What happens when a dose of psilocybin fails to produce the anticipated result
Well, I’ve had the (first) dose. So far it’s taken me a week to recover from it, but I’m gradually feeling better. The reason I needed to “recover” is not because the effects of the dose were so dramatic, but because they weren’t. While I definitely felt as though I was on a path that could take me somewhere interesting during the dosing experience, I never got there. After all the buildup, this left me feeling fairly shattered. This outcome was not the fault of the drug or the research study, nor was it anything I did wrong. It’s just one of those things that happens sometimes and unfortunately for me, this was one of the times it happened.
I have found a quote in the Psychedelic Times that describes the experience I had. It reads, “… some people become anxious at this level of dosage and feel on the crest of ‘breaking through’ to a fuller experience but never do…”. I am not exactly sure what dosage the author is referring to, as I think he is discussing psychedelic mushrooms rather than distilled psilocybin, but the description of what happened is exactly right: while the dose I received is enough for most people to attain “lift off,” that didn’t happen to me. Psychedelics are tricky things. Different people respond differently to the same dose, and the same person can have a different reaction to the same dose on different days. While I think my experience is highly unusual for participants in studies about psychedelics and depression, obviously it happens.
As I’m sure you can imagine after everything I’ve written here, which reflects only a tiny portion of what I’ve read, and listened to, and thought about regarding this journey, I was so devastated with the non-result that my first reaction was to say, “I’m never doing that again!” But after a week, I have come back to my senses (?), and have requested that the study administrators consider me for a second dose.
This post is an overview of what happened to me, but I hope it won’t discourage others from taking advantage of this amazing treatment if they have the opportunity. On the other hand, if anyone else has the experience I did, maybe my account will be of some assistance.
By the time I went for the scheduled dose last week, my anxiety about it – which was exacerbated by the depression and anxiety I was already experiencing following my withdrawal from antidepressants – had intensified to the point where I was in a state of near panic. In fact, I have wondered if the extent of my apprehension before the dose might have interfered with my ability to “break through.” (If so, that part should at least go better next time: no dose I take in future will ever again be my first.)
I had three main fears. First, I was really worried about having a “bad trip,” which I gather is akin to having intensely realistic nightmares that reach into your deepest fears, from which you feel unable to waken, and during which you don’t remember that the experience you think you are having is not real. Guides are usually able to help with this. Just as one does with a person who is actually having a bad dream, they will notice your distress and say a few words or – if you have given them permission in advance – reach out and offer a steadying hand on your arm or shoulder. This is usually all it takes to redirect the thoughts of the person who is having the bad trip and send them in a more positive direction. In addition, since my guides were physicians, they had counteractive treatments at hand if things went really bad. Furthermore, bad trips are not all that common. But even knowing all of this, as the experience approached I kept thinking about the accounts I’d read of people who’d had bad trips, and it didn’t help that, two days before my dose, I listened to a really interesting interview of Roland Griffiths by Sam Harris, to which Sam had appended his account of a trip he recently took (basically because Terence McKenna had thrown down a gauntlet, it seems, which is no reason to do anything as far as I’m concerned) in which he’d consumed 5g of mushrooms all at once. His trip was not “bad,” but it was a very scary ride.
Secondly, although I was sure, and had been frequently reassured, that I would come back in one piece even if I did have a bad trip, I could not get the concern out of my head that I might not come back as the same basic person as I was when I went into the psilocybin session. Some of the benefits of a dose of psychedelics that are widely touted – the expansive sense of oneness with nature, the love for humanity, etc. – all sound great, but they do not sound like me. (Well, they do, but they don’t. It’s hard to explain aside from saying I don’t want to lose ALL of my cynicism nor to relinquish my firm grip on reality, downsides and all.)
Finally, I was worried that the dose would not work at all. I have never responded the way most people do to cannabis – no happy, giggly, floaty stuff for me, just paranoia and sleepiness. So what if the dose had no effect on me at all? I had asked those running the study if I could ask for more psilocybin during the dosing session if nothing happened, and of course I was told that I could not receive more than the original dose. This makes sense because this is a research study, and doses need to be the same for everyone.
So given all these fears, the amount of time I had spent thinking about the upcoming experience, and my wonderful imagination, by the time I arrived for the treatment last Saturday, my stomach was in knots and my heart was pounding. I was basically a basket case.
The worst fifteen minutes were the ones I had to go through following the required Covid test, sitting outside the treatment centre in the car with my (heroically patient and probably quite perplexed) husband. If I’d tested positive and could not have been admitted for the treatment, I honestly do not know what I would have done. It would have been a legendary temper tantrum of Hulkian proportions.
Fortunately, I did not have Covid. I was admitted to the centre, and greeted by my two guides. These are wonderful women, both MDs with an interest in psychology and psychedelics. Having two people in the room throughout the trip is unusual, but it adds a layer of protection because in non-controlled study situations there have been some instances of abuse by unethical guides. I’m sure having two people on board also protects the guides, and it probably allows them to confer on participants’ experiences, and their responses to that.
They asked me how I felt, and I told them how scared I was. They reassured me that this was normal, which helped a bit. I had also been thinking of Michael Pollan’s sleepless nights before his doses, so I knew that I was not the only person who had ever felt this way. We talked for a while about what I was hoping to get out of the day’s experience, but this discussion was really just to help me focus, as I’d already discussed my hopes and expectations in great depth with one of the two guides the previous week.
Then I received the dose, 25 mg of psilocybin in about half a cup of liquid. The concoction was fairly tasteless.
I donned a black mask to keep out light, and put on headphones so I could hear the mixed tape that is apparently the one that Johns Hopkins created for participants in their studies. (BTW, I found the musical selection rather odd: most of the pieces are lovely, but many of them are quite Western and classical, and therefore quite structured. This seems at odds with an experience that is supposed to un-structure everything!)
Once dosed and outfitted, I lay down on the couch, my two guides nearby in armchairs about five feet from my head, and I waited. I was still quite worried. After about 30 minutes, I started feeling like I was on a drug. I’m not sure how else to explain it – I did not feel any more relaxed, but things were definitely not feeling normal. After some additional time, I started seeing things in my head that I can best describe as very much like the images we are getting from the Webb Space Telescope. (I’m not kidding here: the resemblance was uncanny.)
The images in my head grew more personalized as time went on – I thought I saw Yoda in the mists at some point, and a few people I know, and some eyes. It seemed to me that the images that were coming to me were very closely connected to the music: when the music stopped or changed, the images retreated or changed. If the music was majestic I had majestic images (mountains, castles, etc.) and when it was more Eastern, I had images of Mayan- or Hindu-type figures.
This was all very nice and interesting, but I was still fairly nervous because I knew I was not “there” yet, and I was waiting for my “self” to disintegrate (as the literature had told me to expect it would) or at least for my self to become less important. I knew I was not tripping – but I was on my way in that direction. I remember thinking “So this is where cinematic artists got their ideas for the images in sci fi films like 2001: A Space Odyssey and Dune.” I also felt a very deep appreciation for the music that I was listening to. It sounded richer and closer than I had ever heard music sound, and again I felt great appreciation for the composers/creators. I remember thinking as I listened to a piece of flute music that the intake of breath of the flautist was an essential part of the piece – I had never noticed that before. It was lovely. So I was definitely getting stuff from the drug that I do not normally experience.
I had consumed a lot of coffee before I came to the session (next time, I’ll keep my fluid intake to a minimum!) and before too long I had to get up and use the washroom. This was frustrating because it meant I had to leave off from the trip I felt I was beginning to experience, which actually seemed kind of interesting by that point. When I walked to the bathroom, I definitely felt like I was on a drug – it was like moving through a dense but invisible cloud and I had to pay attention to what I was doing. My legs felt a bit rubbery – but I didn’t have any hallucinations or anything. I came back, lay down again, and resumed my journey.
I had to use the washroom a few more times over the next couple of hours, and each time when I got up, I had no feeling that I was in anything more than a mildly altered state. When I came back into the treatment room, I conveyed my frustration to the guides that nothing much was happening. I kept asking what time it was because I was still tense – mostly worried at this point that time was passing and I was not having the experience I came for. They told me the onset was different for everyone, that the trip would come in waves, and that I should just try to let go and let it happen.
And I did “try to let go” (sounds like a contradiction in terms, I know, but as a meditator, I do know how to clear my mind). But these efforts did nothing. About three hours in, I was even thinking, “God, I am so bored. How much longer do I have to lie here?”
I started figuring out how I would describe what I was seeing to people after it was over, and I had no trouble putting words to my visual experiences. An inability to put the experience into words – “ineffability” – is one of the measures that some people have used to describe a psychedelic experience, but I did not see anything that I would call indescribable. Nor was there anything that felt as real as reality (“noetic.” Another measure). And nothing – aside from the music – felt “mystical” (a third measure).
At one point I realized I was hungry so I sat up and ate the lunch they’d suggested I bring with me. By this time I was beginning to suspect the treatment wasn’t “working,” but yet again I tried to give it another shot.
And so it went, until finally I’d had enough. I don’t know what time it was, but I believe that after about four or five hours (which is the length of time these experiences are supposed to last) my sense of being on a drug was gone. I was done with it. It was over. I had never once lost my sense of “self,” or my feeling of being in a room, in my own body, with two guides. I’d had no feeling of euphoria or any pleasant or mystical feelings of any kind.
Maybe I did have a psychedelic experience, but if that is the case, I don’t understand the hype at all, and it certainly offered me no benefits aside from a greater appreciation for the creators of film and music. Here is the analogy I have since developed for what I feel I experienced: It was like going up one of those way-too-high roller coasters (like the Yukon Striker at Wonderland near Toronto – which I haven’t gone on … yet) – up, up, up to the very top, to the point where you can see the entire landscape ahead of you (I could see what it would be like to be fully launched on the psilocybin trip, and it was certainly scary but also quite lovely and I was really interested to see what was going to happen when I did start the actual ride). But then I realized that my roller-coaster car was stuck at the top, completely stuck, and that I was never going to go over the edge. I was never going to drop. And I had no ability myself, no matter what I did, to move the car forward. Instead, I just had to sit there fearing the heights, and wait it out until my brain cleared and I could figure out how to get myself down again. And that part was traumatic.
I have rarely felt so awful in my life as I did after that experience. I was overwhelmingly disappointed. I felt frightened from having hovered in suspense for so long. I felt grumpy and irritable. Also, I was exhausted. I had trouble sleeping that night, and the way I felt the next day was worse. It was like an experience with quasi-PTSD that I’d had in my 40s after jumping out of an airplane during another one of my adventures. (The actual skydiving part was great but everything around it terrified me – what was I thinking? I am afraid of heights! But that’s a story for another day.)
I had an “integration session” with my two guides at 9 the next morning. They reminded me that the dose I had been given was standard and that it had been determined on the basis of the optimal amount in the treatment of depression. It was not intended to zap me into some alternate universe. In other words, they were telling me that it was what it was, and I needed to work with that and see how it had affected my depression.
Talking to them helped a little, but later in the afternoon I was feeling awful again. I felt threadbare, as though the inside of my brain had been stripped of some protective layer that I was unable to get back. I felt like I should be feeling better after the treatment, but I wasn’t, and I felt as though I had no one to blame but myself.
On Monday, after a good night’s sleep, I came to the realization that it was not my fault, and I started figuring out how to put myself back together again.
One week after my first dose of psilocybin, I am feeling less disappointed and more optimistic about the outcome if I give this another try. (In AA they talk about the tendency most of us have to try the same approach to resolving problems again and again, hoping for a different outcome. I hope this isn’t that. 🙂)
I feel no less depressed than I did before the dose, no better psychologically in any way, and I still feel deeply disappointed, but after a week of keeping myself occupied with activities that interest me, in order to avoid thinking about my disappointment, I am regaining my sense of direction. I have been meditating every day, trying to get some exercise (when it’s not too hot!), reading some great books, avoiding the news and social media, talking with close friends and relatives, and doing a bit of work on my novel. Anyone who does these things is bound to feel better, and it’s working well for me.
By this point, I am also fairly tired of thinking and talking about my own state of mind and my efforts to improve it, so I’m just going to carry on with my life on my life’s terms until I find out if I am eligible for another dose – and if so, when. I don’t expect it will happen soon — I gather that those who do get a second dose usually need to wait for ten weeks or so. I’m not going to resume the use of antidepressants after going to all the trouble to go off them (still having brain zaps after eight weeks!), unless I get to a point where I have no other options.
So I’m going to stop writing about psychedelics for a while and focus my attention instead on another trip: the one we are taking to Germany next month. But I will keep you posted on what happens with the study. I offer my sincere thanks to so many people who have been cheering me on during this whole experience. I am sorry I couldn’t have delivered you a happy ending without all of these complications. But I’m probably going to benefit from this experience too – even if it takes a bit more time before I see exactly how.