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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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