Lithium Interaction Poses Major Seizure Risk with Psilocybin
Most physicians were never taught psilocybin in medical school. Their patients in three states can now legally access it. Oregon's program has been operating since summer 2023. Colorado's healing centers came online in 2025. New Mexico passed its Medical Psilocybin Act in 2025 with first patients expected by end of 2026. April 24, 2026: the FDA issued priority review vouchers for two synthetic psilocybin formulations, one for treatment-resistant depression and one for major depressive disorder. The FDA Commissioner has said publicly the first psychedelic drug could be approved as soon as this summer. Lynn Marie Morski, MD, JD, on what every PCP should be able to walk through in clinic without panic: 1. Lithium is the most concerning drug interaction because of seizure risk. One published analysis of online reports found 47% of lithium plus classic-psychedelic cases involved seizures, with about 39% requiring medical attention. Oregon explicitly excludes clients with lithium use in the past 30 days. SSRIs blunt the experience for most patients but recent trial data show a generally favorable safety profile. 2. Personal or first-degree family history of psychosis is unstudied (and Oregon excludes anyone with active psychosis at any time). Bipolar disorder is unstudied. Pregnancy is unstudied. None have enough data to clear. 3. Cardiovascular history matters because psychedelics transiently raise heart rate and blood pressure. 4. In Oregon the physician doesn't write a prescription or pick a dose. The patient works with a licensed facilitator on the session. The PCP's job is risk assessment and an honest conversation. 5. Cost is real: sessions typically run $1,000 to $3,000 out of pocket, with premium packages reaching $3,500 or higher, and not yet covered by insurance. For a treatment-resistant patient cycling antidepressants for a decade, the math against future medication, therapy, and PTSD-related disability tells a different story than the upfront number. The model is one or two sessions, not daily dosing. The conversation arrives in the exam room whether the training caught up or not. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. Which of these five gaps do you think will trip up most PCPs first? #ThePodcastbyKevinMD #PsilocybinTherapy
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