Medical Editor: Dr. David Cox, PhD, ABPP
Psychedelics are a group of psychoactive substances that can cause hallucinations and changes in perception. They have been used as medicines, in spiritual ceremonies, and for recreational purposes by cultures around the world.
In recent years, researchers have expanded the scope of studying psychedelics as they explore potential therapeutic benefits in treating mental health conditions. Psychedelics have sometimes yielded “clinically significant improvement” more quickly than mainstream pharmaceuticals and therapies.
This article will explore how psychedelic substances impact people with bipolar disorder by discussing the effects, potential benefits, risks, and important considerations.
What is bipolar disorder?
Bipolar and related disorders are mental health conditions characterized by unpredictable mood and energy disturbance that impacts functionality through distractibility, difficulty with follow-through, impaired rationale, and decreased self-control. Mood cycles between states of mania (where a person can be unusually energetic, impulsive, irritable, or engage in risk-taking behavior) and periods of depression identified by symptoms like loss of motivation or interest and persistent feelings of sadness.
Types of bipolar disorder diagnoses
Bipolar I disorder manifests as episodes of mania that last at least seven days with depressive episodes typically lasting around two weeks (though it is possible for both to occur simultaneously). Manic and depressive episodes negatively impact social, psychological, relational, or occupational functioning and can require hospitalization in extreme cases.
Bipolar II disorder is known for depressive episodes that alternate with periods of hypomania, a less severe type of manic state lasting 4 consecutive days, as opposed to 7 with full manic episodes. Hypomanic episodes do not typically have a negative impact on social, psychological, relational, or occupational functioning.
Cyclothymic disorder is a diagnosis for people exhibiting extended periods of depressive and hypomanic episodes that each last 2 years or more and do not fit specific symptom criteria to define these episodes as a hypomanic or major depressive episode.
A diagnosis of an unspecified bipolar or related disorder suggests a person has symptoms of bipolar disorder that are not accurately described by any of these 3 manifestations of the condition.
How is bipolar disorder typically treated?
In conjunction with psychotherapy and behavioral therapies, individuals diagnosed with bipolar disorder are commonly treated with pharmaceutical medications like mood stabilizers, antidepressants, and atypical antipsychotics. If it is necessary and safe, medication to address symptoms like insomnia or anxiety is also prescribed.
Unfortunately, many people with bipolar disorder struggle with debilitating side effects from these drugs. The innovation of new and improved medicines to treat the condition is rare, which has some curious individuals curious about possible alternatives like psychedelic medicine.
What are psychedelics?
The term ‘psychedelics’ refers to a group of psychoactive substances that have powerful effects on mood, perception, and cognitive functioning. The word was chosen by Humphrey Osmond, a psychiatrist who is known for studying possible mental health applications for Lysergic acid diethylamide (LSD) in the 1950s. Rooted in Greek, it means mind-manifesting and describes the most commonly reported experience of intensely meaningful personal discovery that often inspires a whole new outlook after a psychedelic experience.
Psychedelics are often referred to as hallucinogens because of how they inspire visions, evoke experiences with perceived deities, create interactions with different dimensions, alter one’s relationship with time and space, or enhance sensory information.
In the 1950s, classical psychedelics like LSD and psilocybin (the psychoactive ingredient in magic mushrooms) were studied by therapists for their possible efficacy in treating mental health conditions like substance use disorders, anxiety, and depression. However, under the Controlled Substances Act of 1970, psychedelics were classified as Schedule I drugs and made illegal before conclusive evidence of their therapeutic benefit was established by researchers. This legislation was passed as a United States government response to the perceived lack of control over the growing counterculture movement as well as fears and misconceptions about the allegedly harmful effects of psychedelics.
While psychedelics are still currently illegal in most of the United States, new research efforts have emerged in the last decade as we learn more about how psychedelics work in the brain. This research increases understanding of psychedelics as therapeutic tools.
Are psychedelics safe for bipolar disorder?
Classical psychedelics like LSD and psilocybin can produce effects such as euphoria, introspection, feelings of peace and connectedness, personal epiphanies, and motivation to change negative behavioral patterns in healthy individuals. However, the beneficial mechanisms by which these psychedelic substances work in healthy people are the exact cause of concern in the case of use by people with bipolar disorder symptoms.
Individuals diagnosed with bipolar disorder are usually excluded from participating in clinical trials for classical psychedelic therapies due to concerns about triggering or aggravating manic episodes (with a few exceptions, like this unique study examining the safety and efficacy of psilocybin for those with a diagnosis of bipolar II disorder who are currently experiencing a depressive episode).
In general, anyone with a personal or family history of psychosis is strongly discouraged from consuming psychedelics. Doing so may further disrupt the balance of neurotransmitters in the brain responsible for regulating mood and may cause a psychotic episode to occur. A psychotic episode may cause harm to the individual or others.
How can substances with reports of such positive effects be harmful to this population? Psychedelic substances like psilocybin and LSD impact the serotonergic system. They activate serotonin receptors associated with positive emotions and meaningful experiences along with other neurotransmitters (such as dopamine and norepinephrine) relevant to alteration of mood, increased energy, and invocation of empathy.
People with bipolar disorder are usually advised to avoid substances that impact serotonin, like commonly prescribed antidepressants (selective serotonin reuptake inhibitors, or SSRIs) because they have the potential to to trigger problematic mood episodes. The concern is that certain psychedelics may affect the serotonergic system in similar ways, and could therefore induce or worsen mania.
Which psychedelics can be used with bipolar disorder?
Due to a lack of sufficient research on psychedelic safety for use with bipolar disorder, little is known about the severity of risks (which complicates the process of creating a protocol for ethical and safe clinical studies). There are legitimate reasons for those with bipolar disorder diagnoses to avoid some psychedelics. There is also hope for those who wish to explore psychedelic medicine as a part of their treatment.
Ketamine is currently the only legal psychedelic substance approved by the Federal Food and Drug Administration (FDA) for treatment of some mental health conditions and is considered safe for people with bipolar depression when first-line treatments have been ineffective.
Ketamine is thought to work differently for depression because of its role in moderating glutamate, another type of neurotransmitter that may impact mood regulation. Its rapid antidepressant fast also works more quickly than traditional antidepressant medication. Some study participants with bipolar depression who were treated with a single dose of intravenous ketamine experienced rapid relief of symptoms, as soon as 40 minutes after administration of the treatment.
Closing thoughts and considerations
The intent of this article is to be helpful and informative, not to act as a substitute for professional psychiatric or mental health care. The best way to determine whether or not a substance is safe to consume is to discuss your current health conditions and treatments with a knowledgeable practitioner who can provide consultation based on your individual needs.
If you are interested in finding a practitioner with mental health experience who is also familiar with psychedelic medicine, consider using Psychable’s directory to locate someone who can answer your questions.