Tag Archives: depression

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

The Adventure Continues….

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

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

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

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

Second Dose: Not Happening

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

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

He pointed out a couple of other interesting things.

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

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

So Now What?

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

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

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

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

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

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

Auf wiederhören!

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

Mary and the Mushroom: Psilocybin, Chronic Depression and Me (12)

What happens when a dose of psilocybin fails to produce the anticipated result

Well, I’ve had the (first) dose. So far it’s taken me a week to recover from it, but I’m gradually feeling better. The reason I needed to “recover” is not because the effects of the dose were so dramatic, but because they weren’t. While I definitely felt as though I was on a path that could take me somewhere interesting during the dosing experience, I never got there. After all the buildup, this left me feeling fairly shattered. This outcome was not the fault of the drug or the research study, nor was it anything I did wrong. It’s just one of those things that happens sometimes and unfortunately for me, this was one of the times it happened.

I have found a quote in the Psychedelic Times that describes the experience I had. It reads, “… some people become anxious at this level of dosage and feel on the crest of ‘breaking through’ to a fuller experience but never do…”. I am not exactly sure what dosage the author is referring to, as I think he is discussing psychedelic mushrooms rather than distilled psilocybin, but the description of what happened is exactly right: while the dose I received is enough for most people to attain “lift off,” that didn’t happen to me. Psychedelics are tricky things. Different people respond differently to the same dose, and the same person can have a different reaction to the same dose on different days. While I think my experience is highly unusual for participants in studies about psychedelics and depression, obviously it happens.

As I’m sure you can imagine after everything I’ve written here, which reflects only a tiny portion of what I’ve read, and listened to, and thought about regarding this journey, I was so devastated with the non-result that my first reaction was to say, “I’m never doing that again!” But after a week, I have come back to my senses (?), and have requested that the study administrators consider me for a second dose.

This post is an overview of what happened to me, but I hope it won’t discourage others from taking advantage of this amazing treatment if they have the opportunity. On the other hand, if anyone else has the experience I did, maybe my account will be of some assistance.

The Build-up

By the time I went for the scheduled dose last week, my anxiety about it – which was exacerbated by the depression and anxiety I was already experiencing following my withdrawal from antidepressants – had intensified to the point where I was in a state of near panic. In fact, I have wondered if the extent of my apprehension before the dose might have interfered with my ability to “break through.” (If so, that part should at least go better next time: no dose I take in future will ever again be my first.)

I had three main fears. First, I was really worried about having a “bad trip,” which I gather is akin to having intensely realistic nightmares that reach into your deepest fears, from which you feel unable to waken, and during which you don’t remember that the experience you think you are having is not real. Guides are usually able to help with this. Just as one does with a person who is actually having a bad dream, they will notice your distress and say a few words or – if you have given them permission in advance – reach out and offer a steadying hand on your arm or shoulder. This is usually all it takes to redirect the thoughts of the person who is having the bad trip and send them in a more positive direction. In addition, since my guides were physicians, they had counteractive treatments at hand if things went really bad. Furthermore, bad trips are not all that common. But even knowing all of this, as the experience approached I kept thinking about the accounts I’d read of people who’d had bad trips, and it didn’t help that, two days before my dose, I listened to a really interesting interview of Roland Griffiths by Sam Harris, to which Sam had appended his account of a trip he recently took (basically because Terence McKenna had thrown down a gauntlet, it seems, which is no reason to do anything as far as I’m concerned) in which he’d consumed 5g of mushrooms all at once. His trip was not “bad,” but it was a very scary ride.

Secondly, although I was sure, and had been frequently reassured, that I would come back in one piece even if I did have a bad trip, I could not get the concern out of my head that I might not come back as the same basic person as I was when I went into the psilocybin session. Some of the benefits of a dose of psychedelics that are widely touted ­– the expansive sense of oneness with nature, the love for humanity, etc. – all sound great, but they do not sound like me. (Well, they do, but they don’t. It’s hard to explain aside from saying I don’t want to lose ALL of my cynicism nor to relinquish my firm grip on reality, downsides and all.)

Finally, I was worried that the dose would not work at all. I have never responded the way most people do to cannabis – no happy, giggly, floaty stuff for me, just paranoia and sleepiness. So what if the dose had no effect on me at all? I had asked those running the study if I could ask for more psilocybin during the dosing session if nothing happened, and of course I was told that I could not receive more than the original dose. This makes sense because this is a research study, and doses need to be the same for everyone.

So given all these fears, the amount of time I had spent thinking about the upcoming experience, and my wonderful imagination, by the time I arrived for the treatment last Saturday, my stomach was in knots and my heart was pounding. I was basically a basket case.

The worst fifteen minutes were the ones I had to go through following the required Covid test, sitting outside the treatment centre in the car with my (heroically patient and probably quite perplexed) husband. If I’d tested positive and could not have been admitted for the treatment, I honestly do not know what I would have done. It would have been a legendary temper tantrum of Hulkian proportions.

Fortunately, I did not have Covid. I was admitted to the centre, and greeted by my two guides. These are wonderful women, both MDs with an interest in psychology and psychedelics. Having two people in the room throughout the trip is unusual, but it adds a layer of protection because in non-controlled study situations there have been some instances of abuse by unethical guides. I’m sure having two people on board also protects the guides, and it probably allows them to confer on participants’ experiences, and their responses to that.

They asked me how I felt, and I told them how scared I was. They reassured me that this was normal, which helped a bit. I had also been thinking of Michael Pollan’s sleepless nights before his doses, so I knew that I was not the only person who had ever felt this way. We talked for a while about what I was hoping to get out of the day’s experience, but this discussion was really just to help me focus, as I’d already discussed my hopes and expectations in great depth with one of the two guides the previous week.

Then I received the dose, 25 mg of psilocybin in about half a cup of liquid. The concoction was fairly tasteless.

The Event

I donned a black mask to keep out light, and put on headphones so I could hear the mixed tape that is apparently the one that Johns Hopkins created for participants in their studies. (BTW, I found the musical selection rather odd: most of the pieces are lovely, but many of them are quite Western and classical, and therefore quite structured. This seems at odds with an experience that is supposed to un-structure everything!)

Once dosed and outfitted, I lay down on the couch, my two guides nearby in armchairs about five feet from my head, and I waited. I was still quite worried. After about 30 minutes, I started feeling like I was on a drug. I’m not sure how else to explain it – I did not feel any more relaxed, but things were definitely not feeling normal. After some additional time, I started seeing things in my head that I can best describe as very much like the images we are getting from the Webb Space Telescope. (I’m not kidding here: the resemblance was uncanny.)

The images in my head grew more personalized as time went on – I thought I saw Yoda in the mists at some point, and a few people I know, and some eyes. It seemed to me that the images that were coming to me were very closely connected to the music: when the music stopped or changed, the images retreated or changed. If the music was majestic I had majestic images (mountains, castles, etc.) and when it was more Eastern, I had images of Mayan- or Hindu-type figures.

This was all very nice and interesting, but I was still fairly nervous because I knew I was not “there” yet, and I was waiting for my “self” to disintegrate (as the literature had told me to expect it would) or at least for my self to become less important. I knew I was not tripping – but I was on my way in that direction. I remember thinking “So this is where cinematic artists got their ideas for the images in sci fi films like 2001: A Space Odyssey and Dune.” I also felt a very deep appreciation for the music that I was listening to. It sounded richer and closer than I had ever heard music sound, and again I felt great appreciation for the composers/creators. I remember thinking as I listened to a piece of flute music that the intake of breath of the flautist was an essential part of the piece – I had never noticed that before. It was lovely. So I was definitely getting stuff from the drug that I do not normally experience.

I had consumed a lot of coffee before I came to the session (next time, I’ll keep my fluid intake to a minimum!) and before too long I had to get up and use the washroom. This was frustrating because it meant I had to leave off from the trip I felt I was beginning to experience, which actually seemed kind of interesting by that point. When I walked to the bathroom, I definitely felt like I was on a drug – it was like moving through a dense but invisible cloud and I had to pay attention to what I was doing. My legs felt a bit rubbery – but I didn’t have any hallucinations or anything. I came back, lay down again, and resumed my journey.

I had to use the washroom a few more times over the next couple of hours, and each time when I got up, I had no feeling that I was in anything more than a mildly altered state. When I came back into the treatment room, I conveyed my frustration to the guides that nothing much was happening. I kept asking what time it was because I was still tense – mostly worried at this point that time was passing and I was not having the experience I came for. They told me the onset was different for everyone, that the trip would come in waves, and that I should just try to let go and let it happen.

And I did “try to let go” (sounds like a contradiction in terms, I know, but as a meditator, I do know how to clear my mind). But these efforts did nothing. About three hours in, I was even thinking, “God, I am so bored. How much longer do I have to lie here?”

I started figuring out how I would describe what I was seeing to people after it was over, and I had no trouble putting words to my visual experiences. An inability to put the experience into words – “ineffability” – is one of the measures that some people have used to describe a psychedelic experience, but I did not see anything that I would call indescribable. Nor was there anything that felt as real as reality (“noetic.” Another measure). And nothing – aside from the music – felt “mystical” (a third measure).

At one point I realized I was hungry so I sat up and ate the lunch they’d suggested I bring with me. By this time I was beginning to suspect the treatment wasn’t “working,” but yet again I tried to give it another shot.

And so it went, until finally I’d had enough. I don’t know what time it was, but I believe that after about four or five hours (which is the length of time these experiences are supposed to last) my sense of being on a drug was gone. I was done with it. It was over. I had never once lost my sense of “self,” or my feeling of being in a room, in my own body, with two guides. I’d had no feeling of euphoria or any pleasant or mystical feelings of any kind.

The Aftermath

Maybe I did have a psychedelic experience, but if that is the case, I don’t understand the hype at all, and it certainly offered me no benefits aside from a greater appreciation for the creators of film and music. Here is the analogy I have since developed for what I feel I experienced: It was like going up one of those way-too-high roller coasters (like the Yukon Striker at Wonderland near Toronto – which I haven’t gone on … yet) – up, up, up to the very top, to the point where you can see the entire landscape ahead of you (I could see what it would be like to be fully launched on the psilocybin trip, and it was certainly scary but also quite lovely and I was really interested to see what was going to happen when I did start the actual ride). But then I realized that my roller-coaster car was stuck at the top, completely stuck, and that I was never going to go over the edge. I was never going to drop. And I had no ability myself, no matter what I did, to move the car forward. Instead, I just had to sit there fearing the heights, and wait it out until my brain cleared and I could figure out how to get myself down again. And that part was traumatic.

I have rarely felt so awful in my life as I did after that experience. I was overwhelmingly disappointed. I felt frightened from having hovered in suspense for so long. I felt grumpy and irritable. Also, I was exhausted. I had trouble sleeping that night, and the way I felt the next day was worse. It was like an experience with quasi-PTSD that I’d had in my 40s after jumping out of an airplane during another one of my adventures. (The actual skydiving part was great but everything around it terrified me – what was I thinking? I am afraid of heights! But that’s a story for another day.)

I had an “integration session” with my two guides at 9 the next morning. They reminded me that the dose I had been given was standard and that it had been determined on the basis of the optimal amount in the treatment of depression. It was not intended to zap me into some alternate universe. In other words, they were telling me that it was what it was, and I needed to work with that and see how it had affected my depression.

Talking to them helped a little, but later in the afternoon I was feeling awful again. I felt threadbare, as though the inside of my brain had been stripped of some protective layer that I was unable to get back. I felt like I should be feeling better after the treatment, but I wasn’t, and I felt as though I had no one to blame but myself.

On Monday, after a good night’s sleep, I came to the realization that it was not my fault, and I started figuring out how to put myself back together again.

Moving Forward

One week after my first dose of psilocybin, I am feeling less disappointed and more optimistic about the outcome if I give this another try. (In AA they talk about the tendency most of us have to try the same approach to resolving problems again and again, hoping for a different outcome. I hope this isn’t that. 🙂)

I feel no less depressed than I did before the dose, no better psychologically in any way, and I still feel deeply disappointed, but after a week of keeping myself occupied with activities that interest me, in order to avoid thinking about my disappointment, I am regaining my sense of direction. I have been meditating every day, trying to get some exercise (when it’s not too hot!), reading some great books, avoiding the news and social media, talking with close friends and relatives, and doing a bit of work on my novel. Anyone who does these things is bound to feel better, and it’s working well for me.

By this point, I am also fairly tired of thinking and talking about my own state of mind and my efforts to improve it, so I’m just going to carry on with my life on my life’s terms until I find out if I am eligible for another dose – and if so, when. I don’t expect it will happen soon — I gather that those who do get a second dose usually need to wait for ten weeks or so. I’m not going to resume the use of antidepressants after going to all the trouble to go off them (still having brain zaps after eight weeks!), unless I get to a point where I have no other options.

So I’m going to stop writing about psychedelics for a while and focus my attention instead on another trip: the one we are taking to Germany next month. But I will keep you posted on what happens with the study. I offer my sincere thanks to so many people who have been cheering me on during this whole experience. I am sorry I couldn’t have delivered you a happy ending without all of these complications. But I’m probably going to benefit from this experience too – even if it takes a bit more time before I see exactly how.

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

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

Ketamine? I’ll Pass

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

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

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

My Interest Is Piqued

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

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

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

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

In the meantime, I started investigating ketamine.

Ketamine Is Not a True Psychedelic

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

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

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

Ketamine Benefits Don’t Last

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

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

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

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

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

Ketamine Treatments Are Expensive

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

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

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

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

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

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

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

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

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

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

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

From There to Here

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

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

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

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

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

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

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

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

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

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

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

I’ll write about ketamine next time.

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

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

Some Background

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

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

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

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

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

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

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

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

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

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

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

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