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This is a first-person account from a psychiatry resident (me) enrolling in a clinical trial of psilocybin. Somewhere between a trip report, an overview of the pharmacology of psilocybin, and a review of the clinical evidence suggesting pronounced benefits for depression.
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Notes -
Had a friend who got really into shrooms. It basically ruined his life for a while, and he was only able to recover after he fully quit doing drugs. Went into a sustained severe manic state, spent his entire life savings in short order, lost multiple jobs in quick succession due to erratic behavior, revealed to me detailed plans that if acted upon would have lead to severe social and potentially legal/criminal damage. And the entire time he was subjectively convinced that he had achieved enlightenment and his actions were infallible. It permanently put me off of ever trying shrooms and has made me skeptical of all accounts that portray psychedelics as "harmless".
(Full disclosure, this was confounded by the fact that he was also doing massive quantities of THC at the same time. But then, people present THC as harmless too, so you'd think that harmless thing 1 + harmless thing 2 would be fine...)
I'm sorry to hear that, and I'm glad to hear he got better.
However, the dose makes the poison. I presume he was using very large doses on a frequent basis, in conjunction with "massive quantities of THC". I can't speak authoritatively about the risks of psychosis from the former, at least not without reviewing the literature first, but the latter? If you have some kind of genetic predisposition, such as to schizophrenia, that will fuck you up. And the more drugs you throw into the mix..
In the case of psilocybin, for therapeutic doses, especially under supervision, the risks are minimal. I would never call psychedelics "harmless", but at least in this instance, when compared to how awful depression can be, I felt the odds were in my favor. Even something as 'benign' as SSRIs can cause mania shortly after initiation. Holding out for something that truly has no risk associated with it is a fool's errand I'm afraid.
It’s possible that the THC was the principal culprit. I have witnessed THC inducing acute psychotic episodes on other occasions before. Bit counterintuitive since most people would think of THC as being less “intense” than psilocybin but I suppose the whole thing is under-studied. I’m surprised that the risks of THC haven’t really permeated cultural consciousness.
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Good post but bruh…
Frankly: I hate all this clinical trial bullshit around psychedelics and mushrooms. They definitely have anti depressive effects, but anyone that does drugs knows that the set/setting of these clinical trials is absolutely awful and retarded. You’re tripping and they just have you watching ig reels and tv?
Take 2 gs of real mushrooms and go for a forest walk and think about life. You’ll actually have some real insights about what’s making you that way. Treating these substances like just another pharma substance isn’t the way.
Drug prohibition is a crime against humanity!
I see people out there getting absolutely wasted on kratom, acting like lunatics, wasting huge amounts of money on it, not washing, being aggressive, getting in fights. Maybe drugs should be legal for people who are not idiots.
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I brought my own entertainment. The study design only offered "relaxing music" and an eye-cover if you were feeling overwhelmed. The music would have worked okay in an elevator or a Thai spa, but was absolutely not to my taste haha.
It's hard to blame them, really. Getting IRB approval for a clinical trial is a PITA on a good day, I strongly suspect that if they wanted to offer entertainment or a walk outside, they'd be raked over the coals, leaving aside the increase in liability and the demands on personnel. I'm certainly interested in trying shrooms in a more congenial environment!
Can you give us some more details about what the set and setting was for the session?
I had had to head down to London twice to attend the sessions. Beyond that? Not much to say, it was a bog-standard NHS hospital.
You go in, they take your vitals and your measurements, primarily focusing on making sure your blood pressure is okay (psilocybin affects it, not that the risk is notable). By that point in time, you've gone through phone screening, but on arrival, they conduct drug screening. They're looking for any illicit substances that might confound their results.
Once you get the all clear, you swallow a dose, then head to a clinic room. I was alone, but I think I saw a few other people who were probably participants. They had extremely dull music playing, and offered me eye covers if I wanted them. I had a pressure cuff on, with continuous monitoring. A nurse would swing around every few minutes at the staff to make sure I was okay, but eventually I told her I felt fine and she didn't really bother. There was also a psychologist on staff, but I told them I didn't need anything in particular at the time.
Once 8 hours was up (I think they could have let me leave earlier, but I didn't want to risk it since I was unsure about the come down), they took another set of measurements and I was good to go.
Overall, very boring and clinical. Not that there was much else to do, it was a rainy day out there.
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