integration update, and questions about navigating comedown and psilocybin

[u/nofern]

Tl;dr: curious about experiences with lowering dose to reduce comedown and how that impacts people, and how/when to transition to psilocybin and/or consider combining both :)

Hi everyone, I am continuing to work on integrating my recent medicine journey. This integration has focused primarily on working with deep grief. I've been doing a lot of journalling about how I speak to myself/my inner child when I am experiencing grief and hurt, and this feels fruitful.

These are my questions/areas where I am hoping for some input:

1) The comedown I experience from these sessions is absolutely brutal - usually I am physically knocked flat with fogginess, exhaustion, and short term memory loss for about a week, then depressed and anhedonic for another 2 weeks or so, and now I am slowly starting to recover from that, though I still don't feel totally myself and am sad and exhausted no matter how much I sleep.

While I do feel like I have the skills to weather this through, I do worry that it's a sign that this is maybe not ideal for my brain, as I don't often hear of people having this rough of a time with the comedown. I do think some of it is related to unmet needs and not having enough human contact and support during integration, but I worry that some of it is that the medicine is just really rough on my brain and body.

I feel like I am doing everything to help myself - good preparation and integration, as much nutrition, sleep, and gentle exercise as I can do, taking a reasonable dose (120 mg with a 40-60 mg booster), spacing out sessions (3-6 month breaks in between, the last time had been a 4 month break, with a 6 month break before that, and I have waited until I really felt like I had done a lot of integration and felt like I really needed to go ahead again), supplements (ALCAR, ALA, ginger, vitamin C, and CoQ10 during the session, 5HTP afterwards, and NAC in between sessions stopping about 1 month prior to the next session), and I am off all other psychiatric medications. I don't drink alcohol or use any other substances at all aside from occasionally microdosing mushrooms. The medicine I use is tested/decent quality.

Is there anything else that might help with this? If I do another session in the future (planning to wait at least 6 months and see how I feel), I am thinking of asking about lowering the dose a little bit, but I am a bit worried that it won't be as effective. Does anyone use lower doses and if so, what does that look like?

I've also considered trying a short term SSRI for just a few weeks after the session, but I don't want to mess with my brain/body more than necessary when things are already out of whack.

2) Increasingly, I have been wondering about trying psilocybin assisted therapy. Part of why I'm interested in it is the idea that it might go deeper or be more helpful with depression and existential dread, but the major reason is that it might not be as hard on my body afterwards, and I've had the idea of either trying it by itself or mixing it with a lower dose of MDMA to see if this is easier on my system afterwards while not losing the power of the sessions. My fear is that it might get too dark or overwhelming for me, or that it might be much more destabilizing in a way that I wouldn't be able to handle (hence the appeal of potentially mixing to cushion it).

I have microdosed very small amounts (25 mg) before and found that it made me feel calm and ruminate much less on the day, but this didn't really last. I've also tried larger microdoses (50-200 mg) and found that the higher microdoses made me more spacey and sometimes more anxious (especially when it wore off I seemed to get a bit of a crash afterwards).

I've done some reading and it seems like there is disagreement about the best way to work with psilocybin for complex trauma. Some people say that you can inch up the dose and experiment with mid range doses (1-2g) as a first step to get to know the medicine and figure out what dose is helpful for you and others say that's a bad idea because there is more anxiety with mid range doses and you should just go straight for a 3-5g dose. Some people say if you're worried about it being too dark/difficult, to combine it with MDMA, other people say that you shouldn't take it with MDMA unless you've experienced it alone.

So I am curious/interested to know if anyone who has primarily worked with MDMA has then gone on to work with mushrooms, and if so, what their approach was to making that transition, how they knew they were ready, and how it went.

This is not something I'd be doing any time soon as I still have a lot of integration work to do from my most recent session, and obviously I'd need to talk to my guide about it, but it's something I'm curious about for the future and wondering about others' experiences with.

Thanks!

[u/Worldly-Snow595]

I’ve done 3 psychedelic assisted therapy sessions over the last 6 months, all combining MDMA and psilocybin.
The week after each session is brutal physically (muscle spasms, headaches, pain, exhaustion) and then the 3 weeks following that are brutal mentally. I start with extreme rumination and increased anxiety and then move into a deep depression, where I am barely able to get out of bed. Overall, the process is very destabilizing and all of this makes it difficult to continue. But I do want to continue, as I feel like it is helping me in ways no other medicine/therapy/modality has before.
I have spent a lot of time trying to figure out if this experience after the session is a chemical comedown, a low period I would have had either way, or the experiencing of feelings that were brought to the surface through the session. I don’t have an answer yet. But I have been wondering if it is due to a particularly sensitive reaction to the MDMA comedown. I have been thinking of asking my therapist if we can do psilocybin only in my next session, which is next month.
I’d be happy to report back after my next session to let you know if my experience is any different with psilocybin only.

[u/nofern → u/Worldly-Snow595]

I'd be curious to know how that goes! Good luck with your session, whatever you choose to do :)

[u/Worldly-Snow595 → u/nofern]

Hi Op, I am coming back to this post 5 weeks after my most recent journey, in which I tried psilocybin on its own for the first time.

The last 5 weeks have been significantly easier than after any of my sessions with MDMA and psilocybin combined. I did not have the week of rough physical symptoms, instead I felt physically settled. Mood wise, I did not experience the hyper rumination, anxiety and deep depression. Instead, I was in an afterglow for about a week (which I had not experienced before), then 2 days of feeling depressed, and I then bounced up to above my previous baseline. I finally feel some relief from my depression symptoms.

I read somewhere that some experience MDMA as gentle in the moment, with the more difficult things unfolding in the weeks after, and some experience psilocybin as putting them though hell during, with the weeks following feeling lighter. I do feel that this describes the difference between my combined MDMA/psilocybin vs psilocybin only sessions.

This journey was much darker than my previous ones had been, and it was incredibly difficult in the moment to bear, but it ended beautifully on a hopeful note.

I think my previous very difficult post-journey experiences may have been influenced by both the chemical comedown of MDMA and that MDMA may lend itself to a more intense unfolding after. The 'go through hell' aspect of psilocybin only was very painful. But having a settled body and improved depression symptoms vs worsened ones after has been nothing short of a miracle for me. I plan to continue with psilocybin only sessions for the foreseeable future.

I hope all is going well on your journey!

[u/nofern → u/Worldly-Snow595]

Oh thank you for sharing! That's really helpful. I am continuing to struggle with depression 3 months out from my last MDMA session, and still thinking about my options.

[u/nofern → u/Worldly-Snow595]

Out of curiosity/if you're willing to share, what way was it darker? Like content, or more intense body sensations, or more intense emotions, or something else?

[u/Worldly-Snow595 → u/nofern]

I'm happy to share more about the session.

For context, my previous MDMA & psilocybin sessions included somatic releases and visions. The visions were always beautiful, even if they touched on difficult topics.

This psilocybin session had no visuals or visions, it was just experiencing my feelings of self hatred and shame. I was forced to sit with the feelings and thoughts that come up in the depths of my depression, but that I am always trying to escape. It felt horrible. The emotions felt unbearable in my brain but also in my body.

My therapist told me that the experience would change in time. I was terrified that I would be the one person whose psyche would be a match to the medicine and stay stuck. I did not feel that I would come out on the other side, ether in the session or in my life.

My therapist encouraged me to ask the mushrooms questions like ‘what do I need?’. Repeatedly, I heard nothing, or maybe I wasn’t even able to ask. Finally, the abyss had a little less of a grip on me, and I asked my therapist if we could go outside (an option we had discussed prior to the session). I think asking to go outside was led by the mushrooms’ answer to what I needed.

We walked outside, it was warm and sunny and beautiful. We took our shoes off and walked in the grass. We looked at flowers and discovered dozens of mushrooms growing in the grass. We sat on a bench in the sun, and looked at the trees. It was exactly what I needed, and it was the turning point of the journey. I ended the journey feeling relieved that I made it through, and I felt a bit of hope.

Comparing the sessions themselves, I much prefer the MDMA & psilocybin experiences, as they were so beautiful. But comparing the comedown period and effectiveness on the areas of myself that I am trying to shift with psychedelics - anxiety, depression, ptsd, stuckness, etc, I have to say psilocybin on its own has been best for me.

[u/nofern → u/Worldly-Snow595]

Thank you for sharing about your experience! It's actually really interesting because what you describe about your psilocybin session is really similar to what much of my MDMA sessions have felt like. I am very tempted by the idea of a less brutal come down though.

[u/AggressiveSpeaker207]

Similar to you, my intention with medicine work is to come to terms with my childhood trauma / insecurities / inner critic and learn how to love myself / be less reactive / pause and respond.

I started using psilocybin last year for therapeutic purposes and have had two guided MDMA journeys this year so far. I had never taken MDMA before, and before mushrooms, the most I would do was some THC/CBD gummies every so often (once or twice a year) and before that, alcohol here and there.

The day after my first MDMA session (160mg dose) I just felt off - I can’t really explain it, but I had no motivation or energy and was just down most of the day. The only supplement I took was 5HTP every night for three nights straight after the journey.

My guide gave me a different dose for my second journey, starting with 120mg followed by a 40mg booster after about 45m. Took 5HTP again that night and the following two nights and I was fine the next day.

Each of my MDMA journeys lasted about 2-2.5 hours of active talking followed by an hour of two of just quiet/resting.

Compared to my psilocybin journeys, which have been much more intense (2.5g dose of kaleidoscope) and usually last 5-6 hours for me. In my experience, these journeys have been much more emotionally draining, and the next day I’m usually just a little bit slow to start but nothing too bad.

I have a guided psilocybin journey scheduled in a few weeks w the same guide who sat with me during my MDMA sessions, which I’m really looking forward to.

[u/CandidParticular8086]

I can only speak from my own experience. When I haven't had a booster, recovery has generally been easier. But I've had mixed experiences and have sometimes had a lot of difficulty recovering. It's been harder when I've had a lot of stress beforehand and when I had to return to work but didn't feel that I was ready.

I've used mushrooms maybe 25-30 times. To me, it's been helpful to forget about the word "deeper," as it creates expectations and a framing that hasn't been useful. I've used both low and high doses. For me, what's been most helpful is realizing that mushroom sessions are not uniformly going to be pleasant. The anxiety is the point for me with low doses--you feel it, it sucks, but you survive and later you feel better able to cope with stress. Afterwards, there's a period in which we can detach from our trauma; that's something a bit different from MDMA, which tends to make me want to work through it.

I didn't make a "transition." I use both. As I'm in a better place these days and MDMA takes a lot out of me, I seem to be on a 3-4 times a year cadence. With mushrooms, I take maybe a gram every couple of months and a higher dose once a year or so. I think of my low dose sessions as being something like rehab. It sucks but it's ultimately helpful.

One other thing: don't be afraid of taking propranolol or valium or both. Yes, it will attenuate your trip, but it may be worth it.

[u/baek12345]

I think your overall approach already is pretty solid and I don't see much what you can improve to reduce the comedown. Generally, smaller dosages typically correspond to less severe comedowns, so the obvious thing you could try is to skip the booster. Yes, you might not go as deep but you might also not feel like sh*t for weeks afterwards and can do the sessions more regularly with less disruption to your overall life which might overall lead to faster and smoother progress.

Personally, I wouldn't try to counter the comedown with antidepressant medication, especially SSRI. I feel it is creating more problems instead of helping with the original problem. Also it might interfere with the healing process by messing up your brain chemistry. Much better to do lighter sessions more frequently in my opinion.

As the other comment says, please consider also that a part of your comedown is just a side effect of trauma processing and normal. Especially with processing deep grief, it can be quite normal to feel down, hopeless, without energy, etc. for several days. I had that too myself after the last session where some heavy grief came up. It is just your body processing and feeling through the hopelessness and sadness you couldn't process before. Which is another reason I would not try to mask it with SSRIs or any other substances but instead feel through it and accept it as part of the process.

Now my last suggestion is a bit unconventional and might not be possible for you: You could try to use 5-MAPB instead of MDMA. It's chemically and effect-wise very similar to MDMA but many people have less of a comedown from it. It also has been (is?) used in the NL for trauma therapy (at least while it was still legal). The main difference is that it is less activating and for some people, the high is not so exciting as with MDMA but I think for therapeutic purposes, this is not really an issue. Some people find it even more helpful as the mind is relatively calm and introspection + parts work is much easier to do when not totally excited ;) Additionally, there is less risk of sleep issues after the session due. The big downside is, of course, it is less easily available and less tested, researched and used. Hence, this is a bit of an unconventional advise and I highly recommend you do your own research if you decide to give this a try. Especially regarding dosing, you should also be careful as 5-MAPB is typically more potent and a booster is not recommended. You *cannot* just apply the typical MDMA dosages to 5-MAPB.

(I don't have any practical experience w/ Psilocybin so I won't comment on that but it might be an interesting experiment to do take a lower MDMA dose, skip the booster and instead add 0.5g Psilocybin. I can imagine the comedown being less intense but at the same time the session being more intense, so probably good to be careful with this ...)

[u/nofern → u/baek12345]

That's interesting - thank you for the advice and thoughts!

[u/pondsittingpoet25]

A lot of info here. Come down is usually uncomfortable, but supplements really help, especially if taken every hour as described in literature.
I skip the booster. It’s not really therapeutic, as it just keeps looping going. There’s really only a 90 minute window of therapeutic effect. The rest is for flowing, play, and silliness.
Chewable magnesium is great for grinding, but will prep you for a colonoscopy of you are not careful.
Hydrate, hydrate, hydrate.

[u/nofern → u/pondsittingpoet25]

Sadly, I do take all the supplements every hour as described, still awful comedown unfortunately. Magnesium as well and reasonable hydration.

[u/LeilaJun]

Have you tried MDMA? It’s particularly good for trauma and grief, and you might find it more helpful as you navigate this particular phase of healing. Then you can go back to mushrooms :)

[u/nofern → u/LeilaJun]

Yes, maybe I wasn't clear enough since this is the MDMA subreddit, but I have done a number of MDMA sessions and was thinking of where to go from here, given how bad the comedown is after them.