When Psilocybin Therapy Is NOT Recommended: Clinical and Ethical Considerations
Psilocybin assisted therapy appears to have great efficacy in treating people with depression, PTSD, and end-of-life-related anxiety, but it is not a therapeutic approach to take on everyone. Psilocybin therapy should not be undertaken by people with a personal or familial predisposition to psychosis, people with substance abuse issues, people on certain medications like SSRIs and MAOIs, and people with serious issues related to drug metabolics and severe medical issues, respectively. It’s not about restricting people’s access to therapy; rather, it’s related to creating a well-founded set of ethics on which psilocybin therapy can stand and succeed with psilocybin assisted therapy.
While interest in psychedelic medicine expands, the demand for gatekeeping in this realm is rapidly growing as well. Appropriate screening, qualified guides, and comprehensive psilocybin therapy training are necessary to separate those who may find this treatment helpful and those who could be severely negatively impacted by this potent modality.
What is Psilocybin Assisted Therapy?
Psilocybin-assisted psychotherapy combines the administration of psilocybin, a naturally psychoactive compound found in some mushrooms, with structured psychological support. Psilocybin therapy-a non-recreational session-finding setting, takes place in a clinical, controlled setting that is supported by trained facilitators for preparation, navigation during the experience itself, and then integration support afterward.
Standard protocols, including preparatory sessions of building trust and setting intentions, dosing sessions lasting 6-8 hours, and integration sessions post-dosing to process insights, have also been established. A supervised psilocybin therapy session typically lasts 6–8 hours and includes preparation and integration support
Conditions In Which Psilocybin Therapy Should Not Be Conducted
Personal/Family History of Psychotic Disorders
Psilocybin can also cause latent psychosis or contribute to an underlying issue like schizophrenia, schizoaffective disorder, or bipolar I disorder with psychotic features. Simply having a family history of these disorders also puts an individual at risk, as the predisposition has not yet developed.
Clinical example: A 28-year-old male with an uncle who had been diagnosed with schizophrenia used psilocybin treatment for his depression. His psychological questionnaire included his family history, with his therapist advising that he opt for conventional therapy. Six months later, he suffered his first psychotic episode, not resulting from his psilocybin but confirming his genetic predisposition that could have led to a disastrous experience in a psychedelic journey.
Active Substance Use Disorders
People struggling with an alcohol, stimulant, or opioid use disorder may not be emotionally stable enough to deal with the power of the psychedelic experience. Although psilocybin has been studied for addictions, these protocols require highly trained professionals in addictions in specialized settings. They are not necessarily psychedelic treatments.
Severe Personality Disorders
This will include borderline personality disorder, antisocial personality disorder, and other serious forms of personality pathology. The variables that may cloud the treatment relationship and pose threats during states of vulnerability will make it impossible to carry out the Psilocybin treatment protocols.
Certain Neurological Conditions
Epilepsy, head trauma, or any condition impacting cognition require caution. Psilocybin’s physiological impact may pose unpredictable risk regarding how the substance affects the brain.
Unstable Medical Conditions
Uncontrolled cardiovascular disease, severe liver and/or renal failure, and other acute medical illnesses must first be stabilized before any psychedelic treatment is contemplated. The physiological burdens of an intense experience must not be overestimated.
Psychological & Emotional Risk Factors
Limited Emotional Regulation
It acts to enhance existing emotional states. A user who lacks skills in coping with emotional issues or habits of poor emotional regulation may become lost in it and may be led to a psychiatric crisis instead of a breakthrough.
Lack of Psychological Support
The struggle does not end after the effects of the medication have expired. Without proper social support, stable housing, and access to therapy, becoming a member of society is almost impossible. The information and insight received in the therapy session need to be translated into reality in order to notice a difference.
Inability to Integrate Experiences
Some people may not have the reflective ability, flexibility, or therapeutic relationship to make sense of the experience. This means that deep experiences may become confusing rather than healing.
Trauma Considerations
Though psilocybin offers hope to those with PTSD, it is not necessarily a suitable treatment modality for all trauma victims. This is especially true if the victim has experienced recent and unprocessed trauma as well as a tendency to exhibit dissociative symptoms. The fragile nature of a psychedelic experience begins with a prerequisite of feeling secure, which some trauma victims just cannot offer.
Interaction of Drugs
SSRIs can greatly reduce the influence of psilocybin; thus, the treatment will be ineffective. More seriously, the concomitant use of psilocybin and MAOIs may cause serotonin syndrome, which can be fatal.
Antipsychotic & Mood-Stabil
Antipsychotics have been found to directly counter the action mechanism of psilocybin. There have been cases where people have taken lithium and psychedelics together, causing adverse reactions such as seizures.
Why Medication Screening Is Important
Meds management is nowhere near bureaucratic red tape—just plain old common sense when it comes to keeping one safe. There will always be people in a roles like the patient’s in the above scenario who will have to wean off other meds before they qualify for the use of psilocybin, while others will have to just pick other options altogether.
Ethics in Psilocybin Treatment
Informed Consent
In fact, real informed consent involves more than simply signing off on a piece of paper. Patients need to be educated not only on the benefits but also the true risks involved, the fact that the therapy is experimental, the legal status of the therapy, and alternatives that may exist. Comprehensive Psilocybin Therapy Education is essential for ensuring informed consent and ethical clinical practice.
Power Relations in Client-Therapist Relations
The vulnerability encouraged by psychedelics also brings potential for exploitation. You must set strong boundaries while working with psychedelics. The literature includes stories of boundary crossings leading to harm for both the individual and the profession.
Cultural Sensitivity
Psilocybin is indigenous to Mazatec and other practices. Ethical practice honors these roots, avoids cultural appropriation, and recognizes that indigenous practices are more valid than those from within the Western clinical framework. Practitioners should be cognizant of the contrast between indigenous ceremonial use and medicalized therapy.
Avoiding Coercion or Unrealistic Expectations
Desperation clouds judgment. People who are often desperate due to intractable conditions may see psilocybin as a last hope, making them vulnerable to coercion or unreal expectation. Ethical practitioners help their clients engage in making informed decisions, not capitalizing on desperation.
Why Proper Screening & Training are Important
Whether it is transformative therapy or a traumatic event, it is often a matter of professional competence when it comes to screeners. Effective screenings demand clinical skill, an understanding of contraindications, not to mention a willingness to engage in what may be difficult discussions when a prospective subject may not be a good fit.
Quality training in psilocybin therapy involves the provision of skills to the facilitators. Training programs in safety, ethics, and evidence-based practice, such as Changa Institute, prepare professionals to handle challenging circumstances appropriately. Psilocybin therapy Training should encourage the provision of the service, as well as the skills to know when to withhold it.
Poorly trained, unprofessional, self-appointed facilitators may not have the background knowledge to know when to spot warning signs in the screening phase, deal with a psychiatric crisis, or offer a trauma-sensitive approach. The more professional the field becomes, the greater the importance of quality training.
When to Consider Other Treatments
Psilocybin is not a good fit for all patients, but it does not necessarily mean an alternative does not exist.
The benchmark therapy for many disorders to this day remains conventional psychotherapy. Cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychodynamic therapy are some evidence-based therapies showing well-proven advantages without the risk involved in psychedelic therapy.
Medication-assisted treatment is extremely successful in people with depression, anxiety disorders, and other psychiatric issues. Traditional psychiatric medications, while not ideal, have stood the test of time in terms of safety efficacy.
Trauma-informed modalities such as EMDR, somatic experiencing, and internal family systems therapy can be very therapeutic and helpful for those who do not qualify for psilocybin therapy. Trauma-informed therapy can also be a precursor to a future treatment of psychedelics if necessary.
The aim is not to exclude persons from the healing process but to link persons to the interventions that have the best chances of helping while minimizing the risks of doing harm.
Key Takeaways
The contraindications for psilocybin therapy include personal or family history of psychotic illness, use of psychoactive substances, and selected medical problems
If taken with SSRIs, MAOIs, antipsychotics, and/or lithium, drug interactions can be toxic or render treatment ineffective
Psychological readiness is as important as clinical contraindications
Norms of ethical practice will be demonstrated by seeking informed consent, being sensitive to culture, respecting appropriate boundaries,
Proper screening and qualified facilitators, as well as education in comprehensive psilocybin therapy, must be used in order to ensure
Other treatment approaches that could prove more effective include alternative methods of traditional psychotherapy, pharmacological management, or trauma-sensitive care
Recognizing the indications for NOT using psilocybin therapy could be just as important as the indications for using it
Conclusion
Increased interest in psilocybin-assisted therapy presents a challenge and a problem to be managed. It seems that with advancement in research and development of laws around its use, the inclination to consider psychedelic drugs the solution to everything must be checked.
Being knowledgeable about the conditions under which psilocybin therapy is contraindicated prevents vulnerable populations from being harmed and helps maintain the integrity of this growing sector. It is important to screen appropriately and train thoroughly in psilocybin therapy to ensure that those in this sector receive the best possible treatment and are able to practice as safely as possible.
If you’re thinking of taking the plunge into the world of psilocybin therapy, whether as a prospective client or a would-be practitioner, it’s crucial to put a high emphasis on education, consulting professionals, as well as a very honest evaluation of whether this route is the best fit for your situation. The best course of action is never necessarily the most thrilling, but it is always the safest, soundest, and best for the greater good.
