Mindset and Setting are so important to have right. If you are not in the right mindset, go do something else. It reads like the dosage was also a bit too high for the first time, and while I appreciate medical purity levels in things the doc can give you, injecting everything is just ew. You can get plenty of that active ingredient ingesting it like a normal savage through your face like God intended. Anyway, ketamine is not a psychedelic, is it? And if you're 65, find some younger friends and go to a rave. I think the clinical setting is maybe the least helpful for overcoming the emotions you don't want. Too bad the damage is already done with articles like this one, that don't need further inspection by most of the population. Why, one anecdotal uncomfortable experience by someone shafted by the medical sector cashing in on research results without mastery of the medium, just one is enough to derail helpful research and exploration for decades. Is it grossly irresponsible to post what should be in the Erowid experience vault to the Washington Post? Uh. yeah. Yeah it is.
> It reads like the dosage was also a bit too high for the first time, and while I appreciate medical purity levels in things the doc can give you, injecting everything is just ew.
I was thinking about this when the author said he was transiting from lozenge to injection. I'd of wanted to stay with lozenges until that experience became more productive.
Did you seriously just suggest that people should ignore treatment suggestions by real doctors and go to a rave? And then have the gall to call the author irresponsible?
This is one of the many reasons why normal people are disgusted by rave culture.
My girlfriend used to go to camping raves and had to stop. She described the culture as “really smelly and pretty rape-y depending on the set list”. Sounds just lovely.
She still listens to the music, though, much to my chagrin as I think its fucking terrible.
You don’t know enough white suburban conservative Christian seniors. I agree it’s not exactly a huge group, but in my experience in the Midwest that’s where you might find disgust.
Everywhere else? I agree, normal people are not in general “disgusted” by kids at parties dancing all night dressed in neon or whatever the kids these days do.
It's a protestant (or WASP- white anglo-saxon protestant) history in the USA that has caused innumerable damage on medicine, education, and what is 'acceptable'.
In sex-ed, we're not allowed to talk to children/adolescents that sex is enjoyable. It's against protestant morals. If something feels good, we're not allowed to talk about it.
And in that same view, doctors should never give out drugs that make you feel good. We even have a term for this outside of doctors offices: sin taxes. Alcohol, tobacco, cannabis, mushrooms all make you feel 'good', but that feeling good is somehow bad.
So yeah, there has been a stigma on psychotropic drugs in this country because they make you feel good. And that is bad to the WASP types.
(And that's ignoring the fact that white isn't even a race to be racist against. White is a social construct created in Virginia to mean 'not negro and not indian's. Later was also 'not asian and not jew' and sometimes 'not Italian and not Irish'. But I digress....)
You are just long-windedly doubling down on your racism.
But your justificationist theory does not explain why people of other races in Nigeria, Qatar, Japan, and every other non-white majority country do not tolerate drugs.
I don’t agree with the advice but it’s a little silly to act like the institutions that have been ignoring life-saving and life-bettering treatments due to their phenomenological effects have some immediate monopoly on the right way to use those treatments.
Do we know that a clinical setting is advantageous or even neutral for these types of treatments?
Ravers/psychedelic community: “it’s the drugs, music, and community, man!”
Clinicians for 50 years while people are suffering immensely: “no.”
Clinicians after 50 years: “okay, we’ll give you the drugs in our clean room.”
Maybe clinical settings are fine, and surely the way to find out is by doing rigorous science, but it’s very possible still that the medical community is wrong on this and thousands of years of communal drug/dance/music rituals were “more right.”
I'm not sure why there's such outrage at the suggestion. The point is that doing something enjoyable, exciting or joyful when taking these drugs is very effective.
Maybe raves for a 65 year old is not appropriate, but it can be anything really: being out in nature, being with old friends, going to a concert, etc.
Personally I wouldn't take any psychedelic in a doctor's office. That to me would be awful.
Doctors (and other "normal people") are very conservative about drugs, mostly due to a history of toxic and racist politics and law around their use (except those that "normal people" deem acceptable such as alcohol and nicotine). I'd argue personal experimentation can be more useful to many individuals than strict clinical usage.
I was going to say that people in their sixties would have been in their thirties in the 90's so probably went to raves, or at least clubs, and took all manner of drugs.
Maybe she would have had a better experience spooning some handsome gentleman himself out of his mind on mdma than holding the hand of someone writing in a journal with the other hand and telling her to do breathing exercises? Or maybe not.
These are basically religious experiences and there is a human and emotional element to consider. It's highly non-obvious.
Does the rave music become any good once you pop MDMA?
I don't like EDM and unless the MDMA also changes musical tastes then I'd rather be listening to classical, acid rock or ProgRock. Or watch a movie or better yet be having sex if the stim dick I keep hearing about doesn't present itself.
I have taken LSD but not ketamine. It seems crazy to me to take a psychedelic while in any remotely depressed mental state. Even though the author knew it helps to have a positive mindset, I imagine her mindset was not really that positive at all, having been depressed for many years. I don't think we should treat these drugs as panacea, and I don't think our understanding of depression is strong enough to definitely prescribe these in one case versus another.
> It seems crazy to me to take a psychedelic while in any remotely depressed mental state.
I don't think we can apply the same broad stipulations to every psychotropic. I expect we'll eventually become very skilled at treatment and when we do, each substance would require a unique set patient preparation and prequalifications.
Anecdotes and auto-biographies are the easiest to write, as they require the least research and one is already so familiar with the protagonist.
It will be nice to see ketamine and psychedelics as part of a toolbox professionals can use for treatment. Many current antidepressants cause strong suicidal and homicidal urges. Look at the widely prescribed citalopram disclaimer.
Here's an anecdote: close person to me was crying from how hard they wanted to end it all, as well as delivered urinary tract problems, for life, from one month of citalopram, as per prescription dose.
Or you know, we could discuss somewhat proper research in connection to treatment for depression. The current chemical solutions have so many side-effects that there is a reason medical professionals have been proactively trying and seeking alternative treatment. Ketamine appears very promising.
I don't think "this is a possible result of this treatment, as observed one time" is an illegitimate subject of inquiry because it's not a table of statistics.
It's also worth considering that this one person's experience may represent the reactions of many. Over two-decades ago the Chicago Reader published one of the most fascinating "drug memoirs" I've ever read, and the author also had a terrible reaction to Ketamine, albeit under very bad circumstances:
If you check possible side-effects of very common medicine you can probably find some terrifying stuff that happens to 1 out of 10 million people. If it gets reported on in the media, it would seem a lot more common than it is. To be clear I'm not saying that's the case here, I have no idea.
Sure but would that make it wrong for an essayist to write about it if it happened to them? Writing about personal experiences seems to be a substantial portion of this guy's beat.
Does anyone have info on how/why anti-depressants cause suicidal and homicidal thoughts? I know when it comes to the brain, conventional logic fails, but you would think anti-depressants would stop suicidal thoughts.
As far as I know our knowledge of the brain and how anti depressants work is so thin that the answer to your question is … we don’t know.
It does happen tho, I 100% had violent suicidal urges on sertraline due to a misdiagnosis. They immediately put me off it but I was terrified. It was the most sudden and extreme mood change I’ve ever experienced.
Depression often has a component of being emotionally numb. The blunting of emotions can have a protective effect, reverse that and you could be in for an avalanche of emotions you haven’t felt in a long time.
You have to find the right one, and the right dosage. Otherwise it's like having the wrong air/fuel mix in a car. Unfortunately a lot of doctors will just throw out whatever they think works [0].
A competent MHD, in my experience:
- Will use both a patient's verbally provided information as well as lab tests (i.e. neurotransmitter levels) in deciding what to try to prescribe.
- For initial starting of medication will follow up in 30-45 days.
- Changes in medication (examples might be things like dosage change, or changing within the same class of medication, i.e. going from one SNRI to another) will usually have a 45-60 day follow up
- Continued follow-up on neurotransmitter levels, 6-12 months after initial starting of treatment, and once stable every 2 or so years.
[0] - My favorite example of this was a doctor who insisted I continue to take a medication that was causing me to be unable to drive. When I looked around the room and saw that every single calendar, pen, and notepad had the name of said medication, well that frankly ruined my opinion of MHDs for another couple of years (which made it take longer to finally find the right treatment.)
I have never had a doctor test my neurotransmitter levels, and have seen several for depression over the course of my life. For the most part, though, mine has been "mild" enough that I've been treated by general doctors and not psychiatrists (though therapy was involved for a time).
I do wish that there was a shorter check-in period. SSRIs do take 30-45 days to fully kick in, but if they are causing harm, that starts much sooner. I was on two that made me worse, one just gave me headaches for the two weeks that I took it, and the other triggered episodes of intense anger within two days.
Lexapro has been a life saver for me, though I know others for whom it didn't work. I think if I had felt my doctor was more involved than the 6 week check in, I might have felt a bit less alone during some of those times wondering if I was experiencing side effects or simply my illness.
I've taken several courses of SSRIs. I think it works like this: you're depressed and you have dark thoughts but you don't really feel motivated to do ANYTHING. Then you take some pills and at first they send your mood all over the place, but those thoughts are still present and prevalent. So now you feel pretty good about the idea of killing yourself.
The relationship between SSRIs and suicidality is well established, as I understand it (but then, the relationship between the condition SSRIs treat and suicidality is even more well established).
I didn't think that was the case with homicidality, though. I went looking, and I found a lot of nutbag sources saying it was the case; that's no surprise, the claim has become a political football in the US (it's an attempted rationale for our mass shooting problem).
Are there very reputable sources to suggest that SSRIs cause homicidal ideation? It's a big claim.
(A quick note: for me, the first Google result is a BMJ journal hit --- but it appears to be a "letter to the editor" type situation, and opens "The FDA admitted in 2007 that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed".)
I was given ketamine to reduce my dislocated shoulder.
I experienced something very similar to what the author writes, ending up in a black void and feeling like I'm tumbling into nothingness. I remember yelling out in the ER "no, no, NO!" as the spinning and tumbling toward the void increased.
I believe recreational uses refer to this as the "k-hole" and I found it extremely unpleasant.
Can’t possibly discount the possibility that this is FUD put out by the pharmaceutical industry to counterweight the increased openness to psychedelics, in part from Pollan’s How to Change Your Mind book and Netflix series.
My experience has been that with proper set and setting, I got months of relief from a good psychedelic experience. Shrooms. My first mushroom trip I had tears streaming down my face for something like two hours- but there was such profound relief along with it, like I was feeling and letting go of decades of the sorts of things that get a person a complex trauma diagnosis.
I’ve tried LSD; it was more cerebral whereas shrooms had a more emotional component. LSD didn’t provide that sort of relief. But the visuals were stunning (which, while newt to experience, isn’t what I was hoping for).
Also tried ketamine sessions at my primary care dr’s office. Did not like it; during the trip, which seemed to have a duration of eternity, I was a disembodied consciousness considering my life. I could genuinely see this as being somewhere between disconcerting and alarming as hell to a first -timer. Also, it wasn’t particularly cathartic and the clinical setting was an unwelcome distraction.
I'm sure you could find some unhappy trip experiences on erowid if you believe it is literally impossible that anyone could have a negative experience.
I had a single terrible experience with dissociatives, to the point that for many many years I had ongoing panic attacks. It was an absolute nightmare for a long time as I was never sure when one might strike.
Without data it’s hard to say how dangerous these drugs are, but they are dangerous. People will pipe in with how you need the right setting and mindset and on and on, it’s never the drug it’s always the patient. But even if that’s all true, none of that is objectively verifiable, people will still have terrible, life-changing experiences, and we should better understand the rate at which they will before prescribing it broadly.
A piece can be both FUD and true. In fact, often times the more truth that is in the piece the better it can be at sowing fear, uncertainty and doubt.
1. The author admits there was not a long term negative impact on his treatment.
2. People have negative reactions to depression treatments every day. Many of them are much worse. Virtually none of them end up in the washington post.
3. Untreated depression can have a much worse outcome than this treatment had on this patient.
4. This article provides no statistical information required to accurately judge the effectiveness of the treatment, or to compare it to other depression treatments, or to compare it to untreated depression. If this data showed a bleak view of ketamine treatment I think it would have been included in the article, given it's tone.
> Where does that leave me? According to reputable studies, ketamine can be life-changing for a significant majority — as much as three-quarters — of those who take it for depression. That leaves 25 percent, like me, who are not so fortunate.
> I asked John Krystal, chief of psychiatry and behavioral health at Yale-New Haven Hospital and a leading authority on ketamine use for depression, about my experience. “There is a risk that some patients will have extremely upsetting experiences during treatment [with] ketamine or psychedelics,” he said. “The experience of losing control of the form and content of their thought processes and the altered sensory experiences are, themselves, potentially traumatic experiences.”
I believe others call it "ego death" but for me, in all seriousness, it was like being red-pilled. With shrooms I suddenly saw the world clearly, without emotion, without depression or anxiety. It was the "gateway" that gave me the confidence that a pathway existed to a life without depression.. That led to ketamine therapy and remission.
Ketamine treatment seems to induce mania in some people. A friend sent me a picture he took of a notice posted on the wall of a ketamine clinic. It read as a rambling screed about the virtues of ketamine. I really wish I could find that picture. After receiving treatment, my friend became manic, and then he crashed and killed himself.
One of the major problems with "standard" psychotropic medications is that there's no standard information out there about what to expect while taking it. And by that I mean, meds such as antidepressants, mood stabilizers, antipsychotics, tranquilizers are intended to place the user into an altered mental state, but nobody will tell us what that AMS will be like, experientally.
They can easily tell us about side effects, especially physiological ones, and we can watch out for those side effects, but what about the primary effects? What about how we are supposed to feel, the advantages, why am I taking these meds in the first place? My doctors, for the past 30 years, have been wholly incapable of communicating these simple facts to me.
So it's interesting to me, when psychiatry branches into formerly-recreational drugs such as ketamine, LSD, peyote, etc, that there is already a large and substantial body of information about what that altered state of consciousness should be like. Artists have written songs, they've painted pictures, they've composed poetry, they've written novels about it.
So I think that's the only real advantage to psychedelics and such, in that there is actually more documentation on their primary effects, and so I wish all the best to clinicians as they grapple with trying to recreate Haight-Ashbury and Golden Gate Park in a sterile, dreary, clinical setting.
> I wish all the best to clinicians as they grapple with trying to recreate Haight-Ashbury in a sterile, dreary, clinical setting.
I couldn't imagine using psychedelics without being able to go outside (at night, day tripping isn't for me).
From the article:
> In the days that followed I still didn’t feel like myself. Detached.
I feel like this when I do mushrooms. I've also been in trips that scared the shit out of me (the most terrifying times of my life in fact), but they've all been beneficial in the long run. I wonder if this man's life will change more than he expects it to. I've never done ketamine so I have no idea what it's like.
Unfortunate the author 1) wasn't made aware of just how mind altering of an experience it can be and 2) seems to have been misled that this treatment can simply "cure depression" on its own
It's my experience that psychedelics can help open your mind to different perspectives and spot unaddressed issues (I believe they're issues you just aren't "allowing" yourself to see/address), but to just take it in a clinical setting and expect it to work some magic on you.. Idk.
K can be incredibly dissociative in recreational doses & this person was given ~10-20x a recreational dose - with very little warning of the gravity of the effects. I can totally imagine why it was such a terrifying experience!
I agree with another commenter about the importance of mindset and setting. For most people, even getting to the point in their lives where they can & are willing to take psychedelics (non-clinical settings) is a long journey that shouldn't be discounted. Not saying we shouldn't pursue it in more clinical ways, just that the journey & mindset BEFORE taking the drugs is just as, if not MORE, important than the drugs themselves
I’ve read enough anecdotes to conclude that most clinics are downright irresponsible. This could be in part due to the newish nature of the treatment. I was fortunate to find a professional clinic in my area for IV treatment, but even as a semi-experienced drug user, ketamine was a lot at times. Fortunately, the clinic slowly ramped up dosage each session, always confirming my comfort with increasing the dose.
I now do at-home lozenges and let me tell you, 200mg is about as far as I can push it without things getting scary. For someone new to psychedelics, this would be a terrifying amount.
I went through ketamine therapy and it was the greatest thing I've ever done for myself. In about two days, 20 years of depression lifted. It's not a pleasant experience, and to be clear I used the nasal spray because it's covered by insurance (at no cost!) but it was life changing. I went through 8 weeks of it last year and the positive benefits have continued with no negatives.
One caveat: The clinic I went to required that patients be on medication for depression at the time of the treatment. I've often wondered if someone was not on medication would it be different. I did not see any hallucinations, just felt body-drunk.
It's been 8 months and I can still honestly say it is the best thing I ever did for myself.
I accidentally K-holed once (entirely my own careless fault) and it remains one of the scariest and most unpleasant experiences of my life. Despite years of debilitating depression I'm so terrified of feeling even 10% or 20% of the way to that again that I just don't think I could do it.
I'm aware you're not supposed to K-hole from the controlled medical dose, or even from most recreational use, but the feeling of losing my connection to my senses and body was so horrible I just don't think I could bring myself to put any more in me ever again.
Very sad. What she's describing sounds like an intense fear of lack of control, trust issues, paranoia. By accepting her fears as valid, she is reinforcing the need for the blanket of control and distrust that she's probably been walking around with since childhood.
> But this was when I felt that I needed it most.
Maybe that's the reason it didn't work. If you're in distress, throwing yourself into the ocean might not calm you.
There's an increasing body of research on low-dose ketamine, which appears to be effective for persistent suicidal ideation and treatment-resistant depression. That these clinics give hero doses right out of the gate seems weird.
I was making great progress with Spravato (eskatamine nasal spray) from April until the end of July. I then moved from California to Indiana and it took over a month and a half to find someone who could provide treatment (terrible mental health care in the state). Unfortunately I have never been able to reach a disassociative state since then and even spacing the treatments three weeks apart I haven’t been able to feel much effect at all anymore.
Does tolerance build up that quickly? It doesn’t help that Jansen and insurance won’t cover any more than 3x doses (I take them in one visit) a week.
I’ve thought about IV infusion which could give a higher dose but those treatments are also hard to find in Indiana and aren’t covered by insurance (about $1000 a treatment).
Two weeks ago I tried 1/4 oz of shrooms and 5 days later 800 ug of LSD. Besides the body load, the shrooms made me a bit giddy with slightly enhanced colors while the LSD only produced a few visual patterns. Clearly something wasn’t right if those doses weren’t sending me into space like they did 5+ years ago the last time I was using psychedelics.
I discontinued my medications, including Vraylar and Wellbutrin since they seem to have saturated my neuroreceptors or something. Since then I am feeling 100% better (going from 5-15/100 of my original mental health state to about 40-50/100 compared to pre-depression). I’m hoping with more weeks off of my previous medications, they might again have an effect but I’m wondering what other people’s experiences have been.
I am not a doctor, but I have seen some very negative reactions when people stop taking pharmaceuticals to use psychedelics again. I think the combination of your ketamine treatments reducing in effectiveness, the instability from moving, the adjustment period of discontinuing those medications, and the intent on taking such high doses of psychedelics is a concerning combination.
If you are unable to find the medical treatment you need in Indiana my suggestion is to relocate to a place that you do have access to the correct medical treatment.
A relative of mine had an experience like that with Ketamine, believing that she was dead. And a friend of mine had extremely bad nausea from it. It is definitely not for everyone.
I’ve been undergoing ketamine IV treatment every 3-4 weeks, and some of my experiences, especially the first few, were also terrifying. It reminded me a lot of the fear and panic I get from getting too high with weed. But at the same time, many of my depression symptoms were significantly improved almost immediately. I feel “unstuck” in the days and weeks following treatment and can course correct some of my stubborn depressive tendencies that have been going on for years.
So that’s annoying. The experiences are unpleasant but the longer term effects are useful.
The anxiety is definitely the hardest part for me, and I have some health-related OCD stuff, so the constant “checking” that I’m not going crazy is challenging too. I was legitimately worried for a little while that it was making me psychotic after, but my doctor confirmed that my symptoms matched intense anxiety and not psychosis so that helped me relax. And they subside most importantly. Now I’ve done ketamine a bunch of times and know it isn’t going to hurt me. I can almost completely relax into it, though a stressful image or feeling I experience can still induce a bit of panic. For some reason those tend to come up right at the end of my session, if they do at all. But regardless, I’ve gotten better at riding those like waves and letting them go.
For someone like myself with high anxiety, I do wonder if there’s a better way to mentally prepare for experiences like this? Maybe some kind of coaching beforehand? I had an intro call, quick health screening, an orientation where was told a bunch of facts, asked if I had any questions, and that was basically it. I didn’t know how incredibly difficult it could be and was not mentally prepared to begin treatment. I’m okay now, but it was not an easy ride. I imagine science is still figuring a lot of this stuff out.
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[ 2.9 ms ] story [ 150 ms ] threadI was thinking about this when the author said he was transiting from lozenge to injection. I'd of wanted to stay with lozenges until that experience became more productive.
This is one of the many reasons why normal people are disgusted by rave culture.
She still listens to the music, though, much to my chagrin as I think its fucking terrible.
I’ve never been to a rave but I’ve also never met anyone in my life who has expressed disgust by rave culture. Is this a thing?
Everywhere else? I agree, normal people are not in general “disgusted” by kids at parties dancing all night dressed in neon or whatever the kids these days do.
In sex-ed, we're not allowed to talk to children/adolescents that sex is enjoyable. It's against protestant morals. If something feels good, we're not allowed to talk about it.
And in that same view, doctors should never give out drugs that make you feel good. We even have a term for this outside of doctors offices: sin taxes. Alcohol, tobacco, cannabis, mushrooms all make you feel 'good', but that feeling good is somehow bad.
So yeah, there has been a stigma on psychotropic drugs in this country because they make you feel good. And that is bad to the WASP types.
(And that's ignoring the fact that white isn't even a race to be racist against. White is a social construct created in Virginia to mean 'not negro and not indian's. Later was also 'not asian and not jew' and sometimes 'not Italian and not Irish'. But I digress....)
But your justificationist theory does not explain why people of other races in Nigeria, Qatar, Japan, and every other non-white majority country do not tolerate drugs.
Ravers/psychedelic community: “it’s the drugs, music, and community, man!”
Clinicians for 50 years while people are suffering immensely: “no.”
Clinicians after 50 years: “okay, we’ll give you the drugs in our clean room.”
Maybe clinical settings are fine, and surely the way to find out is by doing rigorous science, but it’s very possible still that the medical community is wrong on this and thousands of years of communal drug/dance/music rituals were “more right.”
Maybe raves for a 65 year old is not appropriate, but it can be anything really: being out in nature, being with old friends, going to a concert, etc.
Personally I wouldn't take any psychedelic in a doctor's office. That to me would be awful.
Doctors (and other "normal people") are very conservative about drugs, mostly due to a history of toxic and racist politics and law around their use (except those that "normal people" deem acceptable such as alcohol and nicotine). I'd argue personal experimentation can be more useful to many individuals than strict clinical usage.
These are basically religious experiences and there is a human and emotional element to consider. It's highly non-obvious.
Does the rave music become any good once you pop MDMA?
I don't like EDM and unless the MDMA also changes musical tastes then I'd rather be listening to classical, acid rock or ProgRock. Or watch a movie or better yet be having sex if the stim dick I keep hearing about doesn't present itself.
However, in the case of really obnoxious dubstep, LSD definitely helps
I don't think we can apply the same broad stipulations to every psychotropic. I expect we'll eventually become very skilled at treatment and when we do, each substance would require a unique set patient preparation and prequalifications.
It will be nice to see ketamine and psychedelics as part of a toolbox professionals can use for treatment. Many current antidepressants cause strong suicidal and homicidal urges. Look at the widely prescribed citalopram disclaimer.
Here's an anecdote: close person to me was crying from how hard they wanted to end it all, as well as delivered urinary tract problems, for life, from one month of citalopram, as per prescription dose.
Or you know, we could discuss somewhat proper research in connection to treatment for depression. The current chemical solutions have so many side-effects that there is a reason medical professionals have been proactively trying and seeking alternative treatment. Ketamine appears very promising.
https://chicagoreader.com/news-politics/me-and-my-monkey/
I googled it and couldn’t find anything.
It does happen tho, I 100% had violent suicidal urges on sertraline due to a misdiagnosis. They immediately put me off it but I was terrified. It was the most sudden and extreme mood change I’ve ever experienced.
You have to find the right one, and the right dosage. Otherwise it's like having the wrong air/fuel mix in a car. Unfortunately a lot of doctors will just throw out whatever they think works [0].
A competent MHD, in my experience:
- Will use both a patient's verbally provided information as well as lab tests (i.e. neurotransmitter levels) in deciding what to try to prescribe.
- For initial starting of medication will follow up in 30-45 days.
- Changes in medication (examples might be things like dosage change, or changing within the same class of medication, i.e. going from one SNRI to another) will usually have a 45-60 day follow up
- Continued follow-up on neurotransmitter levels, 6-12 months after initial starting of treatment, and once stable every 2 or so years.
[0] - My favorite example of this was a doctor who insisted I continue to take a medication that was causing me to be unable to drive. When I looked around the room and saw that every single calendar, pen, and notepad had the name of said medication, well that frankly ruined my opinion of MHDs for another couple of years (which made it take longer to finally find the right treatment.)
I do wish that there was a shorter check-in period. SSRIs do take 30-45 days to fully kick in, but if they are causing harm, that starts much sooner. I was on two that made me worse, one just gave me headaches for the two weeks that I took it, and the other triggered episodes of intense anger within two days.
Lexapro has been a life saver for me, though I know others for whom it didn't work. I think if I had felt my doctor was more involved than the 6 week check in, I might have felt a bit less alone during some of those times wondering if I was experiencing side effects or simply my illness.
I didn't think that was the case with homicidality, though. I went looking, and I found a lot of nutbag sources saying it was the case; that's no surprise, the claim has become a political football in the US (it's an attempted rationale for our mass shooting problem).
Are there very reputable sources to suggest that SSRIs cause homicidal ideation? It's a big claim.
(A quick note: for me, the first Google result is a BMJ journal hit --- but it appears to be a "letter to the editor" type situation, and opens "The FDA admitted in 2007 that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed".)
I experienced something very similar to what the author writes, ending up in a black void and feeling like I'm tumbling into nothingness. I remember yelling out in the ER "no, no, NO!" as the spinning and tumbling toward the void increased.
I believe recreational uses refer to this as the "k-hole" and I found it extremely unpleasant.
https://www.youtube.com/watch?v=htApRMWDueg
My experience has been that with proper set and setting, I got months of relief from a good psychedelic experience. Shrooms. My first mushroom trip I had tears streaming down my face for something like two hours- but there was such profound relief along with it, like I was feeling and letting go of decades of the sorts of things that get a person a complex trauma diagnosis.
I’ve tried LSD; it was more cerebral whereas shrooms had a more emotional component. LSD didn’t provide that sort of relief. But the visuals were stunning (which, while newt to experience, isn’t what I was hoping for).
Also tried ketamine sessions at my primary care dr’s office. Did not like it; during the trip, which seemed to have a duration of eternity, I was a disembodied consciousness considering my life. I could genuinely see this as being somewhere between disconcerting and alarming as hell to a first -timer. Also, it wasn’t particularly cathartic and the clinical setting was an unwelcome distraction.
Without data it’s hard to say how dangerous these drugs are, but they are dangerous. People will pipe in with how you need the right setting and mindset and on and on, it’s never the drug it’s always the patient. But even if that’s all true, none of that is objectively verifiable, people will still have terrible, life-changing experiences, and we should better understand the rate at which they will before prescribing it broadly.
1. The author admits there was not a long term negative impact on his treatment.
2. People have negative reactions to depression treatments every day. Many of them are much worse. Virtually none of them end up in the washington post.
3. Untreated depression can have a much worse outcome than this treatment had on this patient.
4. This article provides no statistical information required to accurately judge the effectiveness of the treatment, or to compare it to other depression treatments, or to compare it to untreated depression. If this data showed a bleak view of ketamine treatment I think it would have been included in the article, given it's tone.
> Where does that leave me? According to reputable studies, ketamine can be life-changing for a significant majority — as much as three-quarters — of those who take it for depression. That leaves 25 percent, like me, who are not so fortunate.
> I asked John Krystal, chief of psychiatry and behavioral health at Yale-New Haven Hospital and a leading authority on ketamine use for depression, about my experience. “There is a risk that some patients will have extremely upsetting experiences during treatment [with] ketamine or psychedelics,” he said. “The experience of losing control of the form and content of their thought processes and the altered sensory experiences are, themselves, potentially traumatic experiences.”
Straw man much?
I believe others call it "ego death" but for me, in all seriousness, it was like being red-pilled. With shrooms I suddenly saw the world clearly, without emotion, without depression or anxiety. It was the "gateway" that gave me the confidence that a pathway existed to a life without depression.. That led to ketamine therapy and remission.
There seems to be some literature that discusses mania from ketamine: https://www.psychiatrist.com/pcc/bipolar/ketamine-induced-ma...
They can easily tell us about side effects, especially physiological ones, and we can watch out for those side effects, but what about the primary effects? What about how we are supposed to feel, the advantages, why am I taking these meds in the first place? My doctors, for the past 30 years, have been wholly incapable of communicating these simple facts to me.
So it's interesting to me, when psychiatry branches into formerly-recreational drugs such as ketamine, LSD, peyote, etc, that there is already a large and substantial body of information about what that altered state of consciousness should be like. Artists have written songs, they've painted pictures, they've composed poetry, they've written novels about it.
So I think that's the only real advantage to psychedelics and such, in that there is actually more documentation on their primary effects, and so I wish all the best to clinicians as they grapple with trying to recreate Haight-Ashbury and Golden Gate Park in a sterile, dreary, clinical setting.
I couldn't imagine using psychedelics without being able to go outside (at night, day tripping isn't for me).
From the article:
> In the days that followed I still didn’t feel like myself. Detached.
I feel like this when I do mushrooms. I've also been in trips that scared the shit out of me (the most terrifying times of my life in fact), but they've all been beneficial in the long run. I wonder if this man's life will change more than he expects it to. I've never done ketamine so I have no idea what it's like.
It's my experience that psychedelics can help open your mind to different perspectives and spot unaddressed issues (I believe they're issues you just aren't "allowing" yourself to see/address), but to just take it in a clinical setting and expect it to work some magic on you.. Idk.
K can be incredibly dissociative in recreational doses & this person was given ~10-20x a recreational dose - with very little warning of the gravity of the effects. I can totally imagine why it was such a terrifying experience!
I agree with another commenter about the importance of mindset and setting. For most people, even getting to the point in their lives where they can & are willing to take psychedelics (non-clinical settings) is a long journey that shouldn't be discounted. Not saying we shouldn't pursue it in more clinical ways, just that the journey & mindset BEFORE taking the drugs is just as, if not MORE, important than the drugs themselves
I now do at-home lozenges and let me tell you, 200mg is about as far as I can push it without things getting scary. For someone new to psychedelics, this would be a terrifying amount.
One caveat: The clinic I went to required that patients be on medication for depression at the time of the treatment. I've often wondered if someone was not on medication would it be different. I did not see any hallucinations, just felt body-drunk.
It's been 8 months and I can still honestly say it is the best thing I ever did for myself.
I'm aware you're not supposed to K-hole from the controlled medical dose, or even from most recreational use, but the feeling of losing my connection to my senses and body was so horrible I just don't think I could bring myself to put any more in me ever again.
> But this was when I felt that I needed it most.
Maybe that's the reason it didn't work. If you're in distress, throwing yourself into the ocean might not calm you.
Does tolerance build up that quickly? It doesn’t help that Jansen and insurance won’t cover any more than 3x doses (I take them in one visit) a week.
I’ve thought about IV infusion which could give a higher dose but those treatments are also hard to find in Indiana and aren’t covered by insurance (about $1000 a treatment).
Two weeks ago I tried 1/4 oz of shrooms and 5 days later 800 ug of LSD. Besides the body load, the shrooms made me a bit giddy with slightly enhanced colors while the LSD only produced a few visual patterns. Clearly something wasn’t right if those doses weren’t sending me into space like they did 5+ years ago the last time I was using psychedelics.
I discontinued my medications, including Vraylar and Wellbutrin since they seem to have saturated my neuroreceptors or something. Since then I am feeling 100% better (going from 5-15/100 of my original mental health state to about 40-50/100 compared to pre-depression). I’m hoping with more weeks off of my previous medications, they might again have an effect but I’m wondering what other people’s experiences have been.
If you are unable to find the medical treatment you need in Indiana my suggestion is to relocate to a place that you do have access to the correct medical treatment.
So that’s annoying. The experiences are unpleasant but the longer term effects are useful.
The anxiety is definitely the hardest part for me, and I have some health-related OCD stuff, so the constant “checking” that I’m not going crazy is challenging too. I was legitimately worried for a little while that it was making me psychotic after, but my doctor confirmed that my symptoms matched intense anxiety and not psychosis so that helped me relax. And they subside most importantly. Now I’ve done ketamine a bunch of times and know it isn’t going to hurt me. I can almost completely relax into it, though a stressful image or feeling I experience can still induce a bit of panic. For some reason those tend to come up right at the end of my session, if they do at all. But regardless, I’ve gotten better at riding those like waves and letting them go.
For someone like myself with high anxiety, I do wonder if there’s a better way to mentally prepare for experiences like this? Maybe some kind of coaching beforehand? I had an intro call, quick health screening, an orientation where was told a bunch of facts, asked if I had any questions, and that was basically it. I didn’t know how incredibly difficult it could be and was not mentally prepared to begin treatment. I’m okay now, but it was not an easy ride. I imagine science is still figuring a lot of this stuff out.