Lithium with ketamine, LSD, MDMA, psilocybin or ayahuasca

Can lithium be taken with psychedelics or ketamine?

The answer is clear: no, lithium must not be combined with psychedelics or ketamine. Although lithium, psychedelics, and ketamine all affect mood, neuroplasticity, and serotonergic signaling, they act in such different ways that the combination entails serious neurological and physiological risks.

Why lithium and psychedelics are a dangerous combination

Lithium is used as a mood stabilizer in, among other conditions, bipolar disorder. It dampens excessive brain activity by influencing sodium and calcium channels and the intracellular signaling pathways of serotonin, dopamine, and glutamate.

Psychedelics such as psilocybin (truffles/magic mushrooms), LSD, DMT (ayahuasca) and MDMA do exactly the opposite: they increase neuronal excitability and stimulate glutamate and serotonin activity.

When lithium and psychedelics When taken together, electrical instability occurs in the brain, which greatly increases the risk of severe epileptic seizures (convulsions). In addition, cases of serotonin syndrome, delirium, and sudden loss of consciousness have been reported.

With LSD and psilocybin, this risk is greatest: there are multiple well-documented incidents of people experiencing a seizure within a few hours of ingestion. Ayahuasca is also particularly dangerous due to the MAO inhibitors, which, together with lithium, can cause excessively high serotonin levels.

Lithium and ketamine: less dangerous, but still risky

The combination of lithium and ketamine is in theory slightly safer than with classic psychedelics, but still not without risk.
Ketamine acts as an NMDA receptor antagonist and, via an indirect mechanism, increases the release of glutamate and BDNF (brain-derived neurotrophic factor), which promotes neuroplasticity.

Some studies suggest that lithium may prolong the antidepressant effect of ketamine because it also affects BDNF and GSK-3β. However, clinical observations show that the combination leads to the following in some people:

• Increased risk of confusion or dissociation
• Impaired blood pressure regulation
• Excessive sedation or cognitive slowness

Therefore, psychiatrists generally advise against combining ketamine with lithium.

Medical guidelines

In almost all studies on psychedelic therapy, lithium is considered an absolute contraindication.
In ketamine treatments, the combination is only considered with stable lithium levels and close medical monitoring, but it remains a risky choice.

Anyone using lithium who is interested in psychedelic or ketamine therapy must always discuss this with their treating psychiatrist.
Never stop taking lithium suddenly, as this can lead to manic or depressive relapses.

Conclusion

Lithium must not be combined with psychedelics such as psilocybin, LSD, DMT, or MDMA, due to the high risk of epileptic seizures, serotonin syndrome, and neurological dysregulation.
With ketamine, the combination is theoretically possible, but only under strict medical supervision and with regular monitoring of lithium levels.

Anyone considering psychedelic therapy would do well to first consult with their doctor about safe alternatives or a gradual tapering off of lithium before starting with truffles, LSD analogues, or ketamine work is being done.