Opening
Physical preparation is the least glamorous part of this course and the part people are most likely to underinvest in. It is also one of the most consequential. Unlike emotional preparation — which shapes the quality and depth of the experience — physical preparation shapes its safety. Getting it wrong ranges from reducing therapeutic efficacy (SSRIs blunting psilocybin effects) to genuinely dangerous (SSRIs combined with ayahuasca).
This module covers the pharmacological basis for each preparation requirement, medicine by medicine. It also covers the medication question in detail, because this is where most people have the most uncertainty and the most to lose from generic advice. The 8-week timeline at the end of this module is designed to be used, not just read — it becomes the operational schedule for your preparation period.
Why Physical Preparation Is Pharmacological, Not Spiritual
Figure 1: What to avoid and for how long before each medicine. These are pharmacological requirements — the severity of consequences for non-compliance varies significantly by medicine.
The framing of physical preparation as a "purification" or "cleansing" practice in many retreat contexts obscures what is actually happening. The dietary restrictions around ayahuasca exist because the MAOI alkaloids in the brew — which are necessary to make oral DMT active — also inhibit the enzymes that normally break down tyramine in the gut. When tyramine accumulates, it can cause a hypertensive crisis. This is a drug-food interaction, not a spiritual purity requirement.
Similarly, the advice to reduce alcohol and cannabis before psilocybin isn't about spiritual preparation. Alcohol disrupts sleep architecture (reducing the restorative sleep that preparation requires), and regular cannabis use can blunt serotonergic effects and increase anxiety during the session. These are pharmacological realities.
The MAOI interaction web — ayahuasca specifically
Figure 2: The ayahuasca MAOI interaction map. This is the most complex dietary/drug interaction of any psychedelic. If you're preparing for ayahuasca, this diagram is the most important one in this module.
The MAOI interaction web is the most important pharmacological content in this module for anyone preparing for ayahuasca. The key categories to understand:
SSRIs and SNRIs: Combined with ayahuasca MAOIs, these carry genuine risk of serotonin syndrome — a potentially life-threatening condition. This is not theoretical. Tapering SSRIs before ayahuasca requires significant lead time (typically 2–4 weeks minimum, longer for fluoxetine which has a long half-life) and should be done under clinical supervision.
Tyramine-rich foods: Aged cheeses, cured meats, fermented foods, overripe fruit. The combination with MAOIs can cause hypertensive crisis — severe, sudden increase in blood pressure.
Stimulants: Including recreational use of cocaine, amphetamines, MDMA, and certain prescription stimulants. Combined with MAOIs, dangerous cardiovascular and serotonergic effects.
The Medication Question
Figure 3: The medication decision framework — what requires stopping, tapering, specialist guidance, or is an absolute contraindication. This is a framework for a clinical conversation, not a substitute for one.
The medication question is where people most frequently get dangerous generic advice — both from online communities ("just stop your meds a week before") and from retreat centers that don't have the clinical expertise to advise on this properly. The correct approach depends on what medication, what dose, what medicine you're taking, and your specific psychiatric history.
If you are on any of the following, you need a conversation with a prescribing clinician before proceeding — ideally one with psychedelic medicine familiarity:
SSRIs/SNRIs (sertraline, fluoxetine, escitalopram, venlafaxine, etc.) · MAOIs (phenelzine, tranylcypromine) · Lithium · Antipsychotics · Tramadol · Stimulant medications · Benzodiazepines
This is a clinical conversation, not a retreat center conversation. Retreat centers vary enormously in their medical expertise. Your prescribing clinician is the appropriate person for this guidance.
The 8-Week Preparation Timeline
Figure 4: The preparation timeline from eight weeks before your session through the day before. Each week has specific pharmacological and psychological actions.
Figure 5: The 24-hour pre-session protocol. What you do in the final day — physically, emotionally, and practically — sets the conditions for everything that follows.
The 24 hours before your session are a distinct preparation phase. The goal is to arrive at the session with a nervous system that is settled, a body that is appropriately nourished but not heavy, and a mind that has been allowed to be quiet rather than busy.
Light meal — nothing heavy or fermented. No alcohol. Screens off early. The session intention card (from Module 2) should be written, read once, and set aside. This is not the evening for final research or intensive journaling. It is the evening for rest.
Many people find a short walk in natural surroundings helpful. Some find that sitting quietly with music (the Johns Hopkins playlist, available on Spotify, was designed specifically for psychedelic sessions and makes useful preparation listening) helps orient toward the internal rather than the external.
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Get all 12 modules — $97 →The thing people most want to avoid in this module is the medication conversation. It requires telling a clinician what you're planning, which feels risky — will they refuse to help? Will they judge the decision? In most cases, neither. Clinicians who understand this space can often help you navigate medication safely. The alternative — stopping psychiatric medication without guidance because you didn't want to have the conversation — carries real risk. The medication conversation is not optional.
- Have you identified all medications and supplements you're currently taking, and checked each one against the relevant medicine's interaction profile?
- If you're on SSRIs or any other medication with potential interactions, have you scheduled a conversation with your prescribing clinician?
- Have you completed the 8-week timeline — written, dated, and in a format you'll actually use?
- Do you know the dietary restrictions specific to your medicine and when they begin?
- Do you have a plan for the 24 hours before your session that is specific and realistic?