Mary and the Mushroom: Psilocybin, Chronic Depression and Me (13)

The Adventure Continues….

To say that this summer has not gone as I had hoped would be an understatement. But following my on-line meeting yesterday with the psychiatrist who is the director of the research study I’ve been participating in – one month after my first dose – I now know my status vis-a-vis the study, and understand my options moving forward.

As you will know if you have been following this journey, I was extraordinarily disappointed following the 25 mg dose of psilocybin I received on July 16. I felt I had not received enough psilocybin to attain the result I had expected, and this outcome plus the continuing withdrawal from the anti-depressants I’ve been on for several decades, plunged me into a state of despair the likes of which I have not experienced for a very long time, if ever. The “jaws of the black dogs” (as John Bentley Mays described them in his Memoir of Depression) were nearly unrelenting, and I did whatever I could to keep myself upright: from long walks in nature, to shorter faster walks, to meditation, to reading, to writing, to movie watching, to attempting to be sociable: you name it. Anything to distract myself from the bleak goings on inside my head.

I knew that I could resume a course of antidepressants at any time and relieve the depression I was feeling, which means that I did bring my state of mind on myself. But I did not want to go back on the antidepressants because I was hoping that despite my disappointing outcome with the first dose, I would secure approval in the study to receive a second. (You can’t and shouldn’t receive a psilocybin dose when you are on Selective Serotonin Uptake Inhibitors, or SSRIs, which is what most modern antidepressants are, including mine. It is believed that SSRIs interfere with, or even repress, the effects of the psilocybin. This is why I tapered off them in the spring, and have been off them now for several months.)

Why, you may ask, would anyone want a second dose after feeling so terribly strung out after the first one? It is a question I have asked myself many times. The answer is in part that I have huge faith (based on a lot of clinical research papers I have read, so it’s not just faith) that psilocybin does work in the treatment of depression, and I felt that perhaps my expectations had been so high and my anticipatory tension had been so great that I had interfered with the effectiveness of the treatment simply by being so uptight about it. (Is “uptight” still a word that anyone understands?) I hoped that I could calm down enough the second time to let the dosing work its magic. I had also read that the same dose can have different effects on the same person at different times. If I were approved for the second dose, I wanted to give it a try. And that meant not resuming the antidepressants until I had a decision from the research team about the second dose.

Second Dose: Not Happening

Yesterday I had my scheduled meeting with the director of the research program, a psychiatrist who works and conducts research in the field of neuropsychopharmacology at the University of Toronto. (He is a genuinely nice guy who actually listens to what patients say to him.) He told me that based on all of the surveys I have done, questionnaires I’ve completed and meetings I’ve attended since the first dose, I am not eligible for a second one. The reasons he gave me make perfect sense: this study is approved by Health Canada which means that all of the protocols set out in the study must be adhered to exactly. And the guidelines say that only participants who have benefitted from a first dose (i.e., had their depression alleviated even a little) and who might find even greater benefit from a second dose are eligible to receive one. My depression had, if anything, intensified following the first dose, so I did not qualify.

The doctor also pointed out that if – as I had suggested to him and to anyone else who would listen to me – a higher dose might have brought me the benefits I sought, he couldn’t have given me more than the 25 mg the study protocol allows anyway.

He pointed out a couple of other interesting things.

While it has always been my hope that the psilocybin treatment would alleviate my depression, I was also very interested in experiencing the consciousness-expanding properties of psychedelics that such writers as Michael Pollan, Sam Harris and many, many others have reported. The 25 mg dose which is standard in most depression studies is not intended to send participants far enough out into the stratosphere that they will find themselves closer to understanding the meaning of life, but is rather intended only to help alleviate their depression, PTSD, end-of-life anxiety, etc.

In other words, I may have been seeking more from this dose than the dose in this study could ever have given me. This theory is reinforced by the fact that the colourful imagery and magnificent soundscapes that I did experience while taking the first dose were similar to those reported by people who DO find their depression alleviated by the session.

So Now What?

My discussion with the researcher/psychiatrist/director has let me to two conclusions.

1. People with depression should not base their decisions about whether or not to treat it with psilocybin (if and when that option becomes available to them) on what happened to me. The treatment is effective for so many people and has so few negative side effects (mine being almost totally attributable to having gone off antidepressants and having disproportional expectations) that in my estimation, in this context, psilocybin is still a wonder drug.
2. I am not finished with this.

There are other ways of obtaining a slightly larger dose than the one I received in the research study, some of which are even legal for people in specific mental-health situations. Before I go back on the antidepressants, I am going to explore these other options until I am satisfied that I have done what I personally believe I need to do in order to 1) relieve my depression AND 2) learn more about the nature of consciousness. I will report on my adventures as they continue to unfold – so stay tuned.

In the meantime, I am feeling more optimistic, partly because I am feeling more in control of what happens next, and partly because I found a wonderful psychotherapist online at the Psychology Today website. We conduct our sessions on Zoom, which perfectly suits my needs.

My immediate focus is on a three-week trip to Germany which starts on Friday. I will be reporting on that adventure on this blogsite, as I have previously reported on my/our trips to India, Cuba and Italy.

I also want to draw the attention once again of interested readers to the list I have compiled so far on interesting, useful and scientifically sound resources relating to the use of psilocybin and other psychedelic drugs in the context of mental health and the expansion of one’s mind.

Auf wiederhören!

NOTE: Just came across this article. It’s a good warning, and worth a read. “Psychedelic Clinical Trials and the Michael Pollan Effect.” Psychedelic Spotlight, August 9, 2022.