Tag Archives: ketamine

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

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.

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 (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.