[Solved] Trip therapy with mirtazapine, tramadol, gabapentin

Thank you for your openness. Your question is medically and therapeutically complex! Especially given your situation with CPTSS and chronic pain. You are using three medications (mirtazapine, tramadol, and gabapentin) that each affect the safety and effectiveness of in their own way. psychedelic therapy.

1. Mirtazapine (15 mg)
This drug blocks 5-HT2A receptors, which are the main targets for psilocybin and LSD. As a result, it significantly reduces the effects of psychedelics. Although the risk of serotonin syndrome with mirtazapine is lower than with SSRIs, it does lead to a flatter experience, less depth, less visual impact, and less therapeutic impact. If you are unable to stop taking mirtazapine, the session is still possible with your psychiatrist's approval. For example, you must stop taking Tramadol for psilocybin sessions:

2. Tramadol
This is the greatest concern in your situation. Tramadol is serotonergic and has a depressant effect on the central nervous system. It increases the risk of serotonin syndrome when combined with psilocybin, MDMA, or LSD. Furthermore, it lowers the epilepsy threshold, which makes it riskier in combination with psychedelics. (Psychedelics increase neuronal excitation.) For these reasons, tramadol is a strict contraindication for Triptherapie. Even if you interrupt it only briefly, the risk remains elevated. A safe session is only possible if you have completely tapered off tramadol under the supervision of your doctor and have stopped for at least two weeks prior to the session. This is how it works:

1. With long-term use (weeks to months), tramadol must be gradually tapered off under medical supervision. After complete tapering, you must be tramadol-free for at least two weeks before participating in a psychedelic session.

2. For occasional use, a shorter waiting period may suffice, but even then, you are only eligible for a session when there is no active tramadol left in your system and the receptors have recovered. This also takes an average of 1 to 2 weeks.

3. Gabapentin
Gabapentin is not a contraindication, but it dampens the psychedelic experience. It reduces neuronal excitation via GABA receptors, which can result in a less intense trip. This can be both an advantage (less anxiety) and a disadvantage (less therapeutic breakthrough). If the preference is to have as few inhibitory effects on the psychedelic session as possible, the combination of Mirtazapine and Gabapentin may potentially suppress the effects of psychedelics too much. Stopping Gabapentin intake. Therefore, if you want to reduce the risk of dampening, it is usually advised to stop taking gabapentin at least 24 to 48 hours before a session with psychedelics. With more intensive or prolonged use, a slightly longer waiting period (e.g., 3-5 days) may be beneficial.

What now?

The best next step is filling out the intake for psychedelic therapy. This allows the Triptherapie team to assess your medication profile, symptoms, and goals, and determine if and how you can make use of our services. Sometimes this involves collaborating with your doctor to temporarily review your medication.

Hi,

Your situation is indeed complex, and it is good that you are asking all these questions in advance. There are indeed some additional points that are relevant besides what has already been said.

Mirtazapine acts primarily on 5-HT2A receptors as an antagonist, so it effectively dampens the effects of psilocybin and LSD. But what many people don't know: mirtazapine also has antihistamine properties and acts on H1 receptors. This can actually be beneficial in your case, as it can help with anxiety-related reactions during the session. In chronic pain and PTSD, this is sometimes accompanied by hypervigilance, and mirtazapine can temper this.

The combination with tramadol is truly the critical point, because tramadol acts on multiple systems simultaneously: it blocks monoamine re-uptake (thus increasing serotonin, norepinephrine, and dopamine), and it is also a mu-opioid agonist. This makes the risk of serotonin syndrome truly significant when used with psilocybin. Furthermore, tramadol can cause seizures in certain individuals, and psychedelics indeed increase neuronal excitation, which exacerbates this risk.

Gabapentin is indeed not a true contraindication, but be aware that it is a GABA agonist. This means that it has an inhibitory effect on the nervous system. Therefore, in combination with mirtazapine, you can have a significantly inhibitory environment. This can be both good and bad: a lower risk of panic, but possibly also less therapeutic impact.

A practical piece of advice: if you really must use tramadol for your chronic pain, ask your doctor if there are alternatives that work better with psychedelic therapy. For example, gabapentin alone (without tramadol) for pain, or even considering other painkillers that lack serotonergic effects.

Good luck with your further research!