedelics (LSD, psilocybin) taken with mood stabilisers, from Erowid, Shroomery and Reddit. The abstract's framing: "individuals with bipolar depression may attempt to treat themselves with psychedelics while on a mood stabilizer, particularly given enthusiastic media reports of the efficacy of psilocybin for depression."
The finding: "Strikingly, 47% of 62 lithium plus psychedelic reports involved seizures, and an additional 18% resulted in bad trips while none of 34 lamotrigine reports did. Further, 39% of lithium reports involved medical attention. Most of the lamotrigine reports (65%) but few (8%) of the lithium reports were judged to not affect the psychedelic experience."
The conclusion: "Although further research is needed, we provisionally conclude that psychedelic use may pose a significant seizure risk for patients on lithium."
Worth asking
Online trip reports are the weakest kind of evidence: people who had a dramatic experience are more likely to write it up, so 47 percent is not a rate. But the contrast with lamotrigine, zero of 34, in the same sources with the same bias, is hard to explain away, and a seizure is not a subtle outcome. If you take lithium, this is the combination in this wave with the clearest signal of acute physical danger. If you take lamotrigine, the same reports suggest the psychedelic mostly worked as expected, which is not the same as saying it is safe for someone with bipolar disorder; the trials excluded them for a reason.
Source
Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports — Nayak SM, Gukasyan N, Barrett FS, Erowid E, Erowid F, Griffiths RR (2021)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1055/a-1524-2794
DOI: 10.1055/a-1524-2794
How this was scored
- Study design
- Case series or case report
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- 96
- Preregistered
- not recorded
- Conflicts disclosed
- Yes
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 21, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "contested". Weak or heavily disputed. Treat as a question, not an answer. It scores 38 out of 100 on our published rubric. One caveat travels with that badge: Self-selected online reports with no denominator; the percentages are of reports, not of users, and severe events are over-represented. The lithium versus lamotrigine contrast within the same sources is the finding, not the 47 percent itself. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports — Nayak SM, Gukasyan N, Barrett FS, Erowid E, Erowid F, Griffiths RR (2021). Published in: Reputable peer-reviewed journal. DOI: 10.1055/a-1524-2794. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Case series or case report. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.