Can LSD be taken with Mirtazapine?

LSD + Mirtazapine results in:

1. Neurochemical interactions: LSD is a potent agonist of the 5-HT₂A serotonin receptor. Mirtazapine, on the other hand, is an antagonist of 5-HT₂A (and 5-HT₂C). As a result, mirtazapine is likely to block or attenuate the effects of LSD. Furthermore, mirtazapine blocks 5-HT₃ and α₂-adrenergic receptors, which further counteracts LSD’s stimulatory effect on serotonin.

2. Therapeutic effect: Due to mirtazapine’s 5-HT₂A antagonism, the desired psychedelic experience of LSD will be significantly reduced. Patients taking mirtazapine are likely to experience a reduced effect from LSD, which, in a therapeutic setting, may undermine the positive effects of LSD therapy. Mirtazapine’s strong sedative properties (antihistaminergic) may also limit alertness during an LSD session.

3. Danger or risks: A combination of LSD and mirtazapine does not lead to significant additional toxicity. However, there is a theoretical risk of serotonin syndrome, as mirtazapine is classified as a serotonergic agent and LSD increases serotonergic activity. In practice, however, this risk is small. A real effect is increased sedation: both substances can cause drowsiness or cognitive confusion. Given that mirtazapine is already a potent sedative, the combination may lead to considerable fatigue or difficulties concentrating.