Mary and the Mushroom: Psilocybin, Chronic Depression and Me (7)

It’s Getting Real, and I’m Getting Nervous.

I have been given a date for my first dosing of psilocybin! This news produced in me a curious blend of excitement and nervousness that continues whenever the issue pops into my head. (If you’re just tuning in, you can get the background on my upcoming adventure by reading the first post in this series.)

I am disinclined to share the actual date of the procedure, as I think it would add pressure to the experience if I knew that people were waiting to find out what happened. But I will receive the first dose in July, which isn’t that far off any more.

It seems that ever since the researchers gave me a date, I’ve read and heard about nothing but bad trips, so that has made me apprehensive. So does my inability to imagine what it would be like to be considerably altered by one dose of a drug: it seems impossible and nerve-wracking at the same time. Of course, nothing may happen at all. And on the third hand (?), maybe all the projections and hopes will be realized and I will gain a new lease on life and a new sense of purpose: depression alleviated. Since, according to Michael Pollan, no drug is as suggestible as a psychedelic, if I focus on potential positive outcomes, rather than negative ones, that will probably help. There is a lot of evidence that bad trips can be mitigated if care is taken with “set and setting,” which I discussed in a previous post (scroll down to the heading of that name).

Tapering

Which brings me to my other concern. As of today, May 1, I need to start tapering off the antidepressants. This means cutting the dose in half now and eliminating the medication (duloxetine/Cymbalta) completely in early June.

I have been on anti-depressants of one sort or another for about 35 years, so this is not nothing. I have read that withdrawal can be very difficult; hence the tapering. My research team has advised me that potential withdrawal symptoms include “anxiety, irritability, brain zaps and flu-like symptoms.”

My temptation is to grab a few bags of munchies (both sweet and savoury) and to take to my bed for a month or two with a few books and a remote so I can stream some riveting tv programs and streaming series until the withdrawal passes. I know this is not a good idea as such behaviour is more likely to plunge me deeper into depression than is the withdrawal experience itself. So instead I’m resolving to meditate every day and to get out into the woods every couple of days at least.

Resources

I have started to compile a list of books and articles I’ve read, and programs and podcasts I’ve watched and heard, that relate to the potential benefits of psychedelics in the treatment of depression. I will update this page as I come across new material that I believe will be of relevance to people besides myself who are interested in this issue.

Between now and the first dose, I plan three updates here: I will be briefly reviewing two books: Pollan’s How to Change Your Mind and The Psychedelic Explorer’s Guide by James Fadiman. I am also going to write a post as the time gets closer about what I am expecting from this treatment, and what I am still worrying about. If other topics occur to me, I’ll write about those as well. (Let me know if there’s anything relevant you’d like me to investigate, report and/or confess.) (I’m joking about that last one. I write confessions only when I’m so inclined.)

In the meantime, I am working on a new novel… and worrying about what happens if its author “changes her mind” completely before it is done. I’ll be posting a few chapters of that work of fiction as invented by my pre-psychedelic-treated brain (🙂) on another of my blog sites as they are completed. Because if I don’t post them, I will never write them. (← confession)

I am very happy with the positive feedback I’ve had from readers of this blog. There seems to be a fair amount of interest in the subject. Nice to know I’m not alone.

Mary and the Mushroom: Psilocybin, Chronic Depression and Me (6)

The Meditation Connection

A note to new readers: I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I hope to join the study in a couple of months. I will share the experience with interested readers here. In the meantime, how I got to this point is the subject of this series of blog posts.

My goal in this post is to try to put into words what I have learned from meditating, and then to explain how I hope to apply that knowledge to my experience with psychedelics.

Meditation and Me

In the several decades before I learned to meditate, I took up a lot of other activities, hobbies and personal-improvement strategies that were intended to raise my spirits, improve my health, and/or increase my knowledge. I took on projects intended to overcome bad habits (with greater or lesser success, depending on the habit), took courses and lessons (sewing, piano, Spanish, you name it), travelled when I could. I made friends, joined groups, and attended cultural and recreational events. I wrote – fiction and nonfiction. But always there remained something bleak inside of me from which none of these activities could ever completely distract me.

As I mentioned in a previous post, I had always thought of meditation as a bit “out there,” but by the time I got around to considering it seriously (i.e., ran out of other options), science was getting serious about it too. In addition to the great numbers of individuals who were talking about how meditation had improved their lives, reports on actual research studies into its physical and psychological effects began to appear. To address self-improvement goals in the past, I had generally chosen interventions that been proven to be of merit scientifically (e.g., nicotine patches) or had strong track records (e.g., Weight Watchers); in general, my trust in science and statistics had been vindicated. So when I started meditating, in addition to testing the waters for myself, I started to read the literature.

Research into Mindfulness

Not only have scientists from a multitude of disciplines taken an interest in mindfulness in recent years, research centres with meditation as their focus have now been established at several universities – the Center for Mindfulness Science at the University Southern California (USC), for example. Such cooperative ventures allow researchers in fields ranging from the social sciences to the clinical sciences to work together to investigate the effects of various forms of mindfulness on human health and well being. Faculty at the USC centre include “Buddhist scholars, world-renowned experts on the neuroscience of feeling, emotion, and cognition as well as national experts in self-report science, social science, educational science and research across a wide range of clinical disciplines.”

In a conversation entitled “The Science of Mindfulness,” posted in two parts on Sam Harris’s Waking Up site, Harris and Jonas Kaplan, associate director for mindfulness and neuro-imaging at the USC centre, agree that research into mindfulness and meditation is not an easy task. The many challenges include: reaching agreement about the definition of such terms as “mindfulness,” “meditation” and “meditation practitioner”; finding enough very-long-term meditators (40,000 lifetime hours, for example) with whom scientists can compare mental and physiological status to those with little or no experience; the perennial problems of self-reporting when it comes to conditions of well being (“one man’s meat is another man’s poison,” and all that); and the constraints of current technology when it comes to measuring changes deep inside the brain.

Studies relating to mindfulness that avoid such pitfalls have been published, such as one in Nature regarding the effects of mindfulness training on the brain’s insula networks, but we are still at the very early stages of scientific investigation in this field. Enthusiasm for the potential of meditation has grown to the point where practice has in some cases moved ahead of the science; Kaplan says that meditation has been used in the treatment of psychiatric disorders for which its benefits have not (yet) been shown.

What we do know so far is that there are differences in the way the brain behaves when people are meditating and when they are not, and that there are differences between the brains of long-time meditators and those who do not meditate. What is not clear is what these differences mean.

The Half-Full Part

Kaplan points out that the research undertaken at USC and in many other places is not being done to prove the value of meditation, but instead to look objectively at the measurable effects of the practice. This is not to say that there are no obvious benefits to meditation: masses of anecdotal evidence suggest that it may alleviate depression and anxiety. (Here Sam Harris interjects a caveat, noting that meditation can also have negative effects, both physically and psychologically, depending on the type of meditation and the person.)

Harris says that measurable benefits such as stress reduction may be unimportant to practitioners anyway: for many, the main benefit of meditation is the awareness that we are not identical to your thoughts. This awareness, in itself, helps to relieve a lot of guilt, anxiety and other forms of suffering. So even when we are so new to the practice that we are unable to sustain our independence from thought for more than a few moments, the fact that we know it can be done is likely to make us feel better.

It takes many years to reach a stage of true proficiency in meditation, just as it does with any worthwhile enterprise, but the journey in that direction can add value to our lives. “You can recognize the benefits yourself long before they show up in the world,” Harris says.

In a Big Think video entitled “How Meditation Can Change Your Life,” Emma Seppälä, scientific director at the Stanford University Center for Compassion, tells us that research shows that our minds typically wander at least fifty percent of the time, and that when our minds are wandering, we are never as happy as when when our minds are in the present moment – “even if [we’re] doing a task [we] don’t particularly like.” She adds (and this is a big plus for me) that learning to focus better means that “you’ll naturally be more productive.”

What Meditation Has Taught Me

For much of my life, the number of negative or even merely distracting and time-consuming thoughts that normally arise in my mind and prompt me to dwell on them has been a significant barrier to my productivity and my happiness. Meditation has helped me to separate myself from those thoughts at least once or twice a day. That doesn’t sound like much, to me it is huge. And I know that I can increase the extent and power of that relief if I keep practising. It takes a very long time to become truly proficient.

I have been meditating for ten minutes a day for a couple of years or so. At the beginning I was rigorous about meditating every day, but as is typical of me, it became every other day, then once a week. Then a couple of weeks or more would pass. But when things got tough inside my head, I’d remember meditation and give it another go. Now that I can see the benefits and know what I am working to achieve, I meditate increasingly often. Even if I don’t remember it all the time, I have reached a point where I absolutely recognize that every thought and memory and emotion that comes into my awareness is impermanent. It will go away again. And I have also learned to recognize what remains when no thought is present – no thought, no feeling, nada. That is pure “consciousness.”

What It’s Like

After trying out Headspace, Calm, Ten Percent Happier, and other meditation apps, all of which had (for me) their strengths and drawbacks, I have settled happily into the Waking Up platform, due to the wealth of options, resources, voices, and points of view it offers. In addition to meditations guided by long-time practitioners with areas of interest that range from “Loving Kindness” to “The Koan Way,” there is a “theory” section with talks on such interesting-to-me subjects as “Mind and Emotion,” “Free Will,” and “Mind and Brain.”

Sam Harris, the creator of Waking Up and my favourite meditation guide these days, suggests that consciousness is kind of like physical space. If there is a chair in my office, the physical space in my office does not stop at the edge of the chair. The chair is part of the office space. I can add books, a desk and other things to my office, but that does not change the space itself. The physical space around me is kind of like the backdrop into which everything else may come and go. And it extends away forever: through the walls and out beyond them and on and on and on. Thoughts, feelings and emotions are like the chair, the books, a pen. They are “impermanent.”

To use another analogy, the sky does not stop and start where there are clouds or comets. These things occupy the sky but they come and go. The sky is permanently the sky. So too with consciousness: it is inside, outside, everywhere. It is not located in my big toe or my elbow. Although it can feel as though it is located in my head, it’s not there either.

My consciousness is also timeless: there is really only now. That is all I have. This moment. And this one. And this one.

Everything is just happening. So too with thoughts. Notice these internal sounds and images that appear like waves on the surface of your mind.

Sam Harris

To truly recognize that consciousness is permanent and everything else is impermanent has offered me a form of liberation. I have learned to recognize a thought when it appears in my mind, to see it as separate from me, and to watch it simply flatten and disappear. Then I can go back to resting in the space of consciousness that remains.

When I do attain this uninterrupted state of awareness for a few moments (that’s all I get, being a relative newbie), it is restorative. This is partly because in order to reach a state of “resting in consciousness,” I do not need to work or strive in any way. I just let go. I can do this with my eyes open or shut, and I can do this with a guide talking into my headphones or I can do it in a silent meditation.

Even though thoughts continue to appear while I am meditating (ranging from “My ankle itches” to “Oh my god, Ukraine“), I am getting much better at letting them go, and for longer and longer moments. This gives me a mini-break from negative emotions and even physical sensations. And as a person who has worried about everything for her whole life, this is no small matter.

I’m also learning how to let go like that even when I’m not meditating. Whether I am dithering over whether I might have offended someone on Facebook or despairing over a loss I experienced twenty years ago, I can occasionally remind myself that these thoughts are appearing in my consciousness, but they are not my consciousness. They are not “me.” They have come, they are not bad or good, and I can let them go.

“Thoughts are like soap bubbles,” says John Kabat-Zimm, professor emeritus at UMASS Medical School.

The Bigger Picture

I have not chosen to practice one of the forms of meditation that is rooted in spirituality and based in centuries of Buddhist or Hindu teachings. Nor does my interest lie in a wholly secular practice, intended only to help me relax, lower my blood pressure, and avoid what some of us call “stinking thinking.” The objective of the type of mindfulness I am striving to attain is, in Sam Harris’s words, “to radically transform [my] sense of who and what [I am],” and to gain “fundamental insights into the nature of [my] mind – insights that change [my] whole approach to life.”

It is to expand on this kind of knowledge that I am also interested in the psychedelic experience. Practitioners of meditation who have taken psychedelic journeys have said that psychedelics help you to reach the same state of awareness about the nature of consciousness as meditation does, but faster. Since I (probably) don’t have 40 years to do it the long, slow way (by becoming a guru or even by sitting with one for days on end), nor do I have the interest, this seems like a promising alternative.

I am very curious to know whether the potential benefits of psychedelics in the treatment of depression, anxiety, addiction and so on are related to the principles that I am investigating as I practice meditation, including awareness of the impermanence of thoughts and feelings, and the permanence nature of consciousness.

Note: I am still waiting to hear back with a scheduling date for my experience with psilocybin, but I do not expect that it will be before the first of June. In the meantime, I intend to review a couple of books about psychedelics, and I am creating a page of resources for others who are interested in reading what I’ve read. So stay tuned….

Mary and the Mushroom: Psilocybin, Chronic Depression and Me (5)

A Brief Aside about Microdosing

A note to new readers: I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I hope to join the study in a couple of months. I will share the experience with interested readers here. In the meantime, how I got to this point is the subject of this series of blog posts.

The continuing onslaught of absolutely bat-shit-crazy, apocalyptic-type news has probably driven almost every thinking person on the planet into a state of persistent anxiety and depression; such feelings are not exclusive to those of us with baseline life views that have more in common with Eeyore than Pollyanna. There are times when I almost envy people who seem to have found a new sense purpose and community in groups exchanging false information and conspiracy theories. (Kidding.)

These days, in short, most of us would probably welcome a magic pill that could, almost overnight, alleviate our depression and anxiety enough that we could stop doom-dithering and get on with the initiatives over which we do have some actual control. Such outcomes are, of course, among those promised by psychedelics. At times I find it beyond aggravating to know that such substances do exist, but that I am currently unable to access them.

As I’ve mentioned in previous posts in this series, one significant barrier to seeking immediate relief through psychedelics is the illegality of their use outside of clinical settings. This doesn’t stop a lot of people from giving them a try, but it does raise concerns about quality control for those attempting to source such products. In my case, there is an additional constraint: the researchers conducting the study in which I believe I am now registered require that participants not use psychedelics for a year before their experimental doses.

If I were free of constraints and concerns about experimenting with psychedelics on my own, before I wrote this post I would likely have started with microdosing. For one thing, the effects produced by a microdose do not lead you to states of mind where you are wise to have a coach or therapist on hand (as I intend to do the first time I try a full dose). Microdosing is “the action or practice of taking or administering very small amounts of a drug in order to test or benefit from its physiological action while minimizing undesirable side effects” (Oxford Languages). In the case of psychedelics, microdosing involves taking doses of LSD or psilocybin that are so low that they are “sub-hallucinogenic,” which means that they do not interfere with the normal activities of daily life.

Microdosing usually involves taking approximately one tenth of a “trip-inducing” dose of a psychedelic drug, once every two or three days. Anecdotal evidence suggests that several such doses may be necessary before the benefits are felt.

I first heard about microdosing on one of the many podcasts now available on the subject of psychedelics. Tim Ferriss’s podcast series, for example, includes an episode entitled “Microdosing, Mind-Enhancing Methods, and More.” It is a recording (with transcript) of a 2019 conference session moderated by Ferriss in which panelists explored psychedelic science and a range of related topics, including “investing opportunities, anecdotal personal benefits, legal challenges, and much more.”

This recording is an excellent general introduction to the use of psychedelics in mental-health contexts. Panelists describe the positive outcomes shown by large doses of psilocybin in relation to end-of-life depression and anxiety, and to drug, alcohol and nicotine addiction. They also explain how psychedelics work on the brain and their effect on consciousness: in contrast to anaesthetics, which lead to a drop-off in brain activity, brains on psychedelics show an increase in the richness of their activity.

The session also featured the anecdotal experience of Ayelet Waldman, who microdosed LSD to treat her long-term, previously untreatable depression. Author of A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life (a promising title if ever I heard one!), Waldman defines microdosing with a psychedelic drug as taking just enough to have an effect on the metabolism without any perceptual effects.

Waldman microdosed LSD every three days for a period of thirty days. She says that within just a few hours of the first dose, she was paying more attention to the beauty of blossoms outside her window and she was feeling happier. After decades of depression, “That was an experience that was really mind-boggling,” she says. During the period of time she was microdosing, her general life satisfaction and productivity increased. Her account of the experience is interesting, and similar results have been recounted by thousands of other adults who have microdosed psychedelics.

However, the evidence in support of microdosing is largely anecdotal. Unlike with full doses, there is little clinical evidence so far to support users’ accounts of improvements to their mental health. In fact, a very recent article in the New York Times reports that some scientists have come to the conclusion that the benefits recounted by those who microdose are no different than those given a placebo.

Hope, Emily Dickinson tells us, is “the thing with feathers – That perches in the soul – ” and it is a powerful counterbalance to depression. When it is absent, we feel as though all is lost, that everything is pointless. I suspect that hope plays a role in the similar outcomes reported among those who microdose psychedelics and those who think they are microdosing but are actually receiving a placebo. However, a study reported in the International Journal of Psychopharmacology suggests that hope is not enough to sustain the positive effects: twenty percent of those studied in their cohort stopped microdosing because they experienced no benefits at all.

With the way humanity seems to be self-destructing in every way imaginable, if there were clinical evidence that microdosing made people calmer, happier and more accepting of our differences, I’d start advocating for traces of psychedelics to be added to the water system. But then we’d have to worry about who was doing the dosing, and why. In Aldous Huxley’s Brave New World, the populace is given a soothing drug called “soma” to keep it docile. Sparknotes explains that “Soma is a drug that is handed out for free to all the citizens of the World State. In small doses, soma makes people feel good. In large doses, it creates pleasant hallucinations and a sense of timelessness.” Sound familiar?

Mary and the Mushroom: Psilocybin, Chronic Depression and Me (4)

A note to new readers: I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I hope to join the study in a couple of months. I will share the experience with interested readers here. In the meantime, how I got to this point is the subject of this series of blog posts.

I apologize in advance for the clinical terminology and references I have included in this post, but I wanted to get the wording right for those who like to follow the science. You can skip over any terms, definitions or references that aren’t of interest to you – I hope I’ve written the post in such a way that the citations, links, etc. don’t interfere with your understanding of what I am trying to say.

What I Know About Psychedelics So Far

There has been an explosion of news and media attention relating to psychedelics since I started this blog series. As of January 5, 2022, Health Canada has expanded its Special Access Program to include the psychotherapeutic use of psychedelics and MDMA in the treatment of severe or life-threatening conditions. At the end of January, the Canadian Psychedelic Association announced that the University of Ottawa will soon start offering a master’s degree program in psychedelic research. Numerous clinical trials are now underway or are being planned in various locations across the country and in the USA.

Outside of clinical studies like the one to which I have applied, the Special Access Program in Canada allows psilocybin treatments only for those “with a serious or life-threatening condition on a case-by-case basis when other therapies have failed and where there is sufficient evidence of safety and efficacy for the treatment of the patient’s condition.” Despite the restrictions, psychedelics are poised to become big business – as was the case with cannabis when it was approved for medical use in Canada several years ago. So it is no surprise that since this announcement, dozens of business groups, clinics, psilocybin manufacturers and organizations are fighting for attention in their efforts to attract investors and future customers. (Try Googling “psychedelics mental health” for a sample of what I mean.)

Although most articles relating to recent advances in the therapeutic use of psychedelics do talk about the almost immediate relief they’ve offered many patients with chronic depression, PTSD and end-of-life distress, they don’t talk too much about how and why the treatments work. In the past year or so, I have read and heard quite a bit about these drugs in general, and psilocybin in particular, but as is the case with any complex subject, I still feel as though I don’t know very much. Perhaps I won’t know much more until I’ve actually had a psychedelic experience, but I’m sharing what I know so far and hoping that others who have additional information or perspectives will share them with the rest of us in the comments.

What Is Psilocybin?

You can get a crash course in the chemical composition, sources, nature, history and uses of psilocybin on Wikipedia. Basically, it is a “tryptamine alkaloid” that affects certain serotonin receptor sites in the brain. It occurs in a variety of genera of fungi located in various parts of the world

These mushrooms have been used by Indigenous cultures since the beginning of time, primarily for spiritual or religious purposes.[1] It wasn’t until the middle of the last century, however, that a Swiss chemist named Albert Hofmann became the first person on record to synthesize and ingest lysergic acid diethylamide (LSD), a substance that is extracted from a fungus found in grain – to startling and somewhat terrifying (to him) effect. (After his brain started tripping, he took a bicycle home from work to lie down. The anniversary of the day he did that, April 19, 1943, continues to be celebrated as “Bicycle Day” by psychedelic enthusiasts.) Hofmann also later identified the compound, psilocybin, that produces psychedelic effects in “magic” mushrooms.

The use of LSD and psilocybin in both controlled studies and non-therapeutic (“recreational”) settings “mushroomed” (sorry) in the 1960s, primarily due to the efforts of Timothy Leary and Richard Alpert. These two psychologists were at Harvard until their experiments with psychedelics, and their subsequent enthusiastic promotion of LSD for use by young people, started attracting a lot of negative attention. It was largely due to the misguided efforts of these two and others that the drugs became banned or controlled substances in many countries.

Despite their illegal status, mushrooms (often called “shrooms” in recreational settings, although scientists avoid this term) ­­­are not hard to come by and are pretty widely available on the street. (I do not know which street, so don’t ask.)

What Happens When You Ingest Psilocybin?

The effects of psilocybin, which turns into psilocin when ingested, typically set in approximately 30 to 60 minutes after the drug is ingested, and they peak at between 90 and 180 minutes. The onset of symptoms can be measured externally by monitoring heart rate and blood pressure (which increase), and by watching participants’ behaviour. Over the next five or six hours, the effects gradually recede.

What happens on the inside (i.e., from the perspective of the ingester)? According to Health Canada, “Taking magic mushrooms may cause you to see, hear or feel things that are not there, or to experience anxiety, fear, nausea and muscle twitches accompanied by increased heart rate and blood pressure. In some cases, the consumption of magic mushrooms can lead to ‘bad trips’ or ‘flashbacks’.”

The possible physical manifestations of taking psilocybin as set out by Health Canada may make the experience sound highly unappealing, but keep in mind that the agency is also obliged to remind its readers that “The production, sale and possession of magic mushrooms are illegal in Canada.” However, the site is of value for its scientific summaries and for its link to Health Canada approved studies that are currently underway.

It is the hallucinogen part of psychedelics (“see[ing], hear[ing] or feel[ing] things that are not there”) that is of interest to psychologists, psychiatrists and their patients. The hallucinogens are undoubtedly why these substances gained traction in the religious rites of early Indigenous cultures. (Michael Pollan points out in his book, How to Change your Mind (p. 13), that the Inuit were the only early Indigenous culture not to have used plant-based hallucinogens of one kind or another – most likely, he points out, because magic mushrooms and other mind-altering plants didn’t grow in the regions where they lived .)

Psilocybin is generally said to cause a feeling that the individual ego has disappeared, allowing those who take it to feel more connected with others and with the world as a whole. The psychedelic experience has been said to lead users to observe phenomena as children do, in a fresh way, unimpeded by the intervening repetitive experiences that, to adults, may make them seem routine, ordinary and uninteresting.

In an article in Quartz entitled “Scientists Studying Psychoactive Drugs Accidentally Prove that the Self is an Illusion” (I love this title), Ephrat Livni reports that in a study published in 2017, “Participants showed significant positive changes on longitudinal measures of interpersonal closeness, gratitude, life meaning/purpose, forgiveness, death transcendence, daily spiritual experiences, religious faith and coping.”

In addition to the feeling that consciousness has fallen away, hallucinogenic experiences induced by psychedelics seem to contribute to a sense that the mind is creating new connections to the mystical/spiritual. I am beginning to understand the “falling away of consciousness” part of that statement thanks to my investigation of meditation and my ongoing efforts to attain a meditative state for minutes rather than seconds at a time (sigh. See my next post for more on this), but the second part is beyond my ability to conceive at the moment. However, others have gone where I have not, yet, and they warn that the experience can be great or terrible. Or both.

Sam Harris writes, “If [ …] a person ingests 100 micrograms of LSD, what happens next will depend on a variety of factors, but there is no question that something will happen. And boredom is definitely not in the cards. Within the hour the significance of his existence will bear down upon him like an avalanche” (p. 193, Waking Up). In his own experience, he says, a psychedelic trip can be ”More sublime than I could have imagined or can now faithfully recall,” but it can also be “so painful and confusing as to be indistinguishable from psychosis” (p. 194).

“Ingesting a powerful dose of a psychedelic drug is like strapping oneself to a rocket without a guidance system.”

Sam Harris, Waking Up

Using a similar metaphor to Harris’s “rocket,” Michael Pollan compares his first experience with psilocybin to other psychedelics he has tried as “more like being strapped into the front car of a cosmic roller coaster, its heedless headlong trajectory determining moment by moment what would appear in my field of consciousness” (How to Change Your Mind, p. 261). He goes on to point out, however, that when he took off the eye mask he’d been given to wear during the “trip,” he had a better feeling of connection to the real world, and also experienced the commonly reported amazement at the beauty of the physical world around him.

John Hopkins Study

In a ground-breaking article that appeared in Psychopharmacology in 2006 (“ground-breaking” primarily because it was one of the first reports on a study of spiritual experience to appear in a peer-reviewed, scientific journal), R.R. Griffiths, W.A. Richards et al. reported that two months after receiving doses of psilocybin in a controlled situation, participants in their study reported “mystical-type experiences having substantial and sustained personal meaning and spiritual significance.” These individuals attributed “sustained positive changes in attitudes and behavior” to the psilocybin, and the behavioural changes were confirmed by family and friends.

The article is fascinating and well worth reading. To summarize, 36 well educated, healthy individuals who reported “regular participation in religious or spiritual activities” and who had never before used hallucinogens were recruited for the study. Most said they’d agreed to participate out of “curiosity about the effects of psilocybin and the opportunity for extensive self-reflection…” (p. 2). Each participant had either two or three 8-hour monitored drug sessions, during one of which they were administered a dose of psilocybin. For comparison, during the other session they received another drug, methylphenidate hydrochloride, which has effects similar to psilocybin but without the hallucinogenic component.

In advantage of the drug-treatment session, each participants spent eight hours with their monitor(s) to build trust, which is “believed to minimize the risk of adverse reactions to psilocybin (Metzner et al. 1965)”(Griffiths et al., p. 3) and to manage expectations (“It is widely believed that expectancy plays a large role in the qualitative effects of hallucinogens [Metzner]”). Participants also completed questionnaires intended to measure “psychiatric symptoms, personality measures, quality of life, and lifetime mystical experiences” (p. 3). Some of these and other questionnaires were also administered immediately after the drug sessions and/or two months later, and volunteers met with monitors for four sessions of one hour each following the treatments. The drug-session monitors as well as pre-selected family and friends of the participants were also surveyed on various topics before, during and/or after the drug sessions. (For precise details on the various questionnaires and how the double-blind study was conducted, please refer to the actual paper.)

For many, the road to “substantial and sustained” positive outcomes was not smooth: “Psilocybin produced a range of acute perceptual changes, subjective experiences, and labile moods including anxiety” (Griffiths et al., p. 1). “Eleven of the 36 volunteers after psilocybin and none after methylphenidate rated …. Their experience of fear sometime during the study to be ‘strong’ or ‘extreme’,” and four said that “the entire session was dominated by anxiety or unpleasant psychological struggle” (p. 11). However, “These effects were readily managed with reassurance,” and “no volunteer rated the experience as having decreased their sense of well-being or life satisfaction” (p. 12).

The Discussion section of the Griffiths paper includes an interesting exploration of the issue of “empirical analysis of mystical experience,” but the relevant finding can be found in the first paragraph of that section. “The […] study shows that psilocybin, when administered under comfortable, structured, interpersonally supported conditions […] occasioned experiences which had marked similarities to classical mystical experiences and which were rated by volunteers as having substantial personal meaning and spiritual significance. Furthermore, the volunteers attributed to the experience sustained positive changes in attitudes and behavior that were consistent with changes rated by friends and family” (p. 12).

How Do Psychedelics Work on Depression?

Some reports (see this PubMed paper, for example) indicate that psilocybin may have an antidepressant effect through its action on the serotonin system, serotonin being a neurotransmitter whose “biological function is complex and multifaceted, modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vasoconstriction” (Wikipedia). But this can’t be all of it: the antidepressants I’ve been taking for many years also work with the serotonin system, and they don’t produce out-of-body experiences or induce “sustained positive changes in attitude and behavior.”

Writing in Psychology Today, Scott Aaronson M.D. opines that “The use of psychedelics — in particular psilocybin, which is among the therapies [Aaronson is] investigating — seems to make patients more amenable to changing the thought patterns that underlie depression; these treatments work as, and with, therapy, not instead of it.”

The “suggestibility” occasioned by psychedelics is repeated often in the literature, primarily in relation to the importance of individuals considering their expectations and goals before the drug is taken. However, the fact that one becomes suggestible under the influence of these drugs leads to other issues. Like Pollan at the beginning of his investigation of psychedelics, one of my many questions is whether the “mystical experiences” reported by so many people who have consumed psychedelics are themselves hallucinations. (Then again, maybe life itself is a hallucination, but I’m not going there. At least not yet.)

Set and Setting

It is believed that “set” (being a shortened form of the word “mindset”) and “setting” have an important influence on the outcome of a psychedelic experience.

“Set” is the mental state that a person brings to the experience, such as thoughts, mood and expectations (Wikipedia). This relates to the “suggestibility” component of hallucinogenic drugs and seems to be why there is so much interest in studying the therapeutic uses of these substances in combination with “talk therapy,” rather than just offering patients psilocybin or LSD to trip with, context-free. As mentioned above, volunteers in the study by Griffiths et al. met with a monitor for eight hours before their drug treatment session, and for four hours afterwards.

 “Setting” is the physical and social environment in which the psychedelic experience occurs (Wikipedia). The psilocybin treatments in the Griffiths study were conducted in a peaceful setting, with the patient reclining and using a facemask and headphones to reduce outside distractions.

Negative Outcomes (Bad Trips and Other Stuff)

The paper by W..W. Griffiths et al. contrasted their generally extremely positive results from administering psilocybin to a study known as “The Good Friday Experiment” (Pahnke, 1963), in which ten theological students were given a dose of psilocybin and another ten were given nicotinic acid in a group setting during a religious service. While the participants who received psilocybin did show “significant elevations on the Pahnke Mystical Experiences Questionnaire [link added by me], and reported positive changes in attitudes and behavior at 6 months and at a 25-year follow up,” (Griffiths et al., p. 13) things got a bit weird (and the study’s double-blind component was broken) when some of the participants who’d received the psilocybin began to act “bizarrely,” affecting the experience of the others in the group.

Most of us have all heard reports of people tripping on psychedelics who have been found running around in traffic or throwing themselves off high buildings. We have also heard of people who had trips that were almost entirely horrifying, and led to all kinds of mental distress even when the drugs had left their systems. And then there are the “flashbacks” (officially known as hallucinogen persisting perception disorder, or HPPD) which causes a small percentage of people who have used psychedelics to have occasional or even (rarely) persistent psychedelic symptoms. According to an article published on BigThink, there is no known cure for HPPD.

All of these outcomes and side-effects sound terrible.

Concerns about effects like these on the masses of young people who were using psychedelics at the urging of Timothy Leary and Richard Alpert in the 1960s (“Turn on, tune in, drop out”) was what got the two men fired from Harvard, and eventually contributed to the banning or at least restricted use of psychedelics in many countries, including Canada and the U.S.

However, the risks of using psychedelics seem to be greatly diminished by close attention to “set and setting” in comparison to their being used in uncontrolled situations. Michael Pollan reports that “Many of the most notorious perils are either exaggerated or mythical” (How to Change your Mind, p. 14). In addition, overdosing on LSD or psilocybin is almost impossible, and these substances do not lead to addiction: most people decide early on that one or two doses is enough, and the effects of these substances are reduced with repeated use. (In fact, they show promise in the treatment of other addictions, including to tobacco and alcohol.)

Since the revival of sanctioned psychedelic research beginning in the 1990s, more than a thousand volunteers have been dosed, and not a single serious adverse event has been reported.

Michael Pollan

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So there you have it: all I know, and then some.

In the next post, I’m going to try to put into words what I have been thinking about meditation as it relates to therapeutic treatment with psychedelics, but if that kind of meandering thought doesn’t stir your interest, you can skip that one and wait for the one after that. If you want to subscribe to this blog, which is free of course, you can put your email address into the little “Sign me up!” box on the upper right of this webpage. Then you will get a notice whenever I get around to posting something here.

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[1] “These mushrooms] may be depicted in Stone Age rock art in Africa and Europe, but are most famously represented in the Pre-Columbian sculptures and glyphs seen throughout North, Central and South America.” (https://en.wikipedia.org/wiki/Psilocybin_mushroom#History )

Mary and the Mushroom: Psilocybin, Chronic Depression and Me (3)

A note to new readers: I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I really hope to be admitted to the study. How I got to this point will be the subject of this series of blog posts. By the time I’ve written a few of them, I should have learned whether or not I am admitted to the study. If I am, I intend to share the experience with interested readers here.

Ketamine? I’ll Pass

A drug called “ketamine” (street names include “Special K” and “Kit Kat”) has shown almost instant reported benefits in as many as 70% of patients suffering from depression and PTSD. Clinics offering ketamine as a treatment for these disorders are popping up all over North America. The dosing (often by intravenous infusion, although oral options are now available) is typically administered several times over a period of weeks, interspersed with intensive sessions of psychotherapy.

Many of these treatment clinics, and the media that cover them, have given the impression that ketamine is a psychedelic substance – containing properties like those contained in psilocybin (found in “magic” mushrooms) or LSD (a chemical compound that has similar effects to psilocybin). When I first heard about ketamine treatments, I was keen to try them, because the psychedelics I was actually more interested in trying are currently illegal in most (not all) places, even in clinical settings. However, after reading a few articles about the use of ketamine for depression and PTSD, I decided that this was not the route for me, and I withdrew from a treatment program into which I had applied and been accepted.

I’m sharing here what I discovered about ketamine that made me decide against it.

My Interest Is Piqued

By the time I watched a CTV W5 program Psychedelic Healing, which was broadcast in October of 2021 and is embedded at the end of this post, I had already started serious investigation into the effects of psychedelic substances in the treatment of addiction, chronic depression, end-of-life depression and PTSD. As was the case with cannabis before its legalization in Canada, despite their (il)legal status, lots of people are finding ways to obtain psychedelic mushrooms, and are experimenting with “micro-dosing” and even full-scale “tripping” on their own, so there are plenty of anecdotal reports. However, psilocybin is not legally available for therapeutic use in most of Canada or the U.S., with some exceptions in certain states and now in at least one province.

Late last year I started noticing an avalanche of media interest in a drug named “ketamine” for treating depression and PTSD – not only was it covered exensively in the W5 program, but suddenly there were mentions of it everywhere (e.g., this article in the New York Times). I had heard of ketamine as a recreational drug (not for nothing had I watched Russian Doll) but this was the first time I became aware of its use as a therapeutic.

Ketamine is a “dissociative anaesthetic,” and veterinarians have been sedating animals with it for years. Unlike psilocybin mushrooms and LSD, therapists in North America have been able to use it to treat depression and PTSD for quite some time and, from all reports, the immediate results have been amazing.

Much as I have always known to mistrust “silver bullets,” it is in my nature to still hope that one exists out there that will perfectly address my specific problem – and then to think that I’ve just happened to come across it. And so of course I immediately found myself a ketamine treatment program right here in Toronto – one that looked solid (i.e., employed accredited medical practitioners and psychotherapists; offered an extensive therapy program to complement the dosing; had been in business for a while; etc.). After attending one of their webinars and reading their website carefully, I applied, and was accepted. I looked forward with great interest and hope to the day of my first session.

In the meantime, I started investigating ketamine.

Ketamine Is Not a True Psychedelic

From my initial cursory reading and watching, I had received the impression that ketamine was a psychedelic. Although it seemed like a lot of the promotional materials for ketamine clinics, and media coverage of them, made little or no distinction between the psychedelic properties of psilocybins/ LSD and those of ketamine, I did wonder why Michael Pollan didn’t even mention it in his book How to Change your Mind (which I am currently reading and will review in a future post). So I kept digging.

I soon became aware that ketamine is not considered to be a true “psychedelic,” although the two types of mind-altering substances do share certain neurobiological effects. For one thing, since ketamine is a “dissociative anaesthetic,” if the drug is not properly administered and professionally supervised, it is possible to overdose on it, and ketamine can also be addictive. (Psilocybins and LSD are almost impossible to overdose on, and almost never lead to addiction.)

I rationalized (and continue to assume) that one of the major reasons for taking ketamine in a therapeutic setting – with a knowledgeable guide nearby and a psychotherapist on board – would be to mitigate such risks. But there was another issue with ketamine that concerned me even more.

Ketamine Benefits Don’t Last

Studies to date indicate that in most cases the positive effects of a ketamine dose wear off within a month or less. This was a huge stumbling block for me.

Recent initiatives in clinics such as the one where I’d registered include investigating such related issues as: 1) whether repeated doses of ketamine are more effective in the long term than just one; 2) whether combining ketamine with psychotherapy is more effective in extending the effect than using ketamine alone; and 3) whether taking ketamine orally has a longer-term benefit than intravenous infusions. As yet there is no proof (or even any real indication) that any of these measures will improve the situation.

A peer-reviewed meta study conducted at U Exeter and released in late December 2021 indicates that “Symptoms were reduced as swiftly as one to four hours after a single treatment, and lasted up to two weeks. Some evidence suggested that repeated treatment may prolong the effects, however more high-quality research is needed to determine by how long.” This reflects the findings of other studies I have read.

This means to me (Please note: I am not a doctor, I am not a pharmacist, and I am not a psychotherapist. In fact, I am a fiction writer. So beware of taking anything I say as actual advice) that a ketamine treatment makes sense for those who are so depressed or stressed that they cannot even get any “talk” therapy underway: they are in the absolute pits of despair, desperate, and possibly even suicidal. For such individuals, to get even a few weeks of respite would be an astonishing relief: they might find themselves grounded enough to talk constructively with a therapist and to begin the necessary long-term work on their recovery. The possibility of an immediate release for those mired in PTSD or a drug or alcohol addiction is almost beyond comprehension. But for someone like me who is looking for a long-term treatment for a life-long depression, a two- to three-month period of relief is not the silver bullet I was looking for.

Some, also like me, might decide that to attain a state of mind that is freed from PTSD or deep depression is worth the investment, even if it means getting another job, digging every dime out from the couch cushions, and stretching the limits of the credit card. But if you were going to spend that much money, you’d want the effects to improve things on a somewhat permanent basis. Ketamine, at least on its own, does not appear to do that. (See the Comments section for the story of someone who did find a ketamine treatment program that was worth the money.)

Ketamine Treatments Are Expensive

Aside from an actual funded research setting such as the one at St. Michael’s Hospital, ketamine treatments are not cheap. Ketamine itself is not expensive. It is the therapeutic context that costs money.

Since most clinics offering this therapy strive to maximize the positive benefits by combining doses of the drug with ongoing “talk therapy,” a patient in such a program normally has several one-on-one sessions with a licensed therapist both before and after each dosing session. During these face-to-face sessions (conducted virtually in the Covid era), the issues the patient is hoping to resolve are identified, and expectations for the outcomes are set, modified and monitored.

Each dosing session (done in person, needless to say, usually with the patient reclining, wearing headphones and a eye mask) is approximately two hours long, and each one of those plus the several hours of talk therapy associated with each dose can cost $800 to $1000. (This is according to my cursory survey on the Internet. I have since learned that in some places it may be cheaper, so look around if you are interested in investigating this option.) It is anticipated that patients will need four to six doses over a period of weeks or months, bringing the total cost to $4000 to $6000 or even more. While some health insurance programs may help to defray the costs of the psychotherapy part, the expense is still beyond the budgets of many.

Note: I posted a link to this post on Reddit (in the Psychedelic Therapy subreddit) and a person who has really benefited from ketamine – and obtained this treatment at a very reasonable price at a location in the US – posted an extended response there. I asked if they would add it as a comment to my blog post, and I am so grateful that they agreed to do so. It is a comprehensive and useful response, and I have adjusted a couple of points in this blog post to reflect the new information I gained from it. Thanks Nicky! (BTW: There is an interesting discussion about depression on that thread, and in many other places, on Reddit.)
Psychedelic Therapists in Training?

In my investigation of ketamine, I also read some of the transcript of a panel at the Center for the Neuroscience of Psychedelics at Mass General that included Michael Pollan as a guest. They mentioned ketamine as a useful intervention until scientists can start legally investigating actual psychedelics, but suggested that it was not a long-term solution.

I found Franklin King’s words (about 1:13 in the transcript) noteworthy: “Well, I think the other interesting thing about ketamine is that it not only sort of fills the space, but I think it also allows opportunities for clinicians and other people who are interested in working with psychedelics to sort of get their feet wet and get a little bit of experience working with patients in a clinical setting under non ordinary states of consciousness.”

In other words, it sounds like some ketamine clinics are in part therapeutic treatment centres that are gearing up for the time when they can use actual psychedelics.

In the next post, I’ll explain what attributes of psilocybin made it sound like a better fit for me.

P.S. I welcome your comments on this blog! Please note that I have settings that permit me to approve comments before they are posted (I went viral on another blog once, and I don’t really want to re-experience the downsides of that kind of attention again!) so your comments may not appear until the day after you have posted them.

Mary and the Mushroom: Psilocybin, Chronic Depression and Me (2)

A note to new readers: I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I really hope to be admitted to the study. How I got to this point will be the subject of this series of blog posts. By the time I’ve written a few of them, I should have learned whether or not I am admitted to the study. If I am, I intend to share the experience with interested readers here.

From There to Here

Despite my normally adventurous (some would call it “foolhardy”) spirit (e.g., I’ve skydived… once. Never again… and travelled to India on my own), if I had seen an invitation to join a study into the use of psychedelics in the treatment of depression even five years ago, I might not have submitted an application. Then, I probably would have been worried that: 1) the treatment would do nothing, and I’d be further demoralized, and/or 2) (at the other end of the spectrum) my mind would change so much that I wouldn’t be “me” any more (specifically, that I wouldn’t feel the need to write any more), and/or 3) that my friends and family would disapprove.

It is not that my fears have gone away – in fact I’ve acquired some new ones since I first contacted the study administrators, and I intend to write a whole post about them when I get closer to the actual experience. But my knowledge about mind-altering substances has increased considerably in the past five years. This learning journey started in an effort to find a meditation program that was suited to my needs and I’m recounting that experience here not because I think other people should learn to meditate, but only to explain how for me, that investigation led me from where I was in regard to psychedelics to where I am now.

Several years ago, a person who is close to me said that he was giving serious attention to the practice of meditation, and he’d found it was giving him some relief from the uproar of the world in general and daily life in particular. He was telling me about it because he thought I might be interested. Even though many people I know have found meditation helpful – most notably my sister, who is actually a meditation guide – I have always resisted it. I used to say, “I’ll have time to sit and do nothing when I’m dead” (totally ignoring how much time I spend sitting and doing nothing even without meditation). But since I was deep in my blue ocean at the time, I decided to give it a shot. He’d been reading Dan Harris’s Ten Percent Happier so I started there as well: first with the book and then with the app, and I used the app fairly consistently for several months.

I loved a lot about Dan Harris’s wildly popular program (which thousands if not millions have found helpful) but I had some issues with it: the spiritual dimensions and something about the tone just weren’t right for me. I was grateful for the introduction to Joseph Goldstein and a few other leaders in the field, and I admired the “heart” and generosity at the foundation of Dan Harris’s meditation program. But I was not interested in becoming a buddhist or a saint, and I decided to investigate what else was out there. I tried Headspace for a while, then Calm.

In the meantime, I had become a regular listener to Sam Harris’s Making Sense podcasts. (Sam Harris is totally unrelated to Dan Harris, by the way.) I know there are people who love Sam Harris’s outlook and some who absolutely do not, but I have always appreciated his (usually) rational approach to issues, his intelligence, and his wide range of interests. I don’t always agree with him, but in recent years particularly, I have found him a reasonable and interesting voice in this increasingly distressing – and often downright frightening – world.

Sam Harris had often talked about meditation on his podcasts, but I’d mainly skimmed or skipped those until now. I went back and started listening to his interviews with others in the field (including Dan Harris and Joseph Goldstein), and I learned that Sam now had his own meditation app. Entitled Waking Up, it was pricey compared to other meditation apps, but it offered a lot of other resources I was interested in as well (more talks by interesting people on psychology, philosophy, etc.). I decided to give it a shot.

In the immortal words of Goldilocks, for me Waking Up turned out to be “just right.” It was not too mystical and “oogie-boogie” on the one hand; nor, on the other, was it too bare bones, intended only to relieve my daily stresses and help me learn how to fall asleep. It went deep and made demands of me. I now meditate several times a week and after quite a bit of practice, I’m finally getting the hang of it to the extent that I do feel better when I do it. I’m seeing the world in a new way, and the possibilities continue to intrigue me.

In the meantime, I continued listening to the Making Sense podcast. I realized that several of the guests Sam Harris interviewed, as well as Sam himself, had begun talking seriously about psychedelic experiences they’d had in the past and, as time went on, ones they’d had more recently. They frequently talked about these experiences in terms of what they had learned from meditating. By now I had a high degree of trust in Harris, and I found the guests he was talking to (Tim Ferriss and Michael Pollan, for example) equally sincere, intelligent and rational. I knew they were respected in their fields, and so my ears perked up when they started talking about recent findings regarding the use of psychedelics in the treatment of addiction, depression, and PTSD. They also reported that psychedelics were showing great promise in alleviating end-of-life fears among those with terminal illnesses, freeing them to more fully engage with the world in the time that they had left.

Of course, psychedelics are not available for therapeutic use in Canada, and many of Sam Harris’s guests had cautioned against using them without a knowledgeable and honest guide on hand (there are sleezeballs out there. More about that in another post). So, even though I found several places online where I could apparently order “magic” mushrooms or the spores to grow my own, I was not about to try something that could actually cause me damage.

Late last year – increasingly frustrated to know that they might help but that I could not access them – I began to look more seriously for someone in my geographic area who might be using psilocybin or other psychedelic substances for therapeutic purposes. When a close friend of ours was dying, someone suggested he check out a CTV W5 program on psychedelic healing. As it turned out, our friend didn’t need it (he was not afraid of dying), but I watched it carefully. Twice. I was amazed to learn that treatments using ketamine to treat depression are available in Canada and the U.S., and that clinics that combine ketamine dosing with psychotherapy are opening in many cities. Soon after that, with the support of my family, I registered to attend a ketamine clinic in Toronto.

Ketamine has been showing astonishing, almost overnight, results for people with depression – estimates of those finding relief after using it have been as high as 70%. As you may have noticed, suddenly this approach to treating PTSD and depression is being written about and broadcast everywhere. However, it wasn’t until after I had been accepted into the program that I started reading the scientific literature about ketamine, and a few weeks ago, before my treatment program had begun, I decided to withdraw.

I’ll write about ketamine next time.

P.S. I welcome your comments on this blog! Please note that I have settings that permit me to approve comments before they are posted (I went viral on another blog once, and I don’t really want to re-experience the downsides of that kind of attention again!) so your comments may not appear until the day after you have posted them.

Mary and the Mushroom: Psilocybin, Chronic Depression and Me (1)

Some Background

I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I really hope to be admitted to the study.

How I got to this point (including my decision against trying ketamine instead of psilocybin) will be the subject of my next few blog posts. By then I should learn whether or not I am admitted to the study. If I am, I intend to share the experience with interested readers here.1

I have been depressed for as long as I can remember. During decades of psychotherapy with a wonderful psychiatrist (who has now retired), I recognized that my depression was chronic and was rooted in my childhood. My father died of colon cancer when I was two, leaving my mother to single-handedly raise my younger sister and myself while also working. When I was about eight, my mom was diagnosed with breast cancer and, despite several years of surgery and other nasty treatments, she died when I was thirteen. This was not an era when bereaved children received any kind of counselling, and my family didn’t talk much about what was happening to us all.

My sister and I were “left” to an aunt and uncle who lived in a prairie city about 2000 miles from where we had grown up, and these two – in their mid-thirties when their own children had been born – were none-too-pleased to have two young teens join their household. They were especially unhappy with the elder one, me, who was ungrateful and a bit precocious. I finished Grade 12 at the age of 16 and started university the same year, so I mostly hung out with teens who were at least two years older than I was. I taught my cousins about the Beatles, the Stones and other cultural phenomena their parents felt their primary-school children were too young to hear about, but I also taught them about rage and disobedience. I spent every other weekend grounded and, by the time I was 17, I was no longer living at home.

I’ve had lots of happy times in the decades since, but those times have floated on the surface of a deep grey-blue ocean of sadness and hopelessness that has always been there, always. Sometimes it’s been overwhelming, sometimes it has been something I’ve been able to ignore. But it has always been there. (Note: Although I have considered suicide, I’ve considered it only to ultimately reject the idea. I’m fortunate to have always been able to think clearly enough to recognize what a terrible effect such an action would have on those who love me. Now I have reached an age where I trust myself not to become actively suicidal, and I am very glad of that. If you have suicidal thoughts, get help right now.)

When I was younger, my depression and related issues contributed to anxieties and phobias that I have largely learned to overcome, or at least suppress. Today, stubbornly resistant to the unconditional love of an utterly wonderful family and an abundance of hugely supportive friends, my depression manifests itself primarily in procrastinating on the things I like most to do – like writing – as well as in an increasingly persistent awareness of the size of the ocean of blue inside me, and its longevity. I am tired of it, and I want it to go away.

In addition to counselling and psychotherapy, I have tried many remedies and coping mechanisms over the years. When I was very young I found I felt better when I was smoking and drinking – preferably both at the same time. These activities also made me far more sociable than was my actual nature. So I smoked and drank with increasing dedication for decades, until I finally admitted to myself that these two addictions were no longer making me feel better; instead they were eroding my physical health and making my mental-health issues considerably worse. Recovery from nicotine and alcohol became my newest hope for emotional stability and after many years of trying, when I was fifty I finally managed to quit both.

I have always considered it fortunate that I never had access to “recreational drugs,” but over the years I’ve been prescribed various sedatives and anti-depressants (one of which I continue to take, but want to ditch). I have seen counsellors, psychologists, a hypnotist, and the aforementioned wondrous psychiatrist, among others. I have found the benefits, albeit temporary, of physical exercise and I have taken up meditation in a fairly serious way. Many of these options have helped relieve one symptom or another, but not the big ones (the deep sadness and the procrastination) that I feel are preventing me from living to the fullest the life I want to lead (and am, thank god, still physically and mentally capable of living). I still have three (THREE!) novels I want to write.

I am a pretty good dissembler and most people don’t know that I am perennially depressed. Despite all the therapy, I have always suspected that everyone feels the same way I do, and been certain that it is really my own fault that I have not managed to attain a more cheerful and positive outlook on life. I still think this may be true. In the past few years, with political instability, climate crises and the pandemic always in the news, I have been certain that we’re all in the same boat. Or rather in the same grey-blue ocean, to extend my own metaphor.

However, in the past few years, I have also become interested in some promising results associated with the use of psychedelics in the treatment of PTSD and chronic depression. Not only am I reading some amazing anecdotal accounts of almost-immediate “cures,” the science is also building a case for the use of “magic” mushrooms or a synthetic compound you’ve probably heard of (lysergic acid diethylamide, or LSD), often combined with therapy, in the treatment of these disorders. Although I came of age in the Sixties and early Seventies, somehow I missed out on the psychedelics, so I had no background experience with which to compare what I am now hearing on podcasts, and reading about in articles and books, about these “trips” and their effects. The benefits of “microdosing” these substances is also of great interest to me. Unlike many, I have no negative convictions about such mind-altering substances – and so, unlike most other recreational drugs, I am open to at least giving this a try.

Since prescribing psilocybin is currently illegal in Canada, as is purchasing it for personal use, I was stumped as to how to access this treatment that had so piqued my interest. What I learned in my efforts to track down a source of psilocybin and someone knowledgeable and trustworthy enough to help me use it properly will be the subject of my next posts.

1 The study administration has said that they are fine with my blogging about the experience, whether I get in or not, provided I include no photos of the actual treatment or treatment setting.

My First Sleep Test, Part 2: Thoughts on Sleep Apnea and Other Stuff

I’ve learned a bunch of things from the responses I received when I posted about my first experience with a sleep test.

First, I learned that I should have explained what a sleep test is — not everyone knew. A “polysomnography” or sleep study is primarily intended to determine whether or not the subject has sleep apnea. “Obstructive sleep apnea” occurs when your throat muscles relax when you are sleeping, obstructing your airways, causing your breathing to stop and start while you are asleep. It is usually associated with snoring – those who have heard someone with sleep apnea will recognize the silence in the middle of a snoring session followed by a huge intake of breath in an extended snort.

Sleep apnea can lead to all kinds of cardiovascular problems and other health issues, as well as daytime sleepiness. Researchers have recently identified a link between sleep apnea and an increased risk of dementia. (As I told my son, who pointed this study out to me, nothing is more likely to get seniors to comply with a health recommendation than the threat of dementia.) The major snoring associated with the condition also causes distress to those who have to sleep next to it (or, in really bad cases, anywhere in the same house).

A CPAP (continuous positive airway pressure) machine corrects the problem: it involves a face mask and a steady stream of air. A friend of mine has pointed out that APAP (automatic positive air pressure) machines are now available. These adjust to the particular sleeper’s breathing patterns rather than releasing a continuous stream of air. An internet search reveals that there are also BPAP machines (!. They will eventually take over the whole alphabet!) that increase air pressure when you inhale, and reduce it when you exhale.

Since those who have sleep apnea don’t get enough restful sleep, they are often tired the next day. If you have a sleep test and are diagnosed with sleep apnea, you may not be legally allowed to drive unless you are using a CPAP machine, because of the danger that you might fall asleep at the wheel. Therefore, if you have sleep apnea, by using a CPAP machine you may be avoiding a ticket, saving your own life, preserving your brain, and reducing the risk of running your vehicle into other people and objects. Up to nine percent of adults have been diagnosed with sleep apnea but it is likely that many more have it and are undiagnosed. Therefore, having a sleep test when indicated is a Very Good Idea and my whining post should not discourage you. End of Public Service Announcement, but here’s more if you want it: https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

Here are other (related) things I have learned in recent days:

  1. In the provinces of Alberta and British Columbia, several of my Facebook friends have had “remote” sleep tests where they attach monitors to themselves at home and these are tracked remotely from the sleep lab at the hospital (or wherever it is located). At least those sleep-study subjects get to sleep in their own beds. I don’t know why they don’t do this in Ontario.
  2. People in the United Kingdom don’t seem to be sent for this test as often as people in North America. Several Facebook friends in the U.K. had never heard of a sleep test, while most of those who responded from North America had.
  3. A lot of people I know have had the test, and a lot of people have been diagnosed with sleep apnea and are now using CPAP machines. After they got used to them, most users love them because they sleep so much better with them, and they feel more rested during the day. I’m guessing that many of their sleep partners also love them: in addition to eliminating snoring, CPAP machines are great “white-noise” makers, as I can personally attest.
  4. I wish I had stock in a CPAP company and, now that William Shatner is promoting them, CPAP Machine Sanitizing Systems might be a good investment too. (Not the sanitizing machines themselves: they’re too expensive and likely not covered by insurance. I mean stock in the company that makes them.)

Finally, here is a video of Phyllis Diller — to whom I referred in my previous post — sharing some early-1970s humour and looking sort of the way I did on Monday night hair wise, except that she has no wires.

My First Sleep Test: Hope It’s my Last

I’m sure a lot of readers have had sleep tests. I am far more sympathetic to you today than I was yesterday. I don’t know how long it will be before I get the results, but I hope I never need another “polysomnography” again.

I got to the hospital at 8 p.m. last night and checked in to the sleep lab. They attached wires everywhere, including to a fingertip, my neck, my legs, my chest, below my nostrils, and a bunch of places on my head, using both goop and tape. There were also a couple of devices to wear for a study some students were doing (about sleep tests! They are hoping to create a system you can use at home. Good plan.) They gave me three long questionnaires to complete (seriously. About 15 pages total). Then at about 10:45 p.m., the technician, Steven, a gentle and patient man originally from Ghana, said “Do you have to go to the bathroom before sleeping?” So I walked to the bathroom trailing all my wires. I must have looked like an overfull colander of spaghetti walking down the hall. Managing in the bathroom was quite a trick, as I’m sure you can imagine.

Back in my room, I told Steven that the room was freezing, and he kindly brought me three more sheets, but I was still not warm enough. So in addition to the equipment, I had four sheets, socks and a bathrobe plus my sleep wear, and my hair stood up like Phyllis Diller’s. (Look it up, kidlets.) I felt like a car wired for a boost, and I was a sight for sore eyes, I tell you. Should have taken a selfie.

At 11 p.m., Steven hooked the wires up to the monitoring system and turned out the lights. Despite a sleeping pill, I tossed and turned. I tossed. I turned. I tried listening to podcasts but they were too interesting, and I couldn’t get Spotify (where I sometimes listen to the sounds of rain or ocean waves). So I gave up on that. I tried meditating. It didn’t put me to sleep, and I wasn’t feeling too zen so I probably didn’t do a very effective job of it. In fact, I was about ready to rip off all the wires and tell poor Steven to F*** the test: I was going to sleep without them. At about 2 a.m. I had to go to the bathroom again, so Steven came back in and disconnected me and then when I returned he reattached all the wires I’d disconnected with my tossing and turning and bathrooming.

At about 3 (I think) I finally fell asleep and at 6 a.m., Steven came in and said cheerfully, “Time to get up!” He pulled all the wires off, ripping off a thin layer of skin on my face, neck, chest along with the tape (“Sorry, Sorry, Sorry”), and gave me another questionnaire. There was goop all over me because of how they attach the things that hold the wires, but they can’t let people have showers because of COVID so I left the hospital goopy. Arnie (my guardian angel) was waiting outside at the appointed hour (7) and he drove me to McDonalds for breakfast (we ate in the car), then we came home and I went to bed and slept for three hours. It was a night to remember.

The last question on the last questionnaire was “Do you have any comments?” I said, “The room was too cold.” I figured the rest of the problems came with the territory, but I had to complain about something.

Thanks, but…

I think I’ll have to bail

I really do mean the “Thanks” part. I’m grateful to everyone who sent me messages of support. I wouldn’t have covered nearly as much ground as I had if you hadn’t been cheering me on. Also thanks to you, if intentions had been actions, I’d have covered a lot more territory.

But with two weeks ahead of me before my foot surgery, and a week of swimming and canoeing but no jogging behind me, I am giving up my running aspirations for the nonce. (Nonce = maybe just for six months, and maybe for longer. Time will tell.)

I’m not stopping because of my age: I know (because I have several friends who are doing it) that being over seventy is no reason not to run, unless there are actual physical restrictions. Which fortunately, I do not have. Essentially, in my case, given my appointment with the foot surgeon, I should have started this program in the spring.

On the positive side, my appreciation for walking has increased. 🤓 When you walk, you can take pictures more easily – like the ones I took (below) last week in Muskoka. So that’s what I’ll be doing for a while. Except when I’m sitting on the couch with my foot up.

Special thanks to Dan, for the words of support, and the running chart. At this point, I’m optimistically filing it for next year.