Medication and antidepressant readiness before psychedelic treatment

Interaction screening is only as good as the medication list it runs against, and a verbal list taken at intake is routinely incomplete. Patients under-report supplements, herbal preparations, over-the-counter analgesics and antihistamines, and anything they expect to be judged for.

• Capture each item with dose, frequency, duration of use and last-taken date, not just a name.
• Ask separately about prescription, over-the-counter, supplement, herbal and recreational use — one open question collects far less.
• Accept uploads: a photo of the packaging or of a dispensed medication list catches strengths and formulations patients cannot recall.
• Record the prescriber's name and contact details, because liaison is the intended outcome of most flags.
• Re-check on the day. A list taken six weeks earlier is a historical document.

Interaction risk does not generalise across psychedelics. A rule library that treats them as one category produces both false reassurance and unusable noise.

Whatever library a programme uses, every flag it raises should carry its source, the evidence level behind it, the clinician who reviewed the rule and the date they did. A flag without provenance cannot be defended, and cannot be safely updated when the evidence moves.

Serotonin toxicity is a spectrum, not a binary event, and it is driven by combination and dose. Staff and patients both need to recognise the pattern early: agitation and confusion, tremor, clonus and hyperreflexia, sweating, diarrhoea, tachycardia, hypertension, and rising temperature. Rapid onset after a new agent or a dose increase is the characteristic signature. Education is part of the safety system, not an extra.

Antidepressant history changes what a programme can safely offer, and the relevant detail is rarely just the drug name: how long the patient has taken it, previous dose changes, what happened during any previous withdrawal, and whether their prescriber is engaged at all.

A treatment programme, and any software it uses, must never tell a patient to stop, reduce, increase, substitute or taper a prescription medicine. Medication changes are planned and managed by the patient’s qualified prescribing clinician. The programme’s job is to identify risk, document it, and refer.

In practice that means the screen produces one of four recorded outcomes: reviewed and cleared, more information required, specialist or prescriber referral required, or not currently ready. Each one is a decision with a name and a date on it, and each one is revisitable when the picture changes.

The Medication and Psychedelic Readiness system is included in every licence tier. It holds the medication inventory with uploads, substance-specific interaction screening against a governed rule library with cited evidence, cardiac and laboratory readiness entered by clinicians, antidepressant and withdrawal history, an eleven-stage workflow with recorded prescriber decisions, serotonin safety education, an emergency escalation plan, a one-click clinical report, and an audit entry for every decision and reviewer.