In this episode of the Psychedelic Medicine Podcast, Alexander Lebedev, MD, PhD joins to discuss psychedelic medicine and psychosis. Dr. Lebedev is a physician-scientist, medical AI engineer, and entrepreneur working at the frontier of health and technology. His work spans collective societal dynamics, psychedelics, and medical AI; he leads Lebedev Labs and is co-founder of Dreamseer and Once Wellbeing Center.
In this conversation, Dr. Lebedev explores the complex relationship between psychedelics and psychosis, examining what decades of research—and more recent clinical evidence—actually tell us about the risks. He explains why individuals with personal or family histories of psychotic disorders are typically excluded from clinical trials, clarifies the distinction between transient psychotic experiences and chronic psychotic disorders, and discusses why current evidence has not established a causal link between psychedelic use and persistent psychosis in screened populations. Throughout the discussion, Dr. Lebedev emphasizes the importance of careful screening, preparation, integration, and context, arguing that psychedelics should be understood through both scientific and phenomenological lenses rather than simplistic assumptions about safety or danger.
In this episode, you'll hear:
- What inspired Dr. Lebedev to study psychedelics and psychosis
- Why psychedelics became associated with psychosis and how that perception developed historically
- Why case reports of psychotic episodes following psychedelic use are not definitive to establish a causal link between the two
- How the lenses and frameworks we employ can significantly color how we understand psychosis and altered states of consciousness
- The role of set, setting, sleep, substance use, and integration in reducing psychological risks
- How psychedelic experiences overlap with—and differ from—psychotic states from a phenomenological perspective
- The intersection of psychosis and bipolar disorder and the relevance of this overlap to psychedelic medicine
- Why researchers are beginning to reconsider whether certain psychosis-spectrum populations should eventually be studied under carefully controlled conditions
Quotes:
"The first framework within which psychedelics were studied and considered was the psychotomimetic framework, meaning that they were considered as tools that are supposed to mimic psychotic states." [9:22]
"In the pre-prohibition era, psychedelics were tested on very large populations of different patients—including people with psychosis spectrum disorders, including people with schizophrenia spectrum disorders—with some mixed results. But there was already some data indicating that from a populational perspective, from a statistical link, we didn't have clear indication, even back then, that that link [between psychedelics and psychosis] exists." [12:48]
"Interestingly, unlike for cannabis, for tobacco, for some other substances, this link [with psychosis] was not verified in these large studies for psychedelics." [15:54]
"If the only lens that you have is pathology, you can pathologize transformation as well. On the other hand, if the only lens that you have is spirituality, you can spiritualize the compensation that can come with the psychotic experience." [20:21]
"From a phenomenological perspective, there are, of course, clear similarities [between psychedelic experiences and psychosis] . But of course, the background, the emotional content is very different. … If you read sometimes descriptions of people's mystical experiences or bad trips, sometimes they can actually on the surface look remarkably similar. What is different is the affective balance of it. And that's true for psychedelic experiences and also for psychotic experiences." [40:37]
Links:
Dr. Lebedev on LinkedIn
Dr. Lebedev on Instagram
Dr. Lebedev on Threads
Once Wellbeing Center website
Once Wellbeing Center on Instagram
Once Wellbeing Center on LinkedIn
Psychedelic Medicine Association
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