As a physician with a practice in the realm of behavioral health it's been fascinating to witness the development of approaches to treatment-resistant depression using hallucinogenic agents.
First out of the gate was ketamine (now on the market as esketamine), and currently psilocybin is being studied. It's showing promising results, however, the details re: dosing and adverse effects are still being worked out.
It's an inescapable fact: ALL drugs produce side effects (at least in some recipients). Who will or won't tolerate a given drug is mostly hard to predict beyond the overall odds.
Everyone in my field has seen individuals who have experienced serious harm due to use of hallucinogens including psilocybin. IMO using this class of drugs shouldn't be considered trivial. Sure, a lot of people have taken such "illicit" drugs without lasting problems, but response is a stochastic function. Odds of harm are no doubt small but as use spreads to a larger pool odds are adverse reactions will emerge.
Of course people with serious depression already have major brain dysfunction and likely vulnerable to exacerbated adverse effects. Compared to normal functioning there's sharply decreased room for error.
In medicine the primary rule is "above all do no harm". Absent sufficient data backing particular practices, choosing to step into new territory requires moving forward with great caution and care.
I'm not a health professional but I think medicine for the mentally ill is clearly overprescribed and this seems to be mostly a US thing. Although sadly, it is spreading.
Times past stepping into a therapists office you'd be sent to get zapped for being a gay man or a hysterical woman and prescribed all manner of questionable treatments from cigarettes to most recently opioids. I heard those things might be bad for you too.
The advice "we don't have data you should do nothing" is essentially a no-op. Useless, but you're fulfilling your primary rule, fair enough.
If the advice is "we don't have data on psychedelics, they have an unknown risk factor. But we do have data on this pill with a known factor, so you should take it instead".. well. We're all adults.
If you're in my office and I recommend a medication that you decide not to accept I'm not going to twist your arm to take it.
I might take calculated risks and do things myself, but when there are unknown risks due to utter lack of knowledge, you're right I wouldn't advise it for others. In my role trustworthiness is everything, it simply is wrong to do things that violate patients' trust. So true I won't take unnecessary chances with their health and well-being.
Not my job to defend conduct of others of decades ago. I could argue with your comment about "overprescribing", but really I see no point debating non-issues. Discussion only means something when based on facts, IOW it always comes down to specifics, not squishy generalities.
I don't know how one can reasonably weigh between a medicine with known risks (and plausibly unknown risks!) and the unknown risks of something like psychedelics, which are not yet understood at all but anecdotatlly appear to potentially have a very high reward/risk ratio.
Shrooms is not cocaine, you can't OD on the stuff. That is not to say it can't cause other types of damage.
Not prescribing anything at all might be the safest course of action.
And here you also say that unlike the advice you give your patients you might decide differently when it comes to yourself.
> Not my job to defend conduct of others of decades ago.
I'm not saying this judgmentally, there doesn't seem to be an obvious way to reconcile all these things.
Your predecessors clearly also meant the best and gave the most prudent advice they could at the time. This is something to factor into the risk profile. The most trust worthy thing to do is admit that there are limits to our knowledge. But I understand why you would hesitate to provide this asterisk with your advice as a lot of people will take it poorly and rush to webmd and homeopaths as a result.
> I don't know how one can reasonably weigh between a medicine with known risks (and plausibly unknown risks!) and the unknown risks of something like psychedelics, which are not yet understood at all but anecdotatlly appear to potentially have a very high reward/risk ratio.
Yes, the key word in your statement is "anecdotally". Anecdotal evidence is not good enough. Need to have systematic, carefully vetted evidence documenting specific benefits and risks before it can be said the compound is understood well enough for general use.
There's a process to work out drug dose/risks. A prospective treatment goes through phase 1/2/3 trials. Basically it's about discovering the characteristics of a drug, good, bad and ugly. Well, at least as much as can be discovered in the course of it.
> That is not to say it can't cause other types of damage.
Exactly so. Hallucinogens can be bad for people with predisposition to psychosis, mania, panic attacks, dissociation. That's maybe ~3% of the total population. People may not know or care if they're at risk, so it can be a problem.
> And here you also say that unlike the advice you give your patients you might decide differently when it comes to yourself.
What I mean is that I have an obligation, taken an oath, that I won't knowingly expose patients to unnecessary risks of harm. It's always about having evidence that benefits exceed risk. It's a judgement call to be sure. In any case everything is done under full disclosure and consent.
I might be willing to take on a risk myself with less sure evidence of benefit than I could justify recommending to patients. There I have a higher burden of proof to meet. IOW I can experiment on myself but I won't experiment on others who might go along with it just because they trust me.
> The most trust worthy thing to do is admit that there are limits to our knowledge.
Fully agree and any trustworthy person would say "I don't know" when in fact one doesn't know something. When it comes to human knowledge it's always limited. For one thing we can't know what is unknowable, capabilities are constrained by our neurophysiological construction.
I'm OK with saying so when I don't know. It happens a lot.
One more point. It's true past practices in medicine are troubling to us now. I have qualms about certain things being done now. But cultures evolve, ideas of what's acceptable and not change. Applying today's ideas of standards to prior generations is likely to lead to a negative judgement, but is that a fair appraisal of our predecessors?
If we take a hard, critical look at our own time, and think about how some contemporary practices (not just in medicine) will be viewed by people 100 years from now, really what will they think of us? Plenty of current things would qualify, but it's hard for us to see them that way. Culture is invisible to the people embedded it it.
> It's showing promising results, however, the details re: dosing and adverse effects are still being worked out.
I'm gonna let out a galaxy-level eye roll when the FDA comes out with a "prescription" psilocybin x mg/kg or whatever. People have been taking mushrooms since the stone ages. The standard that these drugs have to meet is just so freaking high compared to say, Ambien, or Xanax, or Zoloft, or Prozac, which are given to at-risk populations by default.
Yes, fascinating to watch, but as usual the hype outpaces the science. Two major issues not discussed in the article: 1. How do you do a placebo-controlled trial? All subjects will know the difference between psilocybin and placebo. And there are often huge placebo effects in depression trials. 2. No one has done a controlled trial with more than one dose. The best RCT so far, done by Compass, only followed patients up for 12 weeks. By that time there was still a numerical difference between drug and placebo, but it was narrowing and no longer significant. Extrapolating from the available data, the drug and placebo groups would have converged after 6 months. So what does that look like for a treatment? Do you have people trip every 3-6 months? How do you structure a Phase 3 trial to test the efficacy of, say, the 4th dose?
It's actually not so easy to assume that hallucinogen-naive test subjects will know the difference between psilocybin and placebo. Knowing the effects of a hallucinogen (i.e. reading about them) and actually experiencing the effects are quite different.
At least, this is something I found surprising after experiencing a hallucinogen (or any psychoactive drug besides caffeine) for the first time.
For me, the experience gave me the realization that everything is a hallucination, that all of your every day experience and thoughts are constructs, and that knowledge becomes as fundamental and intimate as the sensation of breathing or touching. If you're paying attention on psychedelics, you realize that your skull is your very own Plato's cave.
Going from caffeine and occasional marijuana to mushrooms was wild. You'd have a better chance of learning how to fly a helicopter from a book than understanding what psychedelics will feel like by reading or listening. Naive users might get fooled by a niacin flush or placebo, but once you've experienced it (and paid attention) there's no way you'll mistake the real thing.
It also gives you the perspective needed to appreciate music like Shpongle and hippie intellectuals like McKenna and Watts. If you haven't experienced psychedelics, you're like a blind person being told about colors. You literally can't understand it until you live through it. Like orgasms or childbirth or religious ecstasy, some things transcend mere explanation.
Psychedelics are great since they give you a shortcut right into the matrix, and you're confronted with the fact that you are indeed in a simulation, and that your existence in relation to the rest of the universe isn't nearly as distinct and cleanly delineated as you thought.
The radical changes in personality stem from whatever neural machinery that governs openness to experience. I think it makes sense that the change makes people less depressed and anxious. You allow yourself to pay attention to other things, and it becomes easier to avoid fixating and catastrophizing everything wrong in your life.
True, the psilocybin effects might be different than expected, but I think absolutely everyone could tell the difference between psilocybin and a sugar pill.
I'd like to see a trial in which the participants are unconscious for the duration of the "trip". This would not only be trivially blinded, but also help to establish whether the antidepressant effect stems entirely from the subjective experience, or whether there's a chemical component as well.
People always say, "the trip is integral!". But we don't actually know that, do we?
"Of course people with serious depression already have major brain dysfunction and likely vulnerable to exacerbated adverse effects. Compared to normal functioning there's sharply decreased room for error."
Is there actual evidence showing that depressed individuals are more likely to suffer adverse effects?
> Patients with depression are warned not to take psilocybin on their own.
I understand this is a standard disclaimer, but I thought I'd throw in that the drug depressed persons should really avoid taking alone is alcohol, especially in large quantities
Speaking from personal experience, psychedelics can have a very emotionally cathartic effect. At the end of it, you feel like you were a sponge full of emotion that has just been wrung out. I can definitely see how if you're "stuck" in some kind of pattern, exercising those emotions can help get you "unstuck." I would probably recommend someone do this once every other year.
My personal experience is decades old, but different. I never had an emotional release provided by LSD. Instead, there were enjoyable visual hallucinations, ability to concentrate, and a heightened appreciation of beauty.
But then coming down after a few hours was an emotional dumpster fire. It was really hard to endure emotionally; self-doubt, paranoia, and extreme sadness. But after many trips, not overreacting to those feelings, and knowing they'd pass, became a skill.
It was never less painful to come down, but it did become expected, understood, and manageable. That skill has since served me well in other contexts.
This is fascinating, my experience is quite the opposite. The coming up is a very uncomfortable experience, both physically and mentally, but the coming down is the best thing ever: everything is at piece, in its right place, the world has a beautiful glistening aspect to it. I truly bite the bullet of the up phase to bask in the comfort of the coming down phase.
Psilocybin has been in the news lately, but I'd say many drugs that cause a significant, immediate and forceful shift in thinking can work for depression.
From my own experience making and taking a simple drug, just experiencing good thoughts once in a while kind of pulls me out of persistent/chronic depression. I know I'm getting better when I start thinking "wow, trying to kill myself was actually horrifying yo!".
The trick, imo, is to take something that is guaranteed to make you think happy/different thoughts (not only feel good). Which is why I think there's better options than psychedelics that can cause bad trips, at least for some types of depression. Which is also why cannabis can work but is very hit or miss - it having short or long term negative effects is very likely.
Now if only it wasn't so fucking hard and risky to create and use your own medication. Alcohol is perfectly legal and absolutely life destroying. But God forbid you even possess something illegal - they'll make sure you don't end your years of suffering. Oh the Hugh manatee.
Psychedelics are weird: some people will speak very positively about them. Other people get fucked up for life. It's like rolling a dice. Imho that's not a risk any person with sound judgement would take.
But I'm also sure they've helped many people as is evidenced by the replies here.
The older I get (and the more I hear about people ODing in the news and from friends), the more I think that drugs as a whole are bad and alcohol is only borderline acceptable because of inertia
As far as I know you can't sensibly OD on LSD for example. It doesn't really cause addiction and to OD you need to take something like 100x the effective dose.However the psychosis danger would still be a valid concern ("rolling a dice" puts it quite nicely)
the OD part wasn't with respect to LSD but towards drugs in general. I've known people who got started with psychedelics, then moved on to molly (not real MDMA, like the dangerous synthetic street shit), and onto other stuff after that. It makes people more susceptible to drug culture
I can't imagine anyone physically ODing on LSD if it's legit. But there's two risks: adverse mental reactions and adverse physical reactions if the shit you take isn't real
Humans can be allergic to anything - re-read your post replacing 'Psychedelics' with 'nuts' - no-one gets this excited over peanut allergies - we've replaced this fear with education, drugs should be the same.
Inertia is the worst justification for alcohol I have heard yet. If I could wave a wand and remove the most dangerous drug on the planet it would probably be alcohol.
in another thread I mentioned psilocybin mushrooms and how it helped depression in a lasting way I was downvoted to oblivion because it was "shaman and not based on science".
Good to see more and more science come out to explain the mechanics.
We are on the verge of drastic improvements in mental health across the board but I fear that a certain industry with commercial interests will naturally seek to do anything and everything to make sure their interests are unaffected.
I’ve been surprised by the negative opinion of self medicating held by a vocal group here. I can honestly say this medicine saved my life. I put my hands in the care of “the system” for too long and it never got me anywhere. A few months of microdosing, occasional tripping, and meditation/breathwork has completely changed the trajectory of my life.
happy to hear that brother, I also note that this might be geographically related, I saw at one point (posting outside west coast 9~5pm) rise to 20 upvotes, and then downvoted (during work hours in west coast).
consequently when I type some comment near the end of the work day, it gets downvoted initially but then drastically attracts upvote outside the said work hour.
I've heard this many times now: psilocybin and related drugs anecdotally are breakthrough treatments for some patients. Does that mean the "brain gets rewired" or is the experience so profound that it changes the patient's outlook?
Either way it's great for the people that had positive experiences but also sounds scary in general, what if the profound change flips the other way?
Patients with depression are warned not to take psilocybin on their own.
With no physical dependency potential, low abuse potential, and an LD50 of above 250mg/kg, the only significant danger from taking mushrooms comes from the police.
1) (set) A bad trip can result in a massive setback in terms of one's mental health -- which can take months or even years to overcome. This risk is significantly mitigated by the presence of an expert (which may be a therapist, and may be a seasoned psychonaut) who can talk through issues as they arise for the tripper.
2) (setting) People on mushrooms occasionally do really stupid shit. A naive user might not expect the trip to last for hours, realize they're "late" for some real-world engagement, and get into a car to drive there. Early into one of my first trips, I noticed that a 20m cliff appeared to be getting shorter... nearly short enough to jump. This can be mitigated by the presence of an expert (or, honestly, almost any sober adult), who should ensure that the immediate environment is effectively baby-proofed.
>A bad trip can result in a massive setback in terms of one's mental health -- which can take months or even years to overcome
This is extremely rare. For perspective, there are people who drink once and overdo it, and end up dying in accidents or fights. But no one talks about it because it's equally rare and alcohol is socially accepted.
>People on mushrooms occasionally do really stupid shit.
Sober people do really stupid shit all the time, too.
Anecdotally I've taken 6g of dried shrooms (they are decriminalized here, for what that's worth) and was still able to refill my coffee and walk up and down a flight of stairs without spilling it or falling. I still wouldn't drive like that, but liquor impairs my fine motor skills a lot more. Driving myself to the hospital if I had to would've been possible off shrooms, but I can't say the same about half a bottle of whiskey.
Every drug is slightly different for every individual and no two highs are identical, sure, but for most nothing bad happens with psychedelics.
> This risk is significantly mitigated by the presence of an expert (which may be a therapist, and may be a seasoned psychonaut) who can talk through issues as they arise for the tripper.
> Shamans, curanderos and experienced users of ayahuasca advise against consuming ayahuasca when not in the presence of one or several well-trained shamans
I think a seasoned psychonaut friend who actually cares about you and isn't trying to get paid might be nice.
What the hell does a therapist have to do with it? You can just tell this is going to be another bs licensed profession in the future. Welcome to Spores'R-Us may I take your order.
Not everybody can find a seasoned psychonaut, though. The closest they'll have access to is their drug dealer. A therapist with a clean supply and training in trip support is preferable for two reasons: the clean supply, and the legal system. You don't go to the cops if your dealer steals your wallet and car while you're tripping on whatever you bought. If your therapist is a shithead, there's a licensing body you can report that to.
No, I don't trip with my dealer. Nor do I recommend it: I suggest that a risk you could incur is your dealer stealing from you while you're blitzed on the floor of your apartment. And should that happen, the police will happily book you for admitting to one crime while reporting another.
And, yes, your therapist would technically be your dealer at that point. But, key difference: the strictures of legality are stacked in your favor at that point.
Now that the goal posts are squarely on the moon, let's put them back into their original position. We've established that your dealer isn't trip sitting in the absence of an experienced friend. So who is?
Where did we establish this? If you don't personally have an experienced friend willing to do this you can always go out and make one. That would also allow for safer and easier access to the illicit substances.
If that is too overwhelming and difficult perhaps you're not ready for the experience in the first place. This isn't a dig at anybody.
The absolute necessity for a guide is also a completely baseless claim. It is prudent advice I suppose but nobody can really promise you a risk free trip or good results.
This is hardly uncharted territory. I'd start with reading some Terence McKenna rather than taking advice from randoms online/offline.
There is a reasonable body of work and advice on the subject available for those who seek it but you need to use your own judgment, and have good judgment.
Paying for an authority figure (note that I specifically opted not to use the word expert) to do your thinking for you doesn't always work.
If you are afraid of your dealer don't tell them your address. Also, find a not scary one. Meet in public. I don't understand your scenario.
Also if your therapist is selling you shrooms that is still a felony for both of you despite them having a license. The license is for therapy only, not a get out of jail free card.
If a researcher is administering shrooms as part of a study I think you can relax about your car being stolen buddy. Or take the bus there just in case. :P
From my understanding therapists can help you “integrate” your experience (post trip) into your everyday life. Having someone to help you figure out how you can apply useful feelings/mindsets you may have had during the experience seems (to me) helpful in maintaining any sort of benefit longer term.
Who and what bestows upon them such powers other than their own claims? The legal research of psychedelics has only recently resumed and is only available to a very select few.
Well, clandestine psychedelic assisted therapy has been going on for at least a few decades and seemed to be largely based on both psychedelic experiences had by the therapist themselves, and trial and error - which you could argue is not too different from shamanic practice.
I’m not sure how much, if any, scientific rigor was applied in the past - I hope that changes.
A trained therapist (the definition of which will have to wait) is crucial when you leave the domain of surface psychological work, which can last many years even at above high doses without a correct structure in place and understanding of the phases of psychedelic work (there are two phases: sense tuning, where 99% of journeys end because of lack of attention control and reactive immersion of the attention in sense perception changes such as visual or auditory hallucination which then become full experiences due to the immersion; and the work phase, where you coordinate with the psychedelic on the unfolding of your intent).
Once you begin work on root causes of the psychological structure a seasoned psychonaut may not be sufficient, unless they have themselves done root work, because if seasoned means years of experience at high doses at the surface of the structure, they don't have the capacity to hold you and at the same time allow you to continue through root work, when your points of reference framework is taken apart temporarily for the purpose of understanding the pattern of self-judgement that is ingrained in the foundation of your perception of reality, and during that short period of time when your points of reference are suspended, everything within your present environment including empty space reveals a memory that is connected to self-judgement and which triggers self-judgement in the moment. This is happening while the psychedelic is digging out the root of that pattern and until it is dug out, your inner and outer perception becomes a unified experience of self-judgement. Until the root is uncovered, and prior to that day of therapy, the experience of self-judgement in daily life was a series of disconnected nodes in an invisible graph. Depending on your involvement in self contemplation, some patterns within the graph may have become known to you, but that didn't stop the experience of recreating situations that further the self-judgement. Once the root is uncovered in therapy, the whole graph becomes available to your conscious mind and you are able to clearly see the initial experience or set of experiences from which the self-judgement pattern evolved, and are at the same time able to understand every single past experience that had the mildest expression of that pattern and see the aspect of your personal identity that is the growth of those experiences. Most importantly, from that moment onwards integration becomes possible, integration being the recognition of the pattern in the present situation and connection of the present situation to the root of the pattern which enables you to introduce conscious response into what previously was habitual reaction, thus transforming the pattern. Apologies for going off track but it seemed useful to share.
The hell that a therapist has to do with it is the one you are experiencing in the moments just before the root gets uncovered, which hell may seem to last an eternity as the uncountable previous experiences of self-judgement become condensed into the space of now, and not just the experiences, but the very part of your personal identity to which in a way you are fully attached and without which you would feel loss, even though you consider it a pattern that introduces chaos into your daily experience. A good therapist, even one without extensive personal root cause psychedelic experience, will be able to help you navigate that hell, and reach the root. Without the proper structure and guidance you might not reach that experience of even beginning the work on the root, and if you do, a different outcome could be that you do not uncover the root, remain with the memory of a bad trip in which "I got stuck in a loop of self-judgement that seemed to never end", and are potentially further away from coming back to that subject and finishing the work by burying the root due to this experience, because if I went through that and didn't finish it in that sitting, I am for sure gonna take a nice long break from trying to understand self-judgement, and the condensed experience that would have led to uncovering the root will have had at least some temporary impact on my sensitivity, so I'll be fine dealing with self-judgement for a while.
I completely understand your worry though, and have one of my own, because it seems to me very possible that a future awaits where the structure of psychedelic work is not known, and the work will be limited to the surface, curing depression, learning incredible skills, and not realise the possibilities for the deep work. My worry is that psychedelics will be productised before their depth capacity is fully understood, and the product will be so appealing, near limitless in application and well marketed, that the depth work will have to wait for the next disruption opportunity in the product cycle, which in this market seems to be counted in the thousands of years.
The possibility of a bad trip in someone who is not prepared for the experience should not be understated. When reality crumbles around you for the first time, you may not make the best decisions and could hurt yourself or others. Novice users should definitely start with a low dose, and be in the company of someone they trust in an environment where they feel safe.
Definately agree. Two years ago, the death of a close friend lead me to try psilocybin as a means gaining a different perspective / coping with the loss. I don't think my scale was calibrated properly and ended up taking a fairly large dose. I wasn't at all prepared for the come up, where my body felt like it was overheating and I kept drinking chugging water feeling as though I was going to pass out. It scared the hell out of me. Luckily, I was able to call my friend who was experienced with this type of stuff and he guided me through it. If it wasn't for him, I definitely would've freaked out and done something stupid. The experience scared me that I wouldn't touch the stuff outside of micro doses.
Seprately to the point above, I eventually noticed that I could get really emotional on a micro-dose and would feel suicidal. I once did a micro-dose before work in the morning that resulted in sending a very emotionally charged email to a coworker. Haven't touched the stuff since then.
Furthermore not everyone can deal with the aftermath of a bad trip. I've seen people get messed up for a long time because they believed the delusions they had.
Yep.
15 years later, still messed up.
Not with delusions, but with the constant fear of being in that state again. The descent (is it the correct translation?) was more than particularly rough.
I was kinda anxious before, but after it's been a constant hell of anxiety/depression/stress, avoiding anything that can trigger these feelings (yeah, I'm looking at you, sugar).
> the only significant danger from taking mushrooms comes from the police
If you have a history of mental illness in your family, it is not advised to experiment with psychedelics as they can waken up latent mental illness you never thought you even had.
Psilocybin containing mushrooms & truffles were once legal in Ireland and you could just walk into a headshop and buy them like cigarettes. They were banned after someone jumped from a balcony to their death[0] after taking them, presumably after having an acute psychosis.
The popular association between psychedelics and jumping from a great height originated with another crusade by America's columnist Art Linkletter, and his claim that his daughter jumped from her window to her death because she had taken LSD 6 months before.
IMO it's the circulation of this trope that kills. People on psychedelics while having emotional issues and acting out know exactly how they're expected to behave.
And apparently, this guy jumped less than an hour after taking a small amount of them. I can't imagine he was feeling much of anything yet, although others' experiences may vary from mine.
Obviously you never had a bad trip. If you had, you'd understand the power and dangers it can have to a person.
I've had a few (always learned a lot, so all net positive experiences) but I understand the damage it can do for a person that's not fully mentally stable.
I'd call them "intrusive thoughts", like a (silent) voice in my own head that tells me something demeaning about myself (not actually it, but similar to "I'm a racist".)
But when faced with the real world manifestation of these ideas, my emotions play out like these thoughts are indeed false. And I'd expect the reinforcement to correct this over time. But it hasn't. Causes great anxiety in quiet moments, and i'm hyper aware of certain social situations. It also comes up in dreams sometimes.
The idea about myself came up mid-trip, and from it poured out empathy for others (good) but somehow the anxiety inducing parts never left.
They're forced to say that. Though any reference to alcohol should come with a similar warning.
I agree with the safety. Had an astronomical trip yesterday and I feel great for it. Fascinating journey into the nature of my consciousness and the things I fear for no reason.
> In the first, everyone received psilocybin; and in the second - a randomised controlled trial - some were given the drug while others were given a different antidepressant
How does a control group work here? It's (presumably?) pretty clear to the people who got the mushrooms that they got something pretty unusual and powerful, where nobody gets that kind of jazz from anti-depressants. I feel like that would stomp all over trying to narrow down the placebo effect
How does a control group work here? It's (presumably?) pretty clear to the people who got the mushrooms
the study compares effects both reported and measured.
double blind is important to not introduce "outside" influences, but it's not intended that the subject not experience what they take, quite the opposite, that's what is being measured.
If the people who took it report dizziness (aha!), but the people who took the placebo also report dizziness (doh), then that's not evidence that the drug produces dizziness.
You mean that blinding is not meant to be able to separate the effect from placebo? If so, I don't agree. I often hear it mentioned in the context of psychedelic research that it is a problem that psychedelics result in unblinding. E.g. Carhart-Harris the other day https://twitter.com/RCarhartHarris/status/151390616463902310...
The second trial was to compare escitalophram with psylocibin. Both groups were given psilocybin -> then brain scan. Then after a few weeks one group given escitalophram and one group given the placebo -> then brain scan. From what I can tell briefly reading the abstract.
I can't imagine they would be able to 'blind' their experiments for participants though? I mean, when you start tripping balls it becomes clear you got given the LSD and not something else... Unless they use like sub-threshold / micro-doses.
As this area was gaining legitimacy in the late 70s, Reagan and the War on Drugs happened, which made legally obtaining the substances difficult, and research funding dried out.
The backlash actually started sooner than that, and largely due to the excesses of Tim Leary, et al. Michael Pollan's book "How To Change Your Mind" covers it in detail.
A great shame, because psychedelic therapy has so much potential. Just a single data point, but my life was turned around by some formational experiences on LSD and Psilocybin. Glad to see research heating up in this area again.
I read "it changed my life" so many times on internet, but from personal experiences and many friends I don't know anyone who'd noticeably changed their life for better.
Except for only one friend, who ended up suicidal and delusional beyond repair, frequent mental hospital dweller (although all doctors said drugs could only exacerbate a pre-existing condition, but not create it from scratch).
I wonder why so big discrepancy between internet and real life here.
60s and 70s research does not meet modern standards. The validity of almost all medical and psychological research done in the era is very questionable. Some research done in this time was very good, but with psychedelics we are really starting back from square 1 because we've just begun researching it in earnest.
tl;dr If you're in medical or psychological fields and the only empirical evidence you have to back up a claim is from the 60s you are on shaky ground and need to collect more data.
First out of the gate was ketamine (now on the market as esketamine), and currently psilocybin is being studied. It's showing promising results, however, the details re: dosing and adverse effects are still being worked out.
It's an inescapable fact: ALL drugs produce side effects (at least in some recipients). Who will or won't tolerate a given drug is mostly hard to predict beyond the overall odds.
Everyone in my field has seen individuals who have experienced serious harm due to use of hallucinogens including psilocybin. IMO using this class of drugs shouldn't be considered trivial. Sure, a lot of people have taken such "illicit" drugs without lasting problems, but response is a stochastic function. Odds of harm are no doubt small but as use spreads to a larger pool odds are adverse reactions will emerge.
Of course people with serious depression already have major brain dysfunction and likely vulnerable to exacerbated adverse effects. Compared to normal functioning there's sharply decreased room for error.
In medicine the primary rule is "above all do no harm". Absent sufficient data backing particular practices, choosing to step into new territory requires moving forward with great caution and care.