Mary and the Mushroom: Psilocybin, Chronic Depression and Me (10)

Posted on July 11, 2022 | 6 comments

Why You Might Want to Read Pollan’s Book Before You Dose. A Rather-Long Book Review.

How to change your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence, by Michael Pollan (Penguin Press, May, 2018. Also available on Audible)

Anyone who has read Michael Pollan’s writing knows that he not only brings an inimitable perspective to subjects that range across the environment, nature, and food, he does so with a virtuosic literary flair. While his approach is authoritative and science-based, his books are as much aesthetic pleasures as they are troves of compelling information. These attributes are part of the appeal of his most recent work, How to Change your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.

The book opens with a line from Emily Dickinson – “The soul should always stand ajar” – and Pollan invites us to put that advice to use by exploring a world with which most of us (even most “acid heads,” I would guess) are unfamiliar. His opening paragraph is as much a hook as an introduction.

“Midway through the twentieth century,” he begins, “two unusual new molecules, organic compounds with a striking family resemblance, exploded upon the West. In time, they would change the course of social, political and cultural history, as well as the personal histories of the millions of people who would eventually introduce them to their brains. As it happened, the arrival of these disruptive chemistries coincided with another world historical explosion – that of the atomic bomb. There were people who compared the two events and made much of the cosmic synchronicity. Extraordinary new energies had been loosed upon the world; things would never be quite the same” (p. 1).

It’s a paragraph that may strike the reader as hyperbolic, but thanks to Pollan’s fine blend of compelling writing, intriguing facts and riveting anecdotes, his exploration of the world of psychedelics consistently lives up to this initial promise.

How to Change your Mind unfolds in six chapters that cover, among other subjects: the social history of psychedelic use (from the time of the Aztecs to the present); the natural history of “magic mushrooms” and other true psychedelics; a review of the scientific literature relating to these substances; a discussion of the chemical makeup of psychedelics and current research into what effects they may have on the brain; the drugs’ philosophical and mystical dimensions; the political issues that have plagued the entire field of psychedelic use and study and may threaten them again in future; and, perhaps most importantly in this bat-shit crazy era of human history, the promise offered by these drugs to address depression and addiction and to expand our knowledge about the nature of human consciousness.

Pollan personalizes his story by explaining what drew him to write a book about psychedelics and what happened when he (a “healthy normal,” as he calls himself) tried them out for the first time. And for the second time. And the third. He also offers anecdotes relayed to him by others who have taken psychedelic trips.

Perhaps most relevant to my own decision to participate in a clinical study of psilocybin is the material in Pollan’s book relating to the treatment of depression and anxiety. He details the massive clinical evidence that has accrued to date showing the beneficial effects, which can last for months or years or even longer, of one or two psychedelic treatment sessions on those experiencing chronic and/or serious existential depression, addiction and certain other (non-psychotic) forms of mental-health disturbance.

The protracted effects of a well-managed single dose suggest that these benefits cannot be attributed to the chemical itself, and some of the most fascinating content in this book is the discussion of current research into what effect these substances may be having on the brain. Scientists now believe that psychedelics must cause a “temporary dissolution of the ego,” allowing the wiping away of certain debilitating thinking patterns and allowing new, more positive patterns to be built.

The mind-boggling range of interrelated topics that are covered in this book (I can’t begin to convey the vastness of its scope) to my mind makes this essential reading for anyone with any serious interest in the subject of psychedelics. In this post, I talk about some some of the many issues Pollan raises – not in an attempt to offer a condensed version of the book (which would be impossible anyway), but rather out of a hope that the reader’s interest will be piqued enough that they will find a copy of the book and read it for themselves.

The Context

As many of us know, in the early 1960s Harvard professors Timothy Leary, Richard Alpert (who later renamed himself Ram Dass) and others became so enthusiastic about the potential of LSD to save the world that they decided to try to turn on everybody, or at least an entire generation. The effort had several disastrous outcomes – not because of the drug itself but because of the way it was distributed, mostly underground, and used. The fallout put psychedelics out of legal reach for research or individual use for decades.

Although many who tried LSD at the time had wonderfully transformative experiences or just garden-variety amazing trips, others had more negative and newsworthy outcomes. These ranged from disastrous judgement calls (there were incidences of accidental deaths, suicides and cases of long-term psychosis), through accounts of hallucinations that terrified the trippers, to events that mostly horrified disapproving onlookers and the media – such as kids running naked through the streets. The love of humanity and nature engendered by these substances also led to a widespread disinclination among users to march off to fight a war in Viet Nam. Within a few years, alarm about psychedelic drugs had risen to such a level that President Richard Nixon declared war on them, Harvard fired Leary and Alpert, and all research into this intriguing substance was made illegal. It would be thirty years before clinical investigations into the positive aspects of psychedelics could be resumed – legally, at least.

Disabusing Myths

As it turns out, the actual research from the 1950s and 60s and the extensive clinical investigation since the late 1990s clearly indicate that psychedelics are physically safe. “It is virtually impossible to die from an overdose of LSD or psilocybin… and neither is addictive” (p. 11). Tryptamine, the organic compound that causes the psychedelic effect, is not only not toxic, but it works differently on the brain from substances that do lead to addiction. “What is striking about this whole line of clinical research,” Pollan writes, “is the premise that it is not the pharmacological effect of the drug itself but the kind of mental experience it occasions involving the temporary dissolution of one’s ego that may be the key to changing one’s mind.” (Pollan points out that other drugs that are not true psychedelics, some of which are now being used in clinical settings to relieve depression, and all of which are available on the street – such as MDMA [aka “molly” or “ecstasy”] and ketamine [Special K, KitKat] – can be addictive.)

Research is also showing that with screening and supervision, psychedelics are almost always psychologically safe. The incidences of “bad trips” (which can indeed be terrifying from all reports, and are one of my big worries about my impending dose), can almost always be averted or at least mitigated by attention to set and setting. The “psychotic breaks” that emergency doctors unfamiliar with the drugs identified in those (few) people who were admitted to their care after taking LSD back in the 1960s are now believed to have been primarily panic attacks – which are also less likely to happen when dosing takes place in a safe setting in the presence of a knowledgeable guide. Again there are usage warnings: people with psychosis in their family history and young people who are predisposed to schizophrenia may not be good candidates for psychedelic use.

“Set and setting” are so crucial to the successful therapeutic use of psychedelics that early on, Johns Hopkins developed a set of “flight instructions” that are given to research participants in advance of their treatment doses in order to help them avoid bad trips – or to transform bad trips into good ones. These instructions basically involve trusting that you’re going to be okay, letting go, and remaining open to the experience, and they have become part of the standard protocols of clinical studies into psychedelics everywhere – as has the mixed tape of music that Johns Hopkins researchers developed for participants to listen to while they are tripping.

Psychedelics are highly “suggestible,” which means that setting expectations for a psychedelic experience ahead of time is an extremely important step. (This is the “mindset,” or “set,” part of “set and setting.”) It seems, for example, that those who anticipate a mystical experience in which they feel as though they have made contact with a divine being or a deceased loved one are far more likely to have these kinds of experiences than are people whose intentions are (again, by way of example) to learn more about the self or about the nature of consciousness.

Clinical Evidence

The evidence that psychedelics have a dramatic role to play in the treatment of mental-health issues including chronic depression, end-of-life despair and PTSD includes a 2016 publication from New York and Johns Hopkins universities showing clinically significant reductions in measurable incidences of depression and anxiety in 80% of cancer patients. When researchers applied for funding from the FDA in 2017 to extend a study into the effects of these substances on cancer patients, the results they had already amassed were so impressive that FDA staff asked them to expand the next phase to include depressed patients who did not have cancer. As Pollan points out, they made this request “seemingly undeterred by the unique challenges posed by psychedelic research, such as the problem of blinding, the combining of therapy and medicine, and the fact that the drug in question is still illegal” (p. 375). Similar initiatives have occurred in Europe, where there is also serious concern about the pervasiveness of depression in the general population and the inadequacy of current resources and medications to adequately address the situation.

Way back in the 1950s, before psychedelics became illegal, there was already growing evidence that these substances could help people with addictions. Pollan takes an interesting detour in his historical account to report on a highly successful program in Weyburn, Saskatchewan in the early to mid- 1950s – involving Aldous Huxley among others – that made LSD standard treatment for alcoholism in that province. Even before that, indigenous people in North America were using peyote to treat the rampant alcoholism that had accompanied the European invasion of the “New World.” Since the 1990s, research in the addictions field has resumed both underground and above ground, and is showing promising results, with up to 50% of participants in one Johns Hopkins study having quit smoking following a psychedelic session compared to 10% to 35% who used other treatment options.

Even “healthy normals” who have taken standard therapeutic doses of psilocybin or LSD in settings that approximate the ones being used in clinical studies have reported such benefits as increased focus and greater creativity. In small doses, psychedelics have shown a benefit to the fitness of animals, and the implications for humans in this context are also being investigated.

The Spiritual Element

As well as temporarily dissolving the ego (or “shaking the snow globe” as one scientist quoted by Pollan put it), psychedelics have occasioned what many have described as “mystical experiences.” Science is exploring theories about what makes this happen. This is in itself quite an amazing turn of events: we now have researchers focusing their traditional methods of investigation on efforts to discover what causes phenomena that have zero anchors in reality – such as convictions of the existence of higher powers in which people may have faith, but can show no concrete proof. Obviously, the only way to approach this topic in a way that has scientific resonance is to explore the physical side of it. What effect does tryptamine (which is, as explained above, the psychoactive component of psilocybin, LSD, ayahuasca and other true psychedelics) have on the brain that might lead to hallucinations and mystical experiences?

Many studies in England, the U.S., Canada and other countries are now focussed on the effect of tryptamine on the brain’s default mode network (DMN), which “forms a critically and centrally located hub of brain activity that links parts of the cerebral cortex to to deeper and older structures involved in memory and emotion” (p. 301). Wikipedia describes the DMN, which scientists who study the brain did not even know existed until about 2001, as “being active when a person is not focused on the outside world and the brain is at wakeful rest, such as during daydreaming and mind-wandering. It can also be active during detailed thoughts related to external task performance. Other times that the DMN is active include when the individual is thinking about others, thinking about themselves, remembering the past, and planning for the future.” Scientists are able to get the DMN to “light up” during functional magnetic resonance imaging (fMRI) when subjects are asked certain questions about their selves or given feedback about something they have done (such as receiving “likes” on social media), and with other prompts that involve identification of the sense of self. For this reason, neuroscientists sometimes refer to the DMN as “the Me network.”

The positive effects of the DMN on human thinking and behaviour are multifold. The network essentially acts as a conductor of the orchestra in our brain, whose instruments carry out functions such as smelling, seeing, adding, subtracting, etc. It organizes the instruments in a way that prevents all their necessary activity from leading to cacophonous collisions that would send us into madness. However, the DMN can also create patterns of repetitive thinking that are unproductive, causing our minds to wander around and around dark alleyways (wearing deeper and deeper ruts in our mind) that can lead some of us into cycles of depression and addictive behaviours that we seem unable to escape.

Pollan provides a comprehensive report on the recent history and current thinking related to the DMN, all of which – thanks to his strong writing – is truly interesting. The long and the short of it is that some neuroscientists now think that during psychedelic trips, the DMN or “me network” is knocked out of commission, leading to the dissolution of the ego. This allows the brain to stop processing input as it traditionally does, on the basis of memories and learned emotions, and instead to respond in a way that some have compared to how babies and young children see the world: with amazement and pleasure. Because the DMN is not doing its usual job of telling us “this is impossible,” perhaps tryptamine also lets us encounter visions that we interpret as gods and monsters.

Psychedelics can make even the most cynical of us into fervent evangelists of the obvious. (Pollan, p. 251)

Pollan explains it all much better than I do here, but in short, psychedelics may wipe out the ruts we have created in our thinking, allowing us to see trees and flowers as if for the first time, to love those we love as though experiencing love for the first time, and just generally to become much more open and creative in our ways of interpreting the world. And they may do this simply by taking the default mode network out of commission for a few hours. Herein lies a scientific interpretation that may also explain some magic.

The Psychonauts

There is no doubt that the spiritual component of psychedelics is what is attractive and notable to many who are exploring altered states of consciousness through the use of psychedelics. Indeed, it was for their mystical properties – not to get “high” as one does with alcohol or cannabis – that almost every aboriginal group in the world made use of psychoactive drugs from early times. And it was their mystical effect on users that made LSD seem so dangerous to governments in the 1960s – people who had experienced an explosive love for humanity and the world around them as a result of using psychedelic drugs were no more interested in becoming cogs in the capitalist machine than they were in going off to war. (I imagine that this is not a selling point for psychedelics within the industrial complex.)

Interestingly, it was thanks to a paper published in the journal Psychopharmacology addressing the whole mystical side of psychedelics that revived research interest in the use of psychedelics in therapeutic settings fifteen years ago. Entitled “Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance,” it was the result of a study by a highly regarded neuroscientist named Roland Griffiths, a researcher who had grown bored with his previous work after having had a spiritual experience himself on psychedelics.

This aspect of psychedelic use is still of major interest to many, and groups have been established to foster and explore the spiritual experience. Unlike most religious experiences, the contact with higher powers precipitated by LSD and other psychedelics is direct – you don’t need an intercessor (religious leader, shaman, etc.) to tell you about the immutable revelations; you experience them yourself. (I imagine that this is not a selling point for psychedelics among would-be cult leaders – including not only religious leaders, but also some politicians.)

Pollan writes about a whole range of figures from both within and outside of the world of science who are interested in and knowledgeable about the mystical facets of psychedelics – including the aforementioned Roland Griffiths, as well as Bob Jesse (another of the authors on the Psychopharmacology paper and founder of the Council on Spiritual Practices), Rick Doblin (founder and executive director of the Multi-Disciplinary Association for Psychedelic Studies, [MAPS]), Terrance McKenna (creator of the “Stoned Ape Theory” of the evolution of human cognition, including language), and Paul Stamets, a self-taught mycologist who is central to the movement to increase human awareness of the power, ubiquitousness and benefits to the planet of the range of mushroom species (not just those containing psilocybin).

Back to the Neuroscience

“If, as Freud said, dreams are the royal road to the unconscious, is it possible that psychedelic drugs are a superhighway to the unconscious?” (M. Holden, 1980, as quoted in “The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs,” by Robin Carhart-Harris, Robert Leech, et al.)

I personally found it reassuring that despite all of his research and personal “travels” using psychoactive drugs, Michael Pollan has not turned into a mystic, or completely relinquished his atheism (although he does confess to having “communed directly with a plant for the first time” on his first, unguided trip), but those who are interested in the spiritual aspects of these drugs will find lots of non-judgemental and interesting material in his book.

However, I am at this point more interested in living in the world than lifting off from it on any kind of permanent basis. In fact, one of my big worries about my upcoming trip has been that I will lose my groundedness and sense of purpose, both of which I value highly. So it is reassuring to know that the direct effect of psychedelics on the default mode network is temporary, lasting only as long as the drug is having its most intense effects, which is typically between 6 and 8 hours. Psychedelics do not make people permanently delusional.

The lack of permanent physical change to the brain as a result of psychedelic use is of great interest to scientists. Since the nature of the psychedelic journey does not make people want to have trips on a regular basis (or even more than once, in many cases), and since the effects may wear off within months or years, clinical trials such as the one I am involved with now are working to figure out how to extend the benefits of these trips by means of follow-up integration sessions, meditation, and other non-pharmacological means. (I imagine the fact that only one dose is typically administered is not a big selling point for Big Pharma.)

In Conclusion

This review is so long that I am tempted to just throw the whole thing in the trash despite the hours it has taken me to write it, because I doubt others will be bothered to read the whole thing. Even if they did, their time would be better spent in opening Pollan’s actual book and digging in. But I read How to Change Your Mind far more closely than I would have otherwise because I wanted to to write about it, and that was of great benefit to me. Writing this review, or dissertation, or whatever it is, was also beneficial. It would be a better a literary artifact, and become a more appropriate length for readers of this blog, if I now embarked on a great deal of trimming and restructuring, but I have other things to do.

There are unfinished threads I still want to write about that have arisen from my ingestion of so much material on matters psychedelic – I am concerned abut the future role of these drugs in therapeutics and other consciousness-expanding settings, and specifically about how their potential benefits may be eroded yet again by the machinations of Big Pharma, governments and even therapists themselves who may see little benefit to themselves in the relief experienced thanks to psychedelics by ordinary humans, but I’ll write about that next time.

In the meantime, people who are asking other people and/or the Internet to tell them more about psychedelics, as well as people like me who are contemplating a one-off full-dose psychedelic tour of the inside of their brains, will benefit from reading Pollan. How to Change Your Mind is an extraordinarily rich and interesting resource.

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Mary and the Mushroom: Psilocybin, Chronic Depression and Me (9)

Posted on June 19, 2022 | 5 comments

Sobbing at the Symphony, an Amazing Film, and Other Trip Preparations

As the date of my first (only?) psilocybin dose moves closer, I find myself suspended between the relative certainty of what is happening now and the mystery of what will happen afterwards. This feeling of suspension (or should I say “suspense”?) is no doubt attributable in part to the aura of unreality that accompanies antidepressant withdrawal, and in part to my efforts to learn everything I can about psychedelic experiences in advance of actually having one.

It has been nearly three weeks now since I took my last dose of the SSRIs I’ve been on for several decades. The side effects of withdrawal, which I also described in my last post, continue, including the unwelcome feeling every few minutes that a series of little electrical-like pulses are shooting through my brain (aka “brain zaps”), a tendency to burst into tears at the slightest provocation, anxiety, and a more-easily-triggered impatience than is typical for me. I feel as though these side effects are diminishing (I hope so), but it’s also possible that I’m just getting used to them.

Tired of Thinking about my Self

Concurrently, I have been reading and listening to and viewing so much material that relates to psychedelic trips, mushrooms in general, and states and conditions of consciousness, that I am growing tired of the whole subject. I tell myself versions of the following: “This is ridiculous! People drop acid all the time without totally immersing themselves in the science, philosophy and history of it all and perusing narratives that chronicle the experiences of other people. Sure, maybe all they get is a little break from reality, but that is all they’ve asked for: they do not expect to emerge with dramatic alterations to their world views. These are just fungi, after all.”

Of course, there’s a fear of disappointment woven into all of this: after all of the preparation, what if mine is a one-day trip that takes me nowhere? Michael Pollan, whose latest book has become a core reference for those who are interested in how psychedelics can “change [their] mind,” emerged from his first two trips – one on LSD, one on psilocybin – feeling somewhat disappointed, and fairly certain that what had happened to him was not likely to have any permanent effect.

On top of everything else, my anxiety often presents itself as a form of self-castigation that I’m sure is familiar to most people who are dealing with mental health issues: What if I am just blowing everything out of proportion? (To which I answer, Of course I am. That’s part of what I am trying to stop doing.) (<– Circular thinking is another symptom of depression, but it also often seems to be a logical and compelling form of discourse.)

On the other hand….

I’m probably just experiencing information overload. The behaviour that’s led to this is typical of me: when I’m going on a real-life journey, I study as much as I can about the destination before I go, and even attempt to acquire a little of the language in advance. I admit that what I’m learning about psychedelics in general and mushrooms in particular has been interesting and useful no matter what the outcome, and writing about it has been helpful. And I’m happy to hear that it’s also helping others who are in similar circumstances.

The psychiatrist who is supervising “my” research study has suggested that, for a couple of weeks before the dose and at least a week after, I avoid engaging too much with the world on this subject (or most others), as I will want to think about my own expectations, and then about the effect the experience has had on me. To that end, I envision two more pre-dose blog posts – one a review of Pollan’s book, and the other an account of what I am looking forward to and concerned about as the dosing date approaches.

The Study

A few people have asked me what it’s like to be in this research study. Up to this point, the experience has primarily consisted of administrative steps (a blood test, a referral from my family physician, etc.) and completing a whole lot of questionnaires about my state of mind, and about the medications I am on and have been on. The same questions keep appearing on new surveys and seem to be designed for easy processing by computer: most of the questions are Yes/No or number-based (e.g., “For how many years have you been [xyz]?”). I expect the same questions will form a significant part of the follow-up as well: that’s how research works.

I get emails about once a week from the study coordinators asking how I’m doing, and I had a good conversation with the psychiatrist about the withdrawal symptoms. This week I received a list of appointments I am expected to attend before and after the dosing. There are about twenty appointments on the list, extending right through December – about half virtual and the rest in person.

A few appointments before the dose will involve discussing my expectations with the two-person team to which I’ve been assigned, and afterwards we’ll talk about how the experience has affected me. There will also be more surveys, and more blood tests.

Fantastic Fungi: A Fabulous Film

Thanks to several enthusiastic recommendations, including from a couple of biologists in the family, this week I watched a film called Fantastic Fungi. I recommend it to you with equal enthusiasm. (Check out the preview here; you can watch the film for “free” if you have Netflix.)

Fantastic Fungi does talk about psilocybin trips, but its primary focus is on the many other “magical” properties of mycelium and the mushrooms that emerge from it. Along with an explanation voiced by Brie Larson (Go, Captain Marvel!) of what fungi are and how they operate (“There is a world under the earth, full of magic and mystery…” she begins), the film features lay and scientific experts in the field of mycology, including Paul Stamets, Roland Griffith, Andrew Weil, Pollan, and nature and food journalist Eugenia Bone.

The film shows us how fungi already fulfil roles in nature that we are only beginning to understand (they serve as networks of communication among plants and trees in very similar ways to those in which humans use the internet), how they can be used to solve immediate problems (termites in your house? Stamets has cultivated a fungus that will destroy them without harming the environment), and how they can help us to address long-term issues affecting the future of the planet (check out the segment that compares traditional ways of cleaning up oil spills and what happens when fungi are introduced to do the same: not only do they clean up the mess, they start whole new colonies of growth and life). There is convincing evidence that after we humans finish destroying ourselves and the environment, the mushrooms will be here to clean up and rejuvenate our planet – a mycelium staff preparing for the hotel’s next set of visitors, a staff that is fully equipped to survive and thrive on their own if new guests don’t show up.)

Fantastic Fungi is entertaining and educational, and watching it might well change your view of the world.

Fears of Tears

This past week I attended a truly magnificent production of Beethoven’s Symphony Number 9 that featured not only the entire Toronto Symphony Orchestra but also the superlative Toronto Mendelssohn Choir and four outstanding soloists flown in for the occasion from around the world. As the concluding movement approached, I felt a growing sense of apprehension: I was watching the hundred-or-so members of the choir sitting quietly above and behind the orchestra, clad in dramatic black-and-white, ecclesiastical-looking robes and black masks, awaiting the moment when they would stand and sing. As almost everyone in the building knew, this was going to happen in the fourth movement of the symphony, which includes the powerful and uplifting anthem to peace, “Ode to Joy.”

I knew that when they rose, my wobbly illusion of emotional stability was going to take a direct hit. I feared I would be so overwhelmed by emotion that I would be unable to avoid contributing loud tuneless sobbing and hiccoughing noises to the soundscape, seriously diminishing the pleasure of those around me.

As it turned out, I was right about the first part: given everything that is happening in the news, no power on earth or anywhere else could have stopped the tears from pouring down my face and into my mask as the movement began and the choir rose to sing. This waterfall continued beyond the final note and through the standing ovation, both extended and passionate, that seemed to launch itself unbidden on cries of “Bravo!!” from the audience. But to my relief, I did not make a scene.

Afterwards, I told my friend Ksenija – my TSO companion and a woman who has enjoyed superbly performed classical music since she was a child in Europe – that I had never been so viscerally moved by a concert, so unable to stop the tears. She said, “But Mary! Tears are perfectly natural when you hear great music.”

She’s right, of course. They are. And in retrospect I think that to have been able to listen to that monumental work in these hard times, and to have been able feel it all – my emotions unobstructed and undulled by antidepressants – was a gift that was both absolute agony and absolutely glorious.

I really hope that my guides choose less staggering music to play when I am launched into the psychedelic universe (music and eye masks are traditional components of a guided psilocybin experience), and that is one of the things that I now intend to ask about ahead of time. But in the meantime, no matter what happens to me as a result of ingesting psilocybin – and even if nothing does – I will have gained one unforgettable experience that I would never have had if I hadn’t become involved in this study.

So there’s that.

TSO and Mendelssohn Choir assembling before Beethoven’s Ninth.

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Mary and the Mushroom: Psilocybin, Chronic Depression and Me (8)

Posted on June 3, 2022 | 9 comments

An Update: Antidepressant Withdrawal, Brain Zaps and Other Pre-Tripping Diversions

When I was pregnant forty years or so ago, it seemed like the whole world was pregnant. Everywhere I looked there were baby bulges forcing apart the front openings of winter coats and women displaying the latest “maternity smock fashion.” I don’t notice pregnant women so much any more but these days, the same mechanism is at work when it comes to psychedelics. Perhaps because a lot of people are aware that I am planning and preparing for a psychedelic experience, they are referring me to articles, videos, scientific reports, and other materials that they know may be of interest to me. Many tell me stories of their own experiences. (One person told me that she’d been to a wedding recently where, at the reception, the father of one of the central players offered mushrooms to the guests. What??? I don’t think tripping promotes the kind of behaviour one anticipates at wedding receptions! Sociability is one thing, falling in love with the universe during the toast to the groom is another. Bad trips on the dance floor would also be a downer. But what do I know? I’m still a psychedelic virgin.)

On a more serious note, several people have reached out in person, in emails and on social media to say that my blog is relevant to their own depressions or those of loved ones, and has engendered hope in them for a prospective treatment. This pleases me considerably, because that is one of the reasons why I started to write this blog series in the first place.

But it’s not just material that is brought to me by others that I’m noticing: my awareness antennae are up in the same way as they were to “baby bumps” (not that we called them that) back in the day. Thanks to the growing public interest in psilocybin and LSD, these days it seems like I am seeing references to psychedelia everywhere. On May 19, for example, The New York Times Sunday Crossword offered a clue at 28 Down that read “Tab inits [initials].” My first thought was of computer tabs, so I tried “ESC” but I soon realized that the correct answer was “LSD.”

My husband and I watched Nine Perfect Strangers for at least one episode before twigging in to the fact that the plot revolves around the non-consensual administration of psychedelics to the clients at her “health resort” by a very peculiar healer (played to a T by Nicole Kidman), who has more method to her madness than it may at first appear. We did watch the rest of the series, mainly because we couldn’t stop watching it, and we were surprised that as critics we were ultimately satisfied with the outcome, but I was quite unsettled by a lot of it because the whole conceit was far more “oogie boogie” than I am interested in contemplating when it comes to my own psychedelic trip next month. Fortunately Melissa McCarthy was there to cut through the bullshit on a regular basis. (Note: I think there should be a warning to those who contemplate watching Nine Perfect Strangers: if you have endured the agony of losing a child, you should be aware ahead of time that this is an issue that is explored extensively in the series. I have since learned that people on LSD and psilocybin trips often feel as though they are in the company of friends and relatives who have died, but whether this is a beneficial or negative experience is certainly a personal decision.)

Tapering Antidepressants

I am now half way through the tapering of the antidepressants (duloxetine, the generic form of Cymbalta, which is a serotonin-norepinephrine reuptake inhibitor or SNRI) that I have been on for more than a quarter of a century. In the study I am in, going off them is a requirement before receiving a dose of psilocybin. “Tapering” is not fun, and as I must decrease my consumption from half of my former dose to zero at the end of this weekend, I don’t think it’s going to get any more fun for a while.

I am having the kinds of experiences one might expect from being depressed and not being on antidepressants: a tendency to burst into tears at just about everything personal or circumstantial; paranoia and anxiety (yesterday, I was desperately worried that something I’d said on Facebook had offended a dear friend. Fortunately it had not); and even more anger than I normally carry around with me. The news in recent weeks/months has not helped, of course: you’d have to be a psychopath not to be moved to tears and rage by a lot of recent news stories, and I know my response is not unique to those suffering from depression. But I can get into disproportionally massive twists over things I have little capacity to control: such as the fact that a lot of therapists are already making a lot of money from patients who now believe that ketamine is a psychedelic, which is isn’t. As I have said before, there is evidence that ketamine and MDMA administered therapeutically can alleviate depression for a few weeks or months, giving patients some breathing room in which they are able to undertake some cognitive-behavioural or other kinds of therapy, but these substances do not occasion the kind of dramatic and permanent change in awareness reported by many who have used psilocybin or LSD. They can also be addictive, which psilocybin isn’t. I will do whatever I can to straighten out people’s thinking on this subject, but if we can’t even get people to agree that masks prevent Covid transmission, I’m not making it my life mission. I might as well tilt at windmills. (Speaking of which, I wrote a novel a few years ago with my friend John A. Aragon that is based on the great Cervantes tale of Don Quixote. Entitled The Adventures of Don Valiente and the Apache Canyon Kid, it’s funny and heartwarming. Sorry. But I couldn’t just let the windmill metaphor go by without a plug for the wondrous DV, whom my co-author and I continue to cherish.)

Brain Zaps

The worst side effect of the antidepressant withdrawal is a phenomenon called “brain zaps,” a symptom I’ve never before experienced and with which I can’t wait to finish. They are explained at Medical News Today as “electrical shock sensations in the brain. They can happen in a person who is decreasing or stopping their use of certain medications, particularly antidepressants. Brain zaps are not harmful and will not damage the brain. However, they can be bothersome, disorienting, and disruptive to sleep.” The article goes on to say: “In a study that surveyed people who were experiencing brain zaps, people described them as:

  • a brief, electrical shock-like feeling in the brain
  • a short period of blacking out or losing consciousness
  • dizziness or vertigo
  • a zap paired with a buzzing sound
  • “hearing their eyes move”
  • feeling disoriented (a “brain blink”)

I am experiencing the first, third and sixth of these brain zap manifestations almost constantly (thank god I am not “hearing my eyes move”!), and I do not like them one bit. However, I know that with any luck they will go away after a few weeks of total cessation from the medication. The psychiatrist to whom I’ve been assigned in the clinical trial said if they were bothering me too much, I could increase my dosage again for a little while, but I’ve come this far and I am not retreating. I’ve withdrawn from much worse drugs than this (alcohol and nicotine). By the way, I am impressed by the support I have received so far by the investigators on the research team: they check in with me regularly to see how it’s going, and have offered a one-on-one zoom call with the psychiatrist about the withdrawal symptoms, which I have “happily” accepted.

It is only because I am hopeful (albeit also scared. More about all that in a future post) about the psilocybin treatment that I am willing/able to put up with how I feel at the moment. All I can do is move forward, one day at a time, and request the indulgence of my friends and loved ones as I go through this. (They are gentle, kind and understanding, and I am grateful.)

My hope has been fed recently by several things I’ve read. The primary one is Michael Pollan’s book, How to Change Your Mind, which I am reading slowly with an intent to review it in the next post here. Another was an article in The Guardian about the American writer William Brewer, who said of his most recent novel, The Red Arrow, “The writing really got going in 2019 after I finally underwent psychedelic therapy for the depression that had controlled my life for a long time. I was able to write in a way I hadn’t before because my brain had just been so clouded. [….] I was given a dose of psilocybin mushrooms at 10 in the morning, and by 4.30 in the afternoon it felt like a 50 lb tumour had been cut out of my back.” Brewer describes the experience thus: “It isn’t a wild and crazy light show so much as an elegant revelation of how things are connected. Psilocybin, especially, gives you this real sense of momentum, and I wanted that for the book.”

That sounds like an outcome for which I am willing to put up with a few weeks of brain zaps.

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

Posted on May 1, 2022 | 7 comments

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.

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

Posted on April 11, 2022 | Leave a comment

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….

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

Posted on March 6, 2022 | 2 comments

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?

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

Posted on February 13, 2022 | 7 comments

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 )

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

Posted on January 22, 2022 | 3 comments

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.

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

Posted on January 17, 2022 | 4 comments

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.

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

Posted on January 13, 2022 | 16 comments

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.

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