Firstly: we're glad to hear you're reaching out after such a series of difficult experiences, and that you've given yourself a pause on further recreational substance usage while you work through this.

What you're describing is rare, but not unheard of, and something one of us (Ally, writing) has seen in clinical settings with some frequency. People sometimes have such a traumatic time on psychedelics - either due to something that happened during the psychedelic experience itself, or a traumatic experience that it unearthed from their memory - that they develop demonstrate symptoms of PTSD. This includes sometimes a reliving of the trauma in flashback episodes. For other individuals, repeated psychotic episodes after a difficult psychedelic experience may be in part influenced by a genetic predisposition to schizophrenia or other related disorders; it could be that family history is a factor here.

Whatever the cause - and again, it could be a few things - there are folks out there who can help you unpack that in a compassionate, nonjudgmental way, who are also quite skeptical of mainstream behavioral healthcare. (That's why so many of us have shifted our focus into psychedelic-assisted psychotherapy, as we are acutely aware of how poorly the establishment has treated so many with mainstream psychiatry.) As difficult as it may be, a good first step would be seeking the right professional assistance on this to tease out a pattern behind the psychotic episodes. Working with someone with a clinical eye to establish what's triggering them - which is sometimes subtle and quite surprising! - can help understand their root cause, and help identify more customized strategies for how you minimize their intensity and reduce their frequency in the long term. If you're not quite up to finding someone to partner with on this, we'd advise starting a journaling practice to try to gather this information for yourself to see if you can pick apart a pattern, and if one of your friends has interest in supporting you in using a co-counseling or similar model.

Also adding: as someone who has operated in clinical environments for much of my career, it's often frustrating that we are pressured by regulatory to create a diagnosis to put on paper to justify insurance billing purposes, or for ease of communication with other providers in such a fast paced environment, when the nuances of an individual case really defy whatever is in the latest already-outdated DSM and can feel dehumanizing. In my experience, a lot of the therapists that specifically work with psychedelics are also skeptical of mainstream diagnostic labeling and mainstream psychiatry for some of the same reasons you are, so you might be best of seeking someone off the MAPS psychedelic integration list. There's some specific nuance to the experience of trauma while on psychedelics that a mainstream behavioral specialist who doesn't have that specialized education just won't get. It's such a uniquely hellacious experience, and I wouldn't wish it on anyone.

To start with the initial question: Drug-induced psychosis (DIP) refers to a clinical diagnosis. DIP may encompass a few different symptoms that demonstrate a lack of connection to reality, such as hallucinations and feelings of paranoia, and is, by definition, always triggered by use of a drug of some kind. Ego death is a single symptom that some folks may experience, which is not necessarily attached to a psychotic episode (let alone specifically one that is drug-induced.)

To your broader experience: that's unfortunately more common than we'd like to see, and is often preventable with some care taken on the preventative side. We really advise folks take their time to prepare for an experience and really think through all the individual factors that could lead to a difficult time - when you minimize risks, it usually also maximizes potential benefits. We made a checklist of our dosing protocol here, and a more specific one about evaluating set & setting here. Creating a safe container for you to voyage in is absolutely critical, and if you don't have that safe container you're a lot more likely to have a difficult time like what you've experienced.

Here's a table that covers answers to your question in regards to the most common psychedelics.

We don't do much on ayahuasca. Neither of us has taken it, neither of us has been trained on it, and our focus is specifically on providing education to people who take psychedelics outside of a supervised context, which is usually how ayahuasca is used.

Microdosing. Safest, easiest way to take mushrooms.

Another safety thing to consider for solo journeys is only dosing yourself with product you've taken before so you know the potency and aren't going to accidentally get too high to navigate your environment safely. This is especially the case with dissociatives like ketamine.

There are high doses one can calculate that still allow you to find a bathroom or use your phone to call for support or help if needed, and then there are high doses where it's hard to tell if the phone or bathroom even exist at allllll, man....

Part of having a trip sitter is to have someone who can take care of you if you need it and the intention behind that is solid, so one way to split the difference would be to trip alone somewhere with a friend close by, like in another room in a house.

We're safety people, so the main questions we think about with solo journeys are:

"What are the things that could go sideways during a solo trip?"

"How many of those things can I prevent in advance with good technique, preparation and awareness?"

"What are the risks I can't fully prevent, and how do I need to set myself up to access whatever help I might need to address those things in the absence of another person?"

Ally here: can confirm, much more handsome.

Dax here! No, I'm far more handsome than he is.

You're welcome! We're trying to create the resources we wish we had when we were younger.

Fuck yeah. Erowid rocks. They're a huge influence for us and our fledgling website doesn't hold a candle to the groundbreaking thing they made.

That said, we've found there's much information on Erowid that it can be overwhelming if you don't know how to synthesize all the info and plug it into a clear, repeatable safety protocol.

So we made one. Here! Have it for free!

This editing slaps

Word.

One category of psychiatric medication that's contraindicated with a ton of other drugs is the MAOI's, which one could argue might fit under the "categorically dangerous" header.

Our application is currently pending! If it's accepted, all you'll need to do is look for the most fabulous people in the room.

It's very promising! We're excited to see all the research starting to come out on this subject, which has validated reports of people successfully self medicating. Here's a fun preprint study that just came out a few months ago.

Easy: Buy some sketchy black market drugs from an untrained person you don't know, don't test them, take a large, unmeasured dose in a chaotic environment with people you feel unsafe with, throw a bunch of other drugs in the mix without checking for potential interactions, and see what happens!

Just kidding. We've seen people do all those things and it rarely goes well.

We made a masterclass to answer this question. It covers all the skills and awareness you need to have if you plan to take psychedelics outside of a supervised medical, therapeutic, or ritual environment and want be as safe as possible.

We still don't recommend that anyone take psychedelics without professional supervision, but if you're gonna do it anyways, you might as well know all the ways people accidentally fuck themselves up so you can avoid same.

You already said it. Harming and criminalizing indigenous communities sucks, as does endangering any plant or animal species. There are plenty of other ways to get the benefits of psychedelics.

Chacruna is a psychedelic justice organization that does work around this for anyone who wants to know more.

Tim Ferriss also put out a piece about this not too long ago.

Firstly, we're sorry to hear that you're experiencing such long term negative effects - and unfortunately far from the first we've heard. HPPD is not well understood (especially when start of symptoms is when the brain is still developing as a young adult); consequently, the clinical treatment options are scarce and inadequately studied.

To start on simply keeping it from getting worse: you're definitely on the right track with ceasing use of hallucinogens. Anyone with lasting detrimental side effects from taking psychedelics should probably not take those psychedelics in the future. There is some anecdata indicating the other stimulants, such as common ones like caffeine and nicotine, may also exacerbate symptoms.

There are a few case studies out there in the clinical research indicating off label treatment using Lamotrigine has been successful. It might be worth seeking out a psychiatrist who has worked with HPPD specifically in the past to tailor a treatment protocol for you. Treatment of any co-occuring anxiety or other mental health issues has also been indicated to reduce severity of symptoms.

There's a whole field of psychedelic harm reduction dedicated to just this thing, and they have hella best practices to share.

During a challenging psychedelic experience, one of the easiest things you can do is call the free hotline offered by the Fireside Project, where someone trained to hold space for your difficult time can monitor you and help you through it over the phone.

For general theory on what to do, the Manual of Psychedelic Support is one of the texts a lot of people point to.

If you know anyone with a lot of money who'd like to fund a psychedelic safety organization to wrangle a bunch of experts to do a literature review on this topic and compile an at-a-glance resource for folks with this question, we might know some people they'd want to talk to. ;)

There's not enough research on this and not enough of it is centralized, which sucks given that this is a common question.

It's a really complicated thing to try and study given how many psychedelics and psychiatric medications there are.

Here's a table we found about combinations between various psychedelics and antidepressants.

We don't know of anything relevant to contraindications with anti-anxiety meds and many psychedelics, but because ketamine is a legal medicine, you can at least find contraindications between ketamine and various psych meds using the Drugs.com Interaction Checker.

There's some research you can do on Google by typing "__name of psychedelic___" and "__name of psychiatric medication__", then adding the words "interaction," "combination" and "contraindications" to that in three successive searches. Much of what you'll find through this method is not medical research and thus should be treated as for informational purposes only.

Great, thanks for your input! We've heard of Chacruna but are not familiar with the other organizations you've mentioned (we're much more on the science/harm reduction side than the policy side), but will avoid recommending Decriminalize Nature in the future if they suck.

For dosage info, here's the Erowid vault for psilocybin mushrooms