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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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