This is the most important practical document on the site. Read it carefully, and don’t skip the parts that don’t seem to apply to you. If you take anything — prescribed or otherwise — assume it’s relevant until you’ve checked.
Before we go further: I’m not a physician. Nothing here constitutes medical advice. The information below is what I share with the people I work with so we can have an informed conversation; final decisions about your medications belong to you and your prescriber, not to me.
With that said.
The medicine I work with interacts meaningfully with several classes of substances. Some interactions are dangerous. Some are merely complicating. Some are minor. Let me walk through the categories.
SSRIs and SNRIs
The most common class of medication I encounter is antidepressants — SSRIs like Lexapro, Zoloft, Prozac, Celexa, and SNRIs like Effexor or Cymbalta. These medications affect serotonin signaling. The medicine I work with also affects serotonin signaling, though through different pathways.
The combined risk is twofold. First, there’s a theoretical risk of serotonin syndrome, though clinical reports of this specific interaction are rare. Second, and more reliably, SSRIs tend to dampen the experience — sometimes mildly, sometimes substantially. People on SSRIs frequently report a “muted” or “muffled” experience that doesn’t reach the depth they were hoping for.
The conventional wisdom in this space is to taper off SSRIs four to six weeks before ceremony, working with your prescriber. This is not something to do on your own. Tapering too quickly can produce withdrawal symptoms that are themselves distressing — flu-like symptoms, brain zaps, heightened emotional reactivity. Done well, with your prescriber’s guidance, it’s manageable. Done poorly, it’s miserable.
Whether to taper at all is a personal decision that depends on why you’re on the medication, how long you’ve been on it, and what your life looks like off it. Some people choose to remain on their medication and accept a muted experience. That’s a legitimate choice. Others choose to taper, do the work, and decide afterward whether to resume. That’s also legitimate. What I won’t do is encourage anyone to taper off psychiatric medication for the purpose of ceremony if their stability depends on it.
MAOIs
Less common but more serious. MAOIs — including Nardil, Parnate, and the irreversible MAOI Selegiline — must be discontinued well before ceremony. The interaction risk is substantial. Talk to your prescriber. The standard washout is two weeks, but verify this with the person who prescribed it.
Stimulants
Adderall, Ritalin, Vyvanse, and similar. Stop 24 to 48 hours before ceremony. These medications elevate baseline arousal in ways that make settling into the experience difficult. If you take them daily for ADHD, work with your prescriber on a brief pause around ceremony.
Benzodiazepines
Xanax, Klonopin, Ativan, Valium. These dampen the experience significantly. If you take them as needed, skip your dose on the day of and the day before. If you take them daily, this requires a longer conversation with your prescriber, because abrupt discontinuation of daily benzodiazepines can be dangerous.
Mood stabilizers and antipsychotics
Lithium, Lamictal, Depakote, antipsychotics like Abilify or Risperdal. If you’re on any of these, we need a more detailed conversation before proceeding. The combination of indications that lead someone to these medications, and the way the medications interact with this work, requires individual evaluation. Some people on these medications can do this work safely; many should not.
Cannabis
Stop two weeks before, ideally longer if you’re a heavy daily user. Cannabis affects the same broad neurochemical territory and tends to interfere with both the experience and the integration. People who continue using cannabis through their preparation often report difficulty staying with what arises in ceremony, and difficulty making the integration period stick.
Alcohol
Stop two weeks before. Same reasoning, with the additional issue that alcohol withdrawal — even from moderate daily use — can elevate the nervous system in ways that complicate ceremony.
Caffeine
Reduce gradually over the week before. On the day of, skip it if you can. If you’re a heavy daily drinker, taper rather than stop cold to avoid headache.
Supplements
This is where people get lazy. Common supplements that matter:
- 5-HTP, St. John’s Wort, SAM-e, anything that affects serotonin: stop two weeks before
- Ashwagandha, kratom, kava: stop one to two weeks before
- High-dose B6 (above 100mg daily): stop one week before — chronic excess can affect nerve function
- Most everything else: probably fine, but tell me what you’re taking
Recreational substances
Anything not on this list — MDMA, ketamine, psilocybin, ayahuasca, LSD — should be stopped at least four weeks before. The reason isn’t dangerous interactions; it’s that doing this work close to other strong work tends to muddy both. Give yourself time.
What to do with this list
Send me a list of everything you take, prescription and otherwise, including supplements, at least three weeks before our planned ceremony date. We’ll review it together. If anything needs to be tapered, you’ll need that conversation with your prescriber to start soon — these timelines are real, not advisory.
If you read this list and realize you’re on something I haven’t mentioned, ask. The fact that I haven’t mentioned it doesn’t mean it’s safe. It means I haven’t thought to mention it.
The point of all of this is not to make you anxious. It’s to give you the information that lets us proceed safely and helps you get the most out of the experience. The people who do the best in this work are the ones who take the preparation seriously. The medication question is the most important practical piece of that.
When in doubt, ask. There are no stupid questions here. I’d rather answer the same question fifty times than have one person sit with an interaction we should have caught.
