Ok like most of you I’ve taken psychedelic drugs. I’ve had bad experiences sure, but I’m fine now.
The issue is that what people generally say, like, “oh sometimes you need to encounter your demons,” maybe that will be temporarily traumatizing—in general people recover from that. The real issues are…more complex. More complex than any diagnoses in the DSM can cover. The brain is very complicated, and everyone’s brain is a bit different, and we do not know, really, what goes on in there when you take a drug like Psilocybin. Sometimes something gets a little knocked out of place, and the system doesn’t fully recover.
The last time I took a very high dose of psychedelics I couldn’t think straight for a few weeks after. Thoughts came out of nowhere, I had no control over them; often the constant, unceasing flow of thought was distressing and uncomfortable. Thankfully I could still talk to people—talking made me better. I got plenty of sleep, cut out all drugs, even caffiene, got regular exercise and ate a very healthy diet: about a year and a half later I was back to my old habits. But it wasn’t an easy recovery, and certainly not one any psychiatrist could’ve treated adaquetely. But, now I know to be more careful in the future.
> we do not know, really, what goes on in there when you take a drug like Psilocybin
FYI, same goes for SSRIs. The scientific consensus is that the serotonin deficiency theory of depression was wrong. When SSRIs actually work, we still don’t know why.
I’ve had bad trips, too. Very bad, but I still think that psilocybin (in a controlled, supportive setting) is a better bet. My bad trips were all due to being in bad settings and being completely unprepared for what could go wrong. I was young and dumb and just fucking around. But tripping in positive supportive settings was incredibly helpful. And if we do find a way to do this right, then people don’t have to take drugs for the rest of their lives. Psychiatric drugs are generally lifelong sentences, and negative side effects tend to compound over time, which often leads to polypharmacy, and more side effects.
I agree. But I don’t think psychedelics are the end all be all, that’s all
Anyone who has ever tried to fine-tune medication for psychological issues knows how challenging it can be to get the dosages and combinations just right. In my experience, even medications within the same class can have different effects on different people, especially when combined with drugs from other classes.
The interactions between medications, as well as the patient’s individual response, are hard to predict. These reactions can change over time, too, as bodies and brains adapt, and lifestyles shift.
Yet, you often hear oversimplified statements like "depression means you have too little serotonin," "feeling sluggish means you lack noradrenaline," or "difficulty focusing means you have too little dopamine." These explanations are so reductive that they barely make sense.
The more I read about drug trials, the more I realize how little I — and even many professionals — truly understand about how these medications work and the best way to make informed treatment decisions.
Did you take it in a controlled environment like the study suggests? Every time serious conversation of medical progress comes up, it's polluted by naysayers with anecdata about how they took it while raving beside a live volcano.
We need to give psychedelics a fair chance, and sure after we can discount them. The article suggests at scale there is potential
In my experience (this thread, too), the conversation gets polluted by people that swear by their self-medication and call more cautious people naysayers.
How come every time we try to have a conversion, it always ends up all "point counterpoint" and "personal experience with the topic" and "differing personal experience" and "discussion of how those experiences relate to the topic"!? EVERY TIME!
The only valuable conversation about such research is an objective discussion of the quality of the study at hand.
Its almost as if all experience is subjective…
In the pre-modern world people had a very different relationship to death and there wasn’t anything like anxiety as its experienced today. Psychedelics are essentially an attempt to bring someone back to a more “authentic” experience of life before technological controls settled in. Perhaps its better to take the chance? I think so, but I want others to recognize it as a genuine risk that is truly unpredictable and not a personal failing on the part of the user.
> Ok like most of you I’ve taken psychedelic drugs.
I would like to see some actual data because my assumption has always been that most people have never tried any. I personally have not had any. I have always subscribed to the slippery slope theory of vice.
Most people in this thread who are taking the position I’m critiquing, then
Had a very similar experience. Took ~2y to fully go away.
“Like most of you”
“Objection, assuming facts not in evidence”
I'm a little ambivalent about this response. It sounds like you're describing invasive thoughts of some kind, though your description is vague. At any rate, despite the perceived negative effects, by your own account, it apparently spurred you to lead a healthier life; in other contexts, this is precisely the thing that is praised when it comes to psilocybin.
> it apparently spurred you to lead a healthier life
No, I stopped mostly after I’d recovered. And I definitely wasn’t “healthier” then, just addled.
Yeah, maybe don't take "very high doses". I've not done that. And not had any seriously bad experiences. Maybe like everything else is all about moderation?
It was 500ug of LSD mixed with probably 6 or 7 drinks of alcohol. Suffered serotonin syndrome for a few days afterwards.
Regardless I’ve heard stories of people having severe long term psychological issues from even relatively light doses, simply because of how their body in particular interacted with the drug.
That’s a massive dose and you mixed it with alcohol. That is in no way a responsible way to try out psychedelics. You are right that everyone reacts differently which is why you don’t take a very large dose mixed with other other drugs.
Anecdotally, ayuasca quite literally saved my life and helped me tremendously when I was spiraling into a deep depression. Psychedelics when taken responsibly in a controlled environment under supervision can help a lot of people.
Thank you for telling the story.
To me, it’s interesting to consider the inflammatory aspects – the immunomodulatory effects of LSD and other psychedelics on one hand and alcohol on the other.
It’s well established but little-known that psychedelics have a very significant inflammation-reducing effect which includes drastic reduction of neuroinflammation. (I’m fairly sure that this is a primary reason why they work for depression and anxiety; There’s basically always elevated inflammatory biomarkers with these disorders. Stress is directly causative of neuroimflammation.)
Here’s a really solid review paper from 2017 – today a lot more knowledge has been accumulated: https://www.frontiersin.org/journals/immunology/articles/10....
Alcohol is known to be pro-inflammatory.
I have a hunch that these two disjoint forces on the same physiological systems can have made things worse.
500ug of LSD isn’t really a standard dose. It’s almost double your typical dose.
250ug of good acid is still a very high dose! 500ug is more like triple of a typical sane dose. milage may vary i guess but 300ug sent me out of this world
I know a guy who took 1000ug. He told me he had side effects / visual glitches for about an entire week
It's such a bad idea to combine alcohol with psychedelics. You should lead off with exactly what you took so as not to mislead others.
As I said my experience incurred more risk of severe long term side effects, but those are possible in any circumstance with any psychedelic with even a single, low dose.
500ug is nuts
Taking psychedelics is a bit like trying to fix a Swiss watch with a sledgehammer: it might just work, but that's not the way to bet. Therapy and well-guided meditative practice can be a lot gentler than that.
There is actually a ton of incredibly fascinating knowledge about what psychedelics do – neuroimmunobiologically the effects are profoundly interesting. It’s a surprisingly sharp and specific instrument, certainly double-edged though.
https://www.frontiersin.org/journals/immunology/articles/10....
This is sort of how the mechanism of psychedelics fixing depression comes across to me as well. But, surely there must be much more to it, since, as you’re of course aware, fixing a Swiss watch with a sledgehammer will have a very low success rate. The other end of the analogy spectrum could be that it’s a bit like a chemical catalyst. There’s a lot of resistance to a reaction happening on its own, but will very likely happen if given the proper jolt.
A better analogy might be "fixing a heart attack with your fists". It might work, if the problem is fibrillation or a blocked artery and if the impact resolves it… or it might just cause further injury without resolving anything. (Or it might resolve the heart attack, but then cause a stroke a few minutes later.)
I agree, that taking psychedelics is likely not a good idea. But the analogue gives in my opinion totally wrong picture of the actual risks. Psychedelics, at least psilocybin, are quite harmless compared to almost any other substances. The reason for that is that they aren't very habit forming.
Personally I used psilocybin recreationally back in the days. Got once bad experience and ended up in a psychosis and to hospital. I got better in couple of days and long term effects were nonexistent.
Then I have couple of friends whose basic substances are just legal alcohol and cigarettes, and boy have they fucked their lives with those. It just takes a long time to do it that but psilocybin for sure does not lead to that kind of path.
Thank you for the balanced opinion. It's a rarity here.
> "Psychiatrists really focus on negative symptoms of depression. So, if you are not sad anymore, if your sleep or appetite is not impaired, they think you're better. But if you look at what patients define as important, they say it's the degree in which their life is meaningful, in which they can connect with people around them, in which they can function in everyday life," Barba said.
A more wholistic approach to health care would be beneficial. For folks looking for more depth or purpose, Psilocybin seems to help reconnect people with a part of themselves they only dimly remember.
I often hear people talk about the risks of psychedelics, which are to be considered, but what’s the risk of doing nothing or withholding the best treatment?
> Psilocybin seems to help reconnect people with a part of themselves they only dimly remember
Is there science behind this statement?
From what I know, we understanding psychedelics work. We don’t know precisely how.
> I often hear people talk about the risks of psychedelics, which are to be considered, but what’s the risk of doing nothing or withholding the best treatment?
The risk is to make things worse.
And I know that I am preaching to people that are of the opinion that they know better than the FDA, scientists and doctors and are all for self-medicating based off of the echo chamber here and a few cherry-picked, limited and flawed by default (like in the case of this one) studies on the first page of Google.
Many people here are speaking from experience. I trust my own judgment over some knob in the FDA that is steeped in a culture of drug control.
> Many people here are speaking from experience. I trust my own judgment over some knob in the FDA that is steeped in a culture of drug control.
Let me paraphrase this:
Many people here are parroting stuff based on a sample size of 1, who lived to tell the tale. You trust your own judgement based on those people before the rigorous safety and effectiveness studies for the FDA, on a whim that the FDA approves or rejects drugs based on their... ? Culture of hating recreational drugs?
The FDA exists to tell you, a free individual, what you are allowed to put in your body. It has been a very long time since the FDA has been about safety only. It is wholly captured by business interests in food and drug industries. So yes, they, and the government culture as a whole, hate recreational drugs that they don't control in some way. No shooms for you but drugs that cause suicidal ideation are prescribed by the millions.
I am wary of people "looking out for your safety" when there is financial incentive to do otherwise.
And psychiatric drugs don’t ever make things worse? As someone who was severely injured by FDA approved, scientifically validated medications, I’d say some healthy distrust of a corporate-captured bureaucracy is warranted. Remember, OxyContin was FDA approved. Did the FDA ever launch an investigation into how they allowed that disaster to happen? No. They didn’t so much as say “whoops”.
> The risk is to make things worse.
That risk exists in many medical interventions. We need to quantify that risk and weigh it against the chances of making things better.
This is generally what the regulatory system tries to accomplish.
I don't want people self-medicating with psilocybin, just like I don't want people self-medicating with SSRIs.
Which is more dangerous?
Psylocybin? Easily?
You have to put effort into making an experience with psylocybin meaningful and helpful. It could go wrong very easily, especially for those who are in a difficult situation or headspace. (Speaking from experience.)
As for SSRIs? Safe, effective, with a handful of annoying side effects. Straightforward to use, low potential for misuse, requires sustained use for any intended effects. A doctor who already has familiarity with a patient's mild or moderate symptoms of anxiety or depression may very well just prescribe one if asked and if not contraindicated. Not that you should randomly start popping Prozac, but it's unlikely to hurt you if you did.
Ask your doctor, try the things that doctors currently believe are most likely to work first. If for whatever reason you choose to go beyond the current medical consensus, please stay safe and keep your doctor up to date.
I guarantee you the number of people who have died from SSRI misuse is higher than the number of people who have died from psilocybin misuse. I'm not referring to things a person may do in a given state, I'm talking about effects from the drugs themselves. I'm not aware of a single recorded person who has taken any dose of psilocybin, and died from "psilocybin overdose". While it may be uncommon, it is possible to overdose on SSRIs.
Sure, psylocybin won't kill you, but the threat of inescapable psychological distress is real. Maybe it's less likely if you aren't predisposed to psychosis, but you can't easily know for sure that you're not.
And yes, it's possible to misuse SSRIs, but taking an obviously oversize dose is still often a treatable situation. Combining them with depressants I think is a degree of misuse that is incomparable.
So are you okay with people choosing their own dose of SSRIs?
A prescribing doctor will not magically know the precise amount of an SSRI a patient should be taking, or which one to take. For most patients, finding the right drug and dosage is a process. And just like with psilocybin, no one would want to take a random amount. Like with any drug, a person would want to be informed and have proper guidelines about dosage from the start.
> Psylocybin? Easily?
Err.. no?
This is from the Dutch National Institute for Public Health and the Environment: https://www.rivm.nl/bibliotheek/rapporten/340001001.pdf
Page 19 onward has the charts. What do do we find at the very low end in terms of chronic and acute toxicity? Shrooms (“paddos”) and LSD.
It always blows my mind how anti-drug people will do a handwavey gesture to the authority of institutes like the FDA, but never actually check up on what actual research says.
> As for SSRIs? Safe, effective, with a handful of annoying side effects.
Except the multitude of ways you can put yourself into a serotonin coma.
I agree with your assessment that (first) use of psychedelics should be under proper guidance. But what you refer to, “going bad”, can sometimes be a traumatic past experience that people have stuffed away and by surfacing and processing it they can move past it. It’s not always meant to be kumbaya and flowers.
Educate yourself, then talk.
I'm not saying psylocybin can't be used safely, nor have I made any claims about its relative toxicity or harm relative to other scheduled drugs. If you're arguing anything else, I don't think that report says what you think it says. As for my position, I live in SF, it's decriminalized here, I support that. So there's no need for your rude presumption that I find it generally unsafe.
I'm also unfamiliar with the dose of SSRIs that would send you into a coma, but I'm fairly certain it's shockingly large. Happy to be informed otherwise.
edit to reflect parent edit: yes, I'm aware that breakthrough experiences can be helpful. I'm also saying they should not be your first resort.
> > You have to put effort into making an experience with psylocybin meaningful and helpful. It could go wrong very easily, especially for those who are in a difficult situation or headspace. (Speaking from experience.)
> What do do we find at the very low end in terms of chronic and acute toxicity? Shrooms (“paddos”) and LSD.
Breaking your mind doesn't count as toxicity. You're not responding to the point you tried to refute.
toxicity is the least of _psychoactive_ drugs problems
Impotence and weight gain are not just "annoying" side effects. They seriously impact your life. Just putting that out there.
I'm not claiming they don't. Everyone experiences SSRIs differently and it's common to shop around until you find one whose side effects impact your life in a more tolerable way.
That's in contrast to psylocybin, which has substantially more serious potential acute side effects, ones that are more difficult to understand and treat should they occur.
I'm not saying psylocybin is unsafe or that SSRIs are always preferable. But if I'm asked to compare their safety? The choice is obvious, weight gain notwithstanding.
The best thing to do is to consult with a physician on matters related to your health.
I really wish we would retire this chestnut already. As if there’s a reasonable grownup option here and everything else is playing with matches.
No it’s not the best thing to do to brave huge waiting lists, call a hundred providers none of whom are taking new patients, pay a fortune out of pocket, and/or be faced with a distracted impatient person stuck to their screen who has 10 minutes for you.
And I live in Germany, not the US.
The US government severely restricts research on Schedule 1 drugs like psilocybin. Physicians don't have the data they need to inform patients.
That's not clear cut. There clearly exist plenty of combinations of "situation + physician" where this is not the best thing to do. To claim otherwise may as well be religious dogma.
At the very least, consulting with one or more physicians gives more data points than you would otherwise have. If your goal is to know more, having other opinions is pretty fundamental.
I'm sorry, but how is trusting a person who dedicated 10+ years of their life studying/practicing this, and relying on rigorous safety and effectiveness research of drugs religious dogma? Are you sure you know what religion is? Are you sure you know what science is? Are you just trolling?
If you actually read the effectiveness and safety research with a critical eye, you would realize “rigorous” is often the wrong adjective, whereas “cherry picked” to the point of “fraudulent” is often more in line with reality.
Case in point: 50,000 people died, with about 5 times as many suffering life-changing serious adverse events, from “rigorous research” on the safety of Vioxx. Yes, it has since been pulled from the market, which FDA apologists often construe as “system working as designed”. No, it isn’t, even in the least, when you go into the details.
Also: Purdue and OxyContin.
Regulatory capture of the FDA is decades old at this point. Ignoring that is not a rational or healthy position.
I don't know, why don't we ask my colon? Oh, wait, we can't. I was prescribed accutane, subsequently got ulcerative colitis so bad that they had to remove the organ entirely. The surgeon said my colon was literally falling apart in his hands as he took it out. Blind deference to authority of doctors lead to this situation. They do not always make great decisions, especially if there is a financial incentive for them to do otherwise.
The idea that doctors aren't constantly "off base" and must be deferred to uncritically is pretty terrible.
For example, it took literally two decades after it became well known that peptic ulcers were mostly caused by bacteria for the medical community to embrace giving anti-biotics for GI pain. To this day, there are still many American doctors who don't actually know about the Nobel Prize given in 2000 for this discovery, and claim it's "stress" and tell you to go home. Some claim they "know" but than try to "change your gut PH" and still refuse to give antibiotics due to "superbug" risk.
This is a "small" thing (GI pain is not small to those who have it) - but if the doctors are screwing up such a small thing institutionally, what else do they mess up on?
One is travelers sickness. Doctors in the USA do not want to perscribe front line antibiotics for it because of fear of superbugs - but they'll uncritically go eat their lunch at a McDonalds that same day, where they consume meat bathed in antibiotic slop which is more likely to contribute to superbugs then the amoxicillin that they didn't give you would have.
Or what about right now, when it's become clear that Ozempic is literally a super-drug. Every doctor on earth should be trying to give that stuff to literally anyone.
I can go to "third world countries" with deregulated health systems and get infinitely better care that I have real control over for on the orders of 1 USD (that's how much it cost for me in Thailand to get front line antibiotics for travelers sickness INCLUDING THE DOCTORS VISIT!)
Why do we still sell Neosporin despite doctors wanting it off the market (also for risk of superbugs)? Why do few people in America use Providone-iodine for wound treatment despite it being by far the best solution scientifically for it (and it stains yellow)? Maybe it's because we're stupid. There really aren't better explanations.
What about Circumcision? I'd straight up put doctors who do it in jail and many European nations would do the same. American doctors think circumcision is just fine, and long, deeply bitter swaths of medical ethics journals are dedicated to fighting over this again and again.
Or what about the widespread disagreement over even basic stuff like digital rectal exams? There's no agreement on if they are worth it because often sticking one's hand up the butt of an old man does more damage to them than finding out that they (like everyone else at old age) have benign prostate cancer?
Doctors in America have not earned their position of deference. The scientifically minded on HN who do their own research can and often do know how to treat certain conditions better than white-coats.
that's easy to say when you forget about the state of healthcare.. everywhere, actually. I was going to say the US but in other countries it's not like you can just pop in for a chat about taking shroomies, either.
I'm not sure having a ten minute meeting with a stranger who has a PhD in internal medicine is going to yield useful strategies for curing the existential dread underpinning your depression whether you're there to discuss getting zonked on LSD or something more "traditional" like Xanax
> it's not like you can just pop in for a chat about taking shroomies
You sure can just pop in to discuss options for your crippling depression though? And sorry, I do indeed live in a country with a functioning healthcare system, not the US.
Definitely psilocybin. For instance, if you take psilocybin and then spend some time in a cow slaughterhouse house, you might go crazy. The same wouldn’t be true of SSRIs.
My suspicion has always been the majority of adverse reactions have related to improper dosing.
Anyone can have a horrible response with too high of a dose yet with self-medicating theres no sure way to know the amount of medicine you’ve ingested even if weighing.
Rigorously determining the proper effective and safe dose is part of the approval process.
Is there any evidence that psilocybin "makes things worse" or are you just concern trolling?
Probably not…the question is, does Psilocybin have a higher incidence rate of users suffering episodes of severe depression or psychosis than, say, SSRIs. Amongst all the “spiritual” drugs, even counting THC, Psilocybin is the most well tolerated—even so, SSRIs tend to still be very safe, even if they are not very effective.
The best thing to do is to consult with a physician on this matter, еven if side effects, drug interactions and precautions are readily available and cardiac arrest and death are among them. Idk, is this worse?
> A more wholistic approach to health care would be beneficial.
Maybe. My personal experience has been that those "negative symptoms" were in fact the entire disorder. I didn't need purpose or depth. I needed to not be so sad that I couldn't function. I needed to be able to hold a coherent thought for 5 minutes without getting stuck into a negative spiral of self loathing.
I want "purpose" and "connection", but those things are what everybody on earth are looking for. The search for those things is the _stuff_ that life is made of. I needed help to get back to a place where I could pursue those things. Pursuing them is my life.
The article discusses the risks of treatment:
> 'He added a word of caution for therapists that "psilocybin requires active confrontation of painful, negative emotions and people who take this drug need to be open and prepared for the idea that they are going into a state where they may probably end up crying and confronting whatever they are maybe running away from in their lives. Not everyone may want to do this."
The long-term consequences of trying to avoid such issues seem considerable, e.g. it might lead to schizophrenia if people try to wall off parts of their memories they find intolerable, though that's just speculation at this point.
I have been taking seratonin precursors (5-HTP, a supplement) for about 4 months at a very low dosage (.3 of the "normal dose").
My chronic depression is mostly gone, but I have noticed an uptick in physiological signs of anxiety (though no mental signs).
But more importantly, my gut health is better than it has been in 12 years. I am eating more and losing weight. My energy levels have skyrocketed. My impulsiveness has catered so hard that I was worried my libido was impacted. My executive function issues and ADHD are greatly minimized.
All from a supplement. Utterly life changing.
Unfortunately it's hardly possible to do proper case control studies with psilocybin, since the psychedelic effects cause unblinding. The participants know whether they are in the treatment or control group.
> Normally the journey is quite inward, so patients do not require active support during the psychedelic experience [around 6 hours]. Sometimes they do require some hand-holding, or helping them to 'let go', or breathing exercises. The important part is the integration work that comes afterwards," Barba added. [...]
> However, [Rucker] noted, it is also possible that the results reflect biased reporting between groups. This is more likely here because studies involving psilocybin tend to attract those with positive preconceptions about psilocybin and negative preconceptions about conventional antidepressants
If there is a medical question that double-blind studies cannot answer, that doesn't mean the question is unanswerable. It means we should be more skeptical of non-blinded studies (or worse studies that pretend to be blind), and we should look for alternative ways to address biases.
You could compare against other psychedelics. I’d be interested in that.
You could also test it on severely sleep-deprived experimenters undergoing sensory isolation, but that would never get IRB approval.
Sleep deprivation is thought to temporarily relieve depression in a lot of people, so it wouldn't really be a placebo anyway.
https://www.pennmedicine.org/news/news-releases/2017/septemb...
Hardly an issue. When people do similar studies measuring say the effects of prescribed exercise vs not they are also unblinded but we still get good data.
https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
>Post-SSRI sexual dysfunction (PSSD)[62][63] refers to a set of symptoms reported by some people who have taken SSRIs or other serotonin reuptake-inhibiting (SRI) drugs, in which sexual dysfunction symptoms persist for at least three months[64][65][66] after ceasing to take the drug. The status of PSSD as a legitimate and distinct pathology is contentious; several researchers have proposed that it should be recognized as a separate phenomenon from more common SSRI side effects.[67]
>The reported symptoms of PSSD include reduced sexual desire or arousal, erectile dysfunction in males or loss of vaginal lubrication in females, difficulty having an orgasm or loss of pleasurable sensation associated with orgasm, and a reduction or loss of sensitivity in the genitals or other erogenous zones. Additional non-sexual symptoms are also commonly described, including emotional numbing, anhedonia, depersonalization or derealization, and cognitive impairment.[64][68] The duration of PSSD symptoms appears to vary among patients, with some cases resolving in months and others in years or decades;
At least, the mushroom didn't steal my mojo
Can psilocybin restore the mojo, or are you just commenting on the downside of SSRIs?
Not a cure but a treatment (sample size: 1)
https://www.reddit.com/r/pssdhealing/comments/10tjyen/a_trea...
One dude recounted how psilocybin helped him have the best experience with the happy ending , as being out of this world, but the timing was perfect, not sure if it was 'How to Change Your Mind | | Netflix, or another one there.
happy ending?
Psilocybin saved my life. I'm no longer suicidal, I'm no longer a practicing alcoholic, and outside of a few things here and there, I'm generally at peace with my life. I cannot express how grateful I am for psilocybin.
Thanks for sharing this, you’re not the only one. I have a close friend who tried LSD as a last resort to get the best of his severe depression and suicidal thoughts (after being on SSRIs for his entire life) and just one session completely removed his suicidal thoughts for months. After this experience he repeats this whenever he feels the dark thoughts are coming back and it always curbs them down almost completely. It’s mind-blowing how well it worked for him.
Is it something that you still take here and there or was it a time limited therapy ?
Congrats on finding a cure for your ailments
I did 3 sessions of 8 grams in silent darkness for 3 weekends in a row and that basically "beat the devil out of me" as they say - it was very very difficult, and a lot of work, but well worth it.I've only felt the "brain haze" (I call it) once since then, I took a gram and went for a long walk in the forest, back to no haze. It's been about 7/8 months and I can feel the "haze" building in my mind again, so I plan to do another 1g in the forest sometime in the coming weeks.
However, my personal experience has been that Psilocybin != Psilocybin - the mushroom itself is super important to the process, much like Indica and Sativa have different ways of connecting you to the mind and the aether, Psilocybin (at least for me) VERY much is the same thing, and it's much starker than cannabis is. Getting into woo-woo land here so apologize: I have some concern that just "Psilocybin" isn't a good prescription, that the "spirit" that works on you is unique to the mushroom family, and that both not knowing the mushroom to prescribe and also being clinical about it (Psilocybin vs Mushroom) may not be a good direction to go in to help people with their issues. I also think that about LSD, it might work a bit for a while, but imo it's not the best tool.
Totally agree. The variance between species can be dramatic! 2.5 grams of Golden teacher was a standard trip, vs 0.5 grams of PES Amazonian was enough to send my friend into a full blown “awakening” (physical responses and everything).
It’s fascinating how they can hit different.
Also important to keep in mind the same dose can hit someone different each time depending on surrounding life conditions. I’m a big believer that the mushrooms “show you what you need to see” at any given moment, and that can sometimes range considerably.
Anecdotal case study involving a community of about a hundred enthusiasts: many in this community held the opinion you do, which is that something about the mushrooms themselves is unique to the psilocin experience (psilocybin is not always present, and in any case, metabolizes to psilocin).
Then 4-actyl DMT, sometimes call psilacetin, became broadly available. This is a synthetic pro-drug for psilocin, just as psilocybin is a naturally-occurring pro-drug for psilocin.
After that, the opinion that the mushroom per se had anything to do with the experience became very rare. It turns out that psilocin is meaningfully different from, in particular, LSD, 2C-B, and MD(M)A.
There's definitely something special about it. But that something is also present when it comes in vitro, not just in vivo.
Psilocybin tolerance starts building immediately. Even if you microdose (100 mg), it will stop being effective after 3-4 days.
Tolerance also wanes quickly. In 3 days of abstaining, you’re nearly entirely back to baseline tolerance. In 2 weeks you’re entirely back to baseline.
100mg psilocybin is several times a heroic dose, but 100ug is far below a microdose. Do you mean 100mg of dried mushrooms?
I think he means 100mg of mushroom body, which might be 1-2mg of psilocybin.
I wonder how much of an uphill battle it will be to get psilocybin approved for therapeutic use compared to synthetic psilocybin analogues that are being trialed right now. Psilocybin can't be patented and it's already scheduled as a narcotic everywhere.
The 2018 Hemp Farm bill gave the balls back to the citizens that the 2013 Analag act neutered.
Seeing mushroom extracts with all the alkaloids included besides psilocybin at gas stations may be a temporary point of stability until I can go to the "21+" store in 2030 to get my preferred arylcyclohexylamine and phenylethylamine variant.
From what I understand, those “magic mushroom” edibles sold in head shops and gas stations are amanita muscaria derived, which is a completely different psychoactive substance with different alkaloids. Toxic to the liver too, in ways that a cubensis is not.
Northern shamans drank reindeer urine after the animals had eaten amanita muscaria. Passing through the animals reduced the toxic component but left enough alkaloid to trip balls. Maybe the gas station edibles have removed the toxin.
signs point to no:
https://www.cbsnews.com/news/magic-mushrooms-found-in-recall...
It's already being used in therapy. Oregon is giving licenses.
https://www.oregon.gov/oha/ph/preventionwellness/pages/psilo...
In Oregon enforcement of what passes for our drug laws here is so lax (cops quiet quit long before covid) that it's de-facto legalized.
I've literally walked down Portland and had random homeless people unprompted yell out "Want to buy some shrooms?"
There have been unlicensed openly practicing shrooms businesses which survived far longer than one would expect for such a "regulated" industry.
Geneva is home to the only Swiss hospital offering psychedelic-assisted therapy. [0]
Also, Peter Gasser, a Swiss therapist acquainted with LSD during the 1988-1993 window, was granted approval to carry out the first controlled study of LSD-assisted psychotherapy in more than 40 years. [1]
[0] https://www.swissinfo.ch/eng/science/can-psychedelics-therap...
[1] https://theswisstimes.ch/lsd-and-magic-mushrooms-how-switzer...
I doubt about everywhere, as shrooms are sold in shop around here.
In the US, those aren’t from mushrooms that contain psilocybin or related neurotransmitter analogs
Where is here?
california has mushroom stores
I'm taking a prescription med that is basically a schedule 1 drug that's been very slightly modified and declared schedule 3 and prescribed through a tightly controlled program. I'm even taking a generic version.
I think a major criticism of how this study is designed is that it is not truly "blinded". I doubt many of the participants were unsure if they received psilocybin vs escitalopram.
That being said, there are a number of studies that suggest this is an effective treatment, so I hope this can become more available to those who need it. However, for treatment resistant depression (especially with a catatonia component), intranasal ketamine is very hard to beat. Only topped by ECT in my experience.
Having tried all the drugs, Ketamine and its cousins are very "preppy" - the idealization and ruminating seem to be more side-steppable; as if they were intrusive thoughts that were a minor annoyance.
With the after-glow lasting weeks however, it seems to facilitate/allow a period of self-reflection (using whatever else possibly as an aide) that is notably absent of self-pity.
How would you effectively blind a study on a drug with such obvious "side effects"?
I can see such unreasonable objections being used to prevent it's approval though.
That was the "reason" the FDA nuked the MDMA approval. "Unblinded because people could tell if they were on placebo or active therefore how do we know it wasn't just placebo effect based on belief"
Seems spurious as:
- 1) how do you reliably measure "people could tell"?;
- 2) if people sensed it, likely they can sense when they are on active in a whole range of effective medicines, so seems a biased / moved-goalpost application of the "rules";
- 3) what does it matter if the strength of the drug effect is greater than the strength of the placebo? Ie, surely they can model and subtract and control, so what does it matter if the actual effect is more than placebo?
Ugh...
Being blinded isn’t some gold standard. For example we know exercise leads to good health outcomes from unblinded studies. Every study on fitness ever done is unblinded and we consider these results to be a ground truth.
"Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial" (2018)
The randomized controlled double-blind study is a gold standard. It solves for so many different biases. Without it the burden of proof is higher. Luckily, the evidence that exercise is healthy is so overwhelming that we have a scientific conciseness.
The doses of psilocybin being used were so low as to be barely perceptible.
The participants received a 25mg dose; I can assure you that such a dose is very much perceptible.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...
Ah, I made a calculation error by an entire order of magnitude while converting that to “grams of dried mushroom”.
Yeah that dose you would notice a fair bit - it’s equivalent to about 2.5g dried cubes.
Exercise also bests SSRIs. Having had multiple close family members and friends try various cocktails of SSRIs and other drugs for depression, bipolar disorder, and borderline personality disorder, and having to see the side effects they experience, and how many different dosings and combinations need to be tried before they find something that doesn’t make them worse, I would not recommend such medication to anyone with similar issues without trying other more conservative approaches first.
Bad headline. Psilocybin was not significantly different for depression symptoms. Also there was no control group. Confidence intervals were very large. Yet another unconvincing study with bad journalism.
It’ll be good to find positive effects in natural remedies like this. It is ironic we try to keep people safe from themselves but end up dolling out ineffective or destructive drugs instead. A case in point, opium being illegal, but a lab derivative 1k stronger fentanyl, legal and 300k killed globally over the last 10 years.
Where are you that fentanyl is legal in a way opium is not? In the US both are schedule II and approved for medicinal use.
And it's mostly not legally acquired fentanyl that's killing people.
Funny, psilocybin has been largely detrimental to the mental health of everyone I know.
"Funny, psilocybin has been largely detrimental to the mental health of everyone I know."
This statemwnt is true for the people I know who have used it in a recreational manner. This statement is also false for the people I who who have self-treated with it in a controlled setting.
I've have done a lot of drugs and know a lot of people who have done a lot of drugs, and psilocybin is far and away the substance that is most loved and gets the best reviews. It's not even close.
Thoughts on Mescaline/Peyote?
I've known far fewer people who have taken it. Unlike mushrooms, I have heard stories of prolonged and difficult trips that sound much more challenging and arguably dangerous than a average-dose mushroom trip.
my experience has been very different for everyone I know
Agreed with a caveat: SSRIs and other antidepressants are far worse.
In what way were they using it? In what dosages? Was it pharmaceutically pure or bought from some dude?
Overdosing on SSRIs or using them haphazardly could be pretty detrimental too.
Will add a personal anecdote on my mental-health journey and the impact psylocibin has had on my life.
Bio:
- Late 30s.
- Long history of depression my entire life. "Melancholic" child. Bad drunk teenager. Suicidal in college (failed attempt).
- No drugs except alcohol until I was in my mid 20s.
I've been prone to major bouts of depression my entire life. I went to therapy multiple times a week for years and got on SSRI's towards the end of university as a response to a failed (but serious) suicide attempt.
SSRI's never did anything for me except make me feel like shit (and not be able to take one). Eventually I went off them and sort of got by, and I managed to stay safe by drinking no alcohol. Therapy twice a week was an utter waste of time and money.
Then, sort of on a whim, I grew some mushrooms at home with my then fiancée and we took them together. I was mid 20s and had no prior experience with any drug but alcohol. Not knowing what I was doing, we took a BIG dose. I had a trip that was fun at first and then became quite unenjoyable.
For the next twelve months I felt like myself again. The change was subtle but, over a long term, quite obvious.
After about 18 to 24 months, my depression came back. We took mushrooms again and the same thing happened. A year of well being in exhcange for 2 fun hours and 6 tough ones.
So about every two years I'll take a big (2-4g dry) dose of mushrooms and...it's like magic. I feel like myself again. I'm "back." Life is not happy, none of my problems go away, but I feel like I'm an agent in my own life as opposed to a spectator.
The well being lasts about a year or 18 months (less if I've been drinking alcohol). It's almost never as bad as when I was suicidal, but it still sucks. For me depression is like being a professional chef and one day your taste buds make everything taste like ash. Or a painter and one day you see colors less and less.
Last year I went into a VERY deep depression, so deep that I refused to take mushrooms until my wife basically forced me to. Same thing. The very next day I felt like "I was back."
Those things changed my life.
I've since had fun with other drugs maybe 5 times. Acid a couple times, molly a couple times. Cheap (wtf) fun for a half a day, but nothing like the impact mushrooms have on my mind.
I've had one bad trip while taking mushrooms recreationally. I don't understand who would take those things for fun, at night.
Strictly during the day, well-rested, with loved ones, and in nature!
I'm also convinced that the impact they have on me is purely chemical. It has nothing to do with "facing my demons" or "connecting with a higher spirit" or anything like that. I just get off my stupid rut.
"Neurons that fire together wire together" as they say, and when I'm depressed it's the stupid neurons that fire together. Mushrooms makes a whole different set fire, and fire hard, and that seems to be enough.
The deepeest lesson I've gotten while on shrooms is:
"I'm trying my best. Everything is actually fine."
Pretty good lesson.
What 2 decades of on & off therapies and meds couldn't fix, a single psilocybin trip fixed in 5 hours. That's all the proof I need.
Not even getting into the side-effects of SSRIs including PSSD, brain zaps, lethargy, and a whole lot more.
I just don't understand people who do this shit recreationally, as it was quite possibly the worst experience I had in my life.
If you don't mind my asking, what about the experience was so bad? Did it take time or work to process the experience for it to have its beneficial effect?
Full research article:
https://www.thelancet.com/action/showPdf?pii=S2589-5370%2824...
Study design and methods:
> "All the patients provided written informed consent and after discontinuing any pre-trial antidepressants, enrollees received two oral doses of psilocybin (1 mg or 25 mg) with accompaniment from two experienced therapists for ∼6–8 h, separated by 3 weeks, as well as daily pills (escitalopram 10–20 mg or placebo capsules). Thirty patients were randomised to PT and 29 to ET."
> 'The PT condition consisted of two high-dose (25 mg) treatment sessions with the serotonergic psychedelic psilocybin, administered with support from two study therapists...and daily placebo capsules. The ET condition consisted of daily doses of the selective serotonin reuptake inhibitor (SSRI) escitalopram - 10 mg for three weeks followed by 20 mg for a further three weeks—as well as equivalent psychological support including dosing sessions with placebo-like doses of psilocybin (1 mg)."
This is an interesting way to address the placebo issue, giving a noticeable microdose of psilocybin (1 mg) versus the active dose (25 mg) for the non-control group.
Fundamentally I think psilocybin's main overall psychological effect is to push subconscious issues up into the mind's conscious processing space. Large doses can generate visual hallucinations related to those subconscious issues which can be unpleasant, even terrifying, for many people, so that's why caution is warranted. Extremely large doses cause complete dissociation from external sensory input, which is of course very dangerous for the unprepared individual in an uncontrolled situation - an experience unlikely for any herbivore to want to repeat, hence the evolutionary selection pressure for biosynthesis of such compounds by plants and fungi.
It’s a neat study. I don’t know how you account for the intense placebo effect of a psychedelic experience for six hours though. We know that traditional antidepressants may work through this method already where you feel “different” and fix yourself. Trials with an active placebo often have results very similar to antidepressants.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
I guess maybe it doesn’t even matter in the end as long as people feel better.
> I don’t know how you account for the intense placebo effect of a psychedelic experience for six hours though.
You don't need to. It doesn't really matter whether it's the trip itself that works, the belief that a trip will work, or some other aspect of the molecule. The drug category it's being compared to also has its own placebo effects. It is entirely reasonable to compare the complete holistic experience of taking each.
> I don’t know how you account for the intense placebo effect of a psychedelic experience for six hours though.
If what they discovered is a particularly powerful way of applying a placebo effect, that could be just as clinically useful. Maybe more so since it could apply to more conditions.
This might not be ethical, but given a psychedelic naive population, I wonder if the control could be given a non-serotonergic psychedelic such as salvinorin A. There would definitely be a noticeable effect, but for someone who hasn't studied the effects of psilocybin, they may not realize it. The downside is that in order to keep the duration similar, you'd probably have to administer the salvinorin using an IV drip, and a six hour salvia trip could quite possibly be too traumatic.
It might be nice to also have a non-psychedelic non-sari as well. Right now a patient could use whether they tripped or not to determine exactly which treatment they received. But if you had the full 2x2 design of {drug has trip, drug has no trip} x {drug is supposedly therapeutic, drug is non therapeutic} the existence of a trip wouldn’t reveal their exact treatment
For obvious reasons you probably can't put a patient under general anaesthetic before giving them either the placebo or the drug, but I wonder what would happen if you did. Does a patient have to be awake to see the antidepressant effect? How do sedation and sleep differ?
There has been a study of that on ketamine, where they used patients who needed to be put under anaesthetic for other reasons. I'll try and find it in a bit...
Edit: found it https://www.astralcodexten.com/p/does-anaesthesia-prove-keta...
This is true of most if not all drugs / studies. That is, the drug gets "credit" for the placebo effect. Sure they took the meds, but that's correlation in at least some. That is, in some the drug did not actuay work but they still get to benefit from the placebo effect.
I rarely see this discussed. I'm not sure why (short of actual cellular test showing it was the drug that did triggered the success some of the success even in the group taking the real meds is still the placebo effect).
I do LSD once a year with close friends and a beautiful view and it's fantastic at making me appreciate beauty in the world and feel like everything is in it's natural place.
Shrooms sadly do not agree with my digestive system.
When this topic comes up on HN I'm always sure to mention the book:
"How to Change Your Mind" by Michael Pollan
There's also a Netflix doc series based on the book.
This comment ignores the possible effectiveness of both psilocybin and SSRIs and focuses on the usefulness of the research itself. I actually believe that both have a role in psychiatry, but this study tells me nothing with regards to therapy.
Working as a clinical psychologist, who also reads a lot of research, this study is just another brick in the wall that I am banging my head against when it comes to doing actual evidence-based therapy. I actually read the entire paper and the pre-registration. The title on Medscape and the article are, to me, completely reading the research wrong, and just another example of the actual research design and findings living in a different universe than the press release and subsequent discussion.
Let me try to communicate why I feel this way by summarizing the research in my way, as opposed to the title: "Psilocybin Bests SSRI for Major Depression in First Long-Term Comparison."
Hers my take: Research finds no significant difference between psilocybin and SSRI in the primary outcome from pre-registration (self-reported depression on an emailed form), even when only administering SSRI for 6 weeks, where the maximum effect of SSRI is expected at 12 weeks. As such, this does not even qualify as standard treatment with SSRI. This is after excluding 90% of the applicants for the study. The effectiveness is primary supported by p-hacking, as seen by reporting additional measures not in the registered, where some of them favor psilocybin. And SSRI actually scores BETTER in the main outcome.
Now, someone might come along and call me cynical, mistaken, or worse. But having been through this with biofeedback, metacognitive therapy, light therapy, mindfulness therapy, and ketamine treatment already, I can clearly see the same pattern: lying by omission, p-hacking, not taking into account the "decline effect," borderline acceptable results. It all culminates in a big nothingburger, and any progress for my field remains stagnant. Based on the quality of this study, I am certain that if we just aggressively started treating depression with psilocybin, I just know that it wouldn't make much difference, because I have been through it before with the exact same numbers and effect sizes, just different treatment modalities.
Here is the best indication I found for SSRI: Resistant phobic anxiety (panic attacks that don't stop even after long exposure), and burnout-related depression (person worked normally their whole life but is suddenly just empty of energy and does not look forward to anything with joy). These are examples that very often make a big difference with SSRI, in conjunction with therapy.
Psilocybin seems to work best for existential depression and anxiety that is driven by pathological self-focus (not egotism, but inability to stop focusing on one's own inner states).
But these personal theories are just that, and the studies that keep getting funding are very seldom useful, at least for me, as I genuinely am trying my best to help my patients.
> ... burnout-related depression (person worked normally their whole life but is suddenly just empty of energy and does not look forward to anything with joy) ... existential depression and anxiety that is driven by pathological self-focus (not egotism, but inability to stop focusing on one's own inner states)
Is there any rigorous operationalization of these concepts, that might be explored in further studies? Unless one can be found, these fuzzy, heavily qualitative descriptions are unlikely to be helpful for future researchers.
It's counterintuitive to me that a more specific concept/subgroup of a phenomenon would be less useful than a larger catch-all category. Is the self-rated questionnaire depression scale used in this study a good "rigorously operationalized concept"?
We are successfully treating people with this exact kind of indication/operationalization with real success already. For instance, the indication criteria for ECT basically follow the "burnout profile" I described above, with the addition of "treatment resistant to therapy and medication," and it has shown by far the best effectiveness for that kind of depression.
I completely disagree that it's not possible to operationalize the concepts above, for instance with standard BDI or MADRS, supplemented with a ratio with a cutoff to indicate a large fall in everyday functioning. Like an extremely large fall in Global Functioning Scale (GAF) localized to a distinct and pattern-breaking period in a person's life. If you think that these concepts are fuzzy and qualitative, I really hope you have even greater criticism towards this study, not to speak of concepts like anxiety, trauma, and ADHD, which are completely off the rails when it comes to diffuseness and subjectivity.
But even if you are right, that burnout-depression and existential anxiety are not possible to study because of their vagueness, it still would not make this study helpful as it's presented. Or am I mistaken? Do you think it's a good and helpful study, whose implications I should fight for in our clinic? And would I see a marked improvement in our patients, compared to SSRIs for the "Depression" group?
I am willing to admit I am wrong. The only goal is to actually help people.
Obligatory notes of caution:
The primary outcome of depression symptoms (QIDS-SR-16) was not significantly different between the groups. The sample size is small and unrepresentative of the real-world population of depression patients - the trial participants are very disproportionately male and university-educated. There are obvious and much-discussed issues with blinding in psychedelic trials.
These results point to a treatment that may be superior to treatment-as-usual for a minority of patients, but the results certainly aren't revolutionary. There is still the potential for significant risk in wider clinical populations who may have psychiatric comorbidities that would exclude them from trials like this, and in delivering psychedelic treatments in more normal clinical settings that are likely to be far less carefully controlled than a clinical trial.
Taking LSD every few months was the best antidepressant I’ve ever tried and I’ve tried a bunch
This is surely no surprise to anyone who's ever had a good trip. I'd love to do this in a proper, controlled therapy setting, I suspect it would do me the world of good.
You’re right to explicitly mention the part about the good trip. As always in this kind of discussions, there has to be a reminder that psychedelics should be used cautiously, being conscious about the risks associated with a potential bad trip.
My only bad trip was in a proper, controlled therapy setting — at least that’s how it was presented to me.
But no patent, so this is "misinformation" haha
No shit.