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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.
Like you say though, the dose makes the poison, and there's always a risk. I had a bit of a similar experience with pot to your experience with mushrooms. For a long time I followed the advice of the doctors - I'd always refuse it when offered because of its well recognised effects on people like me. But about a decade ago my depression felt overwhelming and that was around the time psychedelics were showing promising results (ecstacy was also being trialled at the time in Australia, I wonder why it didn't take off like psilocybin?) so I wanted to try mushrooms or LSD, but I didn't know anyone who had access and couldn't get into a trial due to my condition. So in a desperate move to just feel something different, I tried pot.
It has basically fixed me. Ok it was probably the CBD and that's hyperbole, I still have the paranoia and the over inclusive reasoning and holistic bias, but I regret not trying it sooner with all my heart. I have stability, a community I love and who has my back, and I no longer need anti-anxiety, anti-depressant or anti-psychotic medication. But I was never taking massive doses - even when I wanted to get high I'm too paranoid to tolerate the cognitive impact.
Also I don't blame the doctors or anything - they were doing the best they could with the information available to them, and people are unique. But like prima said, it's under-researched. In fact to counter balance what I just said, my brother (who is mentally healthy) also avoided pot for the same reason, but accidentally ate an edible while visiting our uncle and came close to disassociating completely and reckons it took him half a year to get over it. And I've met plenty of schizophrenics who were triggered by pot. It's not a gamble I'd suggest others take.
While I'm glad that weed helped you, I have good reason to believe that that's a rather unexpected/idiosyncratic response.
For most people with depression, I'd go as far as to say it's highly inadvisable:
This isn't entirely causal, as there's some evidence that people with a predisposition towards depression are more likely to try weed in the first place. Yet I think the evidence is there, and in particular, there's little evidence of it helping reduce depression.
What I've heard on the grape-vine is that there are quite a few trials ongoing. I googled it, and they've got some big names involved.
A number of trials have concluded, with, as far as I can tell by eye-balling them quickly promising results.
Unfortunately, adoption just takes time. Not all psychiatrists are as open to the idea of psychedelics as I am. While not a psychedelic, ketamine was only relatively recently approved in the UK for depression, and it's a pain to acquire in the NHS.
Not to mention the lack of a profit motive. Most of them are unpatentable, hence pharma companies aren't really raring to go to produce them.
I've looked at the figures, and that's very rare! Remember, you're looking at schizophrenics who you have reason to believe were triggered by pot. What we ought to be considering are people without known schizophrenia, what are the risks they develop it after trying pot?
That figure is very low. Probably in the sub 0.1% or lower range.
Even within schizophrenics, a study in Denmark found that only ~ 6-8% of schizophrenia cases were induced by weed.
There's also a strong dose dependence here, I would expect that even vulnerable people wouldn't be too affected by a small amount of weed. Unfortunately, potencies have only increased over time.
I wouldn't lose any sleep over it, but I'm not a big fan of weed because it can be habit forming, blunts cognition and just makes you lazy-ass drug if you take it regularly.
IDK, this "Drugs are actually, like, medicine, maaan" has been around for a while, and generally dont seem like someone youd want to end up as. Its getting "scientific" now that the taboo has weakened, but... no shit it looks promising, youre literally trying drugs for mood. If the researcher cant make that look promising, how on earth did he get a PhD?
It also seems like theres some disorder in your post. The last paragraph before "The aftermath:" for example has a lot of redundancy and sounds like it was supposed to be before those other instances. I thought the part about pharmacokinetics was double as well, only realised now that one is about the nausea and one the whole thing.
Is this a serious critique? Like, do you think that psychiatry of all professions isn't aware of the difference between "feeling happy" and "not being depressed"??
The scientists and doctors performing the studies are well aware that many drugs cause temporary and transient elevations in mood. Far fewer cause lasting improvements.
Prescribing cocaine and heroin is, unfortunately, not a viable cure for depression. Just making someone feel euphoria shortly after taking a drug isn't a "cure" or even a treatment.
I don't blame you, because the psychopharmacology is a lot of receptor names and binding sites that sound almost the same and vary in the last few letters or numbers.
Has anyone tried? In the manner of these studies I mean, not by just looking at addicts. People whove done heroin generally report that naive use is an experience beyond anything they had before. I would not be surprised if this influences people even months later. But it also might not, there are always those pescy details. E.g. maybe it overlaps too much with the alcohol high to show effects in our society.
Its more that we have now found multiple drugs with different mechanisms of action, but apparently similar in terms of how they are used and effect against depression, and all of them are used recreationally for their short-term effects. That suggests to me that it works off the recreational bit, and it again wouldnt be super surprising if it did. "Drugs can make you feel better when used responsibly" is hardly a new insight - the entire problem is the way they lead to non-responsible use.
Also curious what you think of this one.
I assure you that they're not effective solutions. Cocaine is highly addictive, and the comedowns more than make up for the very short-term euphoria. Heroin? That's akin to borrowing happiness from tomorrow at a very high interest rate, it doesn't end well.
We've got plenty of studies on the long-term effects of stimulants and opiates. They don't help with depression in any meaningful sense.
I've only endorsed psilocybin in a therapeutic, observed context. It's not a particularly habit forming drug. More importantly, it has a short duration of acute effect, while appearing to durably reduce depression for months after a single dose. It's highly reductive to dismiss such advances as "Drugs can make you feel better when used responsibly".
Addictions aren't made alike. Some can be entirely benign, coffee, as Katja intentionally became dependent on, won't kill you, nor will it ruin your psycho-social functioning. ~Nobody has lost their job or family because they drink too much coffee.
Contrast that to becoming a lay-about stoner, a coke fiend, or a heroin addict.
If were talking about the effect of a ~one time experience, then comedowns arent necessarily relevant. We might imagine for example someone seeing "Wow, its possible to be happy" and that giving him hope in life. That hope might point down the abyss, but thats only measurable when you get there.
But taking this at face value: do you think peoples lives are worse for alcohol? Theres a hangover there too, and in the narrow pleasure-pain accounting, youre not coming out ahead - yet there are many apprently non-addicted people who are using it a decent amount.
Yes, thats the point. The value of the cliche depends on not thinking you can outsmart it.
I am well aware. The link is not directly related to my point here, and I was wondering more about the idea that shes better off for it.
It also remains fascinating, the way people will respond to every part of my comment but the main one. Why do you think apparently different drugs work in such similar ways here?
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Sorry, when I said triggered by pot I meant it made them (according to them) overly paranoid or dip into psychosis and they hated it. Isn't that what you meant when you said:
?
Ah, gotcha.
Cannabis can induce outright psychosis and initiation of schizophrenic symptoms in people with genetic vulnerability towards it. The higher the dose, the higher the risk.
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