Dosing regimens for psilocybin

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Posted by pinksharkmark ( on February 12, 2002 at 20:31:42:

In Reply to: Remember Linda ... posted by Bob on February 12, 2002 at 18:26:13:

After reading some of the spectacular success stories that many have reported from a single small dose of psilocybin (or LSD), it is easy to lose sight of the fact that psilocybin is just another drug, and in order to successfully treat cluster headaches with psilocybin certain rules must be followed, just as is the case with any other drug.

Many individuals (substantially more than half, according to the reports posted on this message board) have obtained complete and lasting relief with a single small dose. But that doesn't guarantee that every clusterhead on the planet will. Some (such as Bob Wold) required several doses to achieve complete remission.

Many have gotten complete relief with very low amounts, barely enough to notice any effects at all, much less any psychoactive effects. But others have required larger amounts, sometimes bordering on what is considered a "recreational" dose.

A few have achieved no relief at all, regardless of the dosage and the frequency of ingestion.

Just as with any other medication, it is essential to refrain from taking medications that interfere with the action of psilocybin. This is not always easy to accomplish. Many "blocking" drugs are known and have been listed here on numerous occasions. But there are medications commonly taken by clusterheads whose interaction with psilocybin is still unknown. Some may intensify the effect, others may block it, still others may have no effect one way or the other. As more reports are received, more medications to be avoided will be identified.

Note that the above statements apply to EVERY other preventative medication in the clusterhead arsenal. Let's use Verapamil, the "gold standard" of CH preventatives, as an example.

Verapamil can be effective in doses ranging from roughly 240 mg per day to a maximum of 960 mg per day. For a few people, the effects are noticeable within a few days of starting treatment. For the majority, however, a week or two of daily (sometimes increasing) doses is required for the medication to start working. For a sizeable percentage of people (roughly 30% according to available studies) Veapamil has no effect on their CH at all. There are also medications that cannot be taken while on Verapamil.

The most interesting thing about psilocybin (and LSD) as a CH medication is that it does not just abort a single attack (like Imitrex, Cafergot, or oxygen), and it also does not just prevent an attack from occuring as long as serum levels are high enough (like Sansert, Verapamil, Lithium, Prednisone, Depakote, Neurontin, Topamax, et al), but it actually terminates the entire CH "cycle" for an extended period of time -- long after all traces of it have vanished from the body. In the case of some chronics this period may be as short as two weeks. In the case of episodics, this period may be as long as a year.

The only other treatments I know of that will produce an actual termination of a CH cycle are prednisone (rarely), DHE injections (occasionally) and intravenous magnesium (occasionally).

In your own case, Bob, you did everything correctly for at least the first dose of psilocybin. That first dose didn't terminate your cycle, and the attacks were getting more severe, so you (understandably) started a course of prednisone, knowing that it had helped you in the past. It is possible that the prednisone blocked the action of the subsequent doses of psilocybin. It is also possible that you are an individual for whom psilocybin is ineffective, prednisone or no prednisone, just as I am an individual for whom Verapamil is ineffective. There is no way of knowing for sure which is the case.

As more reports are received, some facts are becoming apparent:

1) The most effective use of psilocybin is as a prophylactic. If taken before a CH cycle is due to start, the cycle will not start. This of course is an option not available to chronic clusterheads.

2) The second most effective use of psilocybin is to take it at the very beginning of a cycle, before the cycle is firmly established, and while the individual is still free of other medications. Again, an option for episodic clusterheads only.

3) Once a cycle is firmly established, it may be necessary to take higher initial doses, and more than one dose may be required to terminate the cycle. This is the case with many chronic clusterheads, and with some episodics. These are also the cases where the factor of other medications become problematical. It is a rare chronic indeed who is completely free of preventative medications, and any episodic who has made it to this stage of a cycle with no medication at all has my utmost respect.

4) It is impossible to determine with any precision precisely how large the first dose of mushrooms should be. The psilocybin content of each batch of mushrooms will vary, sometimes substantially. And, just as with Verapamil or Lithium or Topamax or any other medication, the sensitivity to psilocybin varies from one individual to another. The amount required for subsequent doses becomes much easier to determine, but for the first dose many individuals are (understandably) choosing to underdose.

Anyone who is considering this treatment must bear in mind that there is a possibility that several doses may be required, and that they may have to put up with some short-lived (a few hours) psychoactive side effects in order to achieve success.


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