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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.
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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