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Psilocybin bests SSRI for major depression in first long-term comparison

medscape.com

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Re: Psilocybin bests SSRI for major depression in first long-term comparison

#201

Post by dingnuts »

washadjeffmad wrote: post #198
DiscourseFan wrote: post #82

Ok like most of you I’ve taken psychedelic drugs. I’ve had bad experiences sure, but I’m fine now. The issue is that what people generally say, like, “oh sometimes you need to encounter your demons,” maybe that will be temporarily traumatizing—in general people recover from that. The real issues are…more complex. More complex than any diagnoses in the DSM can cover. The brain is very complicated, and everyone’s brain…

I had a profoundly difficult trip that affected me deeply. It felt eternal, and when I emerged, I could feel it in my head like some antimemetic parasite that fed off disgust and terror. I can still remember the feeling, twenty years later, if I try, so I don't. I had to learn how not to be influenced by it, and in doing so, learned about myself. And as I changed, because I was aware of what I knew, I knew when I'd c…

funny, I could have written the same post but about boring old general anesthesia given before surgery

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#202

Post by NickM »

striking wrote: post #103
farts_mckensy wrote: post #88

Earlier quoted context omitted.

Impotence and weight gain are not just "annoying" side effects. They seriously impact your life. Just putting that out there.

I'm not claiming they don't. Everyone experiences SSRIs differently and it's common to shop around until you find one whose side effects impact your life in a more tolerable way. That's in contrast to psylocybin, which has substantially more serious potential acute side effects, ones that are more difficult to understand and treat should they occur. I'm not saying psylocybin is unsafe or that SSRIs are always prefera…

I'm not claiming they don't.

You were clearly implying they don’t when you downplayed all SSRI downsides as “a handful of annoying side effects”.

Weight gain kills. Suicidal ideation also kills many people when they start SSRIs. People have killed themselves because of permanent sexual dysfunction caused by SSRIs that never went away after stopping the drugs (and yes, this is a known possible adverse effect listed in the official prescribing information).

I don’t think the choice is as “obvious” as you’re making it out to be.

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#203

Post by brandall10 »

DiscourseFan wrote: post #82

Ok like most of you I’ve taken psychedelic drugs. I’ve had bad experiences sure, but I’m fine now. The issue is that what people generally say, like, “oh sometimes you need to encounter your demons,” maybe that will be temporarily traumatizing—in general people recover from that. The real issues are…more complex. More complex than any diagnoses in the DSM can cover. The brain is very complicated, and everyone’s brain…

Why did you take a very high dose?

As someone who was experienced with psilocybin some 20+ years ago, I always took fairly consistent doses (roughly 3 grams), as I could sense taking much more would be playing with fire. This was pretty much a given amongst my circle of a dozen friends who experienced these trips with me… hero doses were almost never a good or healthy idea. Fun to read about on Erowid though, mostly as cautionary tales.

My time with the substance ended after two bad trips (after a few dozen great ones over a period of 5 years), but neither produced any sort of even minor lasting effect.

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#204

Post by dingnuts »

phoronixrly wrote: post #78
dingnuts wrote: post #74

Earlier quoted context omitted.

that's easy to say when you forget about the state of healthcare.. everywhere, actually. I was going to say the US but in other countries it's not like you can just pop in for a chat about taking shroomies, either. I'm not sure having a ten minute meeting with a stranger who has a PhD in internal medicine is going to yield useful strategies for curing the existential dread underpinning your depression whether you're…

> it's not like you can just pop in for a chat about taking shroomies You sure can just pop in to discuss options for your crippling depression though? And sorry, I do indeed live in a country with a functioning healthcare system, not the US.

In the US normally you talk to a therapist (not a doctor) or psychologist (not a medical doctor) about your depression at length, and then if you're deemed sufficiently depressed you get a short consult with a psychiatrist (finally a doctor) to prescribe medication. This is when you would theoretically finally be able to bring up shrooms, and your psychiatrist will laugh at you, write an Rx for an SSRI, and you'll see him next year when the Rx expires

I'm not sure how it is in most countries but I'd expect the biggest difference is that it will cost you money in the US, but I've read many many horror stories about people waiting many months to have only a short chat with a physician from other countries. The lack of time available to spend taking to physicians seems to be a problem in other places too

my point is that consulting a doctor with random questions isn't a simple, casual thing people can easily do in most places. in most places you have to plan ahead and either wait a long time for an appointment, and/or there is a cost barrier.

if you have examples of countries where people are able to get to know their doctors on a personal level and can afford in time and money to talk to their physicians for more than a few minutes per year, please link them below

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#205

Post by wetpaws »

Levitating wrote: post #171
dimal wrote: post #145

Earlier quoted context omitted.

> we do not know, really, what goes on in there when you take a drug like Psilocybin FYI, same goes for SSRIs. The scientific consensus is that the serotonin deficiency theory of depression was wrong. When SSRIs actually work, we still don’t know why. I’ve had bad trips, too. Very bad, but I still think that psilocybin (in a controlled, supportive setting) is a better bet. My bad trips were all due to being in bad se…

SSRIs barely work. For mild to moderate depression a placebo works similarly or better. Only for severe cases of depression are SSRIs found to be helpful because they surpress all emotion.

[dead]

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#206

Post by xterminator »

Psychedelics are nice and powerful - maybe too powerful. I don't trust the system to use them responsibly. I'd rather obtain and use them on my own than as part of some private - or governmental - initiative. There's no one to trust more than a good friend to be there for you when the ride gets bumpy, not some guy in a suit doing it for the money.

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#207

Post by NickM »

dillydogg wrote: post #9

I think a major criticism of how this study is designed is that it is not truly "blinded". I doubt many of the participants were unsure if they received psilocybin vs escitalopram. That being said, there are a number of studies that suggest this is an effective treatment, so I hope this can become more available to those who need it. However, for treatment resistant depression (especially with a catatonia component),…

I think a major criticism of how this study is designed is that it is not truly "blinded". I doubt many of the participants were unsure if they received psilocybin vs escitalopram.

This is already a problem for most psychiatric drug trials; studies have found that most people can tell if they’re on an SSRI or in a control group, since the side effects are pretty noticeable.

There is evidence that this skews study results, to the point that some scientists believe that SSRIs may only be “effective” because the obvious side effects make them a good active placebo.

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#208

Post by hn_version_0023 »

drakonka wrote: post #188
Levitating wrote: post #171

Earlier quoted context omitted.

SSRIs barely work. For mild to moderate depression a placebo works similarly or better. Only for severe cases of depression are SSRIs found to be helpful because they surpress all emotion.

Maybe the effect is different when prescribed for something other than depression, but I did not find my SSRI to suppress my emotions. It simply helps me curb rumination and negative thought spirals. Helps to feel "lighter" and simultaneously more grounded. If anything, that allows me to feel _more_ positive emotion rather than suppressing it.

Cool, glad you had a positive experience. My experience was the opposite: emotionally numb to the point where awfully bad things happened in my presence and I barely shrugged.

Being unable to feel joy or pain, being unable to cry when a loved on passed on; these were the hallmarks of my time on SSRIs. Never again will I subject myself to these drugs.

It took me twice as long to get off them as I was on them. Two years of prescribed meds, 4 years to get off them. Six years of my life spent as a literal zombie person.

We don’t know why they work or don’t. Our experiences are just anecdata.

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#209

Post by NickM »

cubefox wrote: post #56

Unfortunately it's hardly possible to do proper case control studies with psilocybin, since the psychedelic effects cause unblinding. The participants know whether they are in the treatment or control group. > Normally the journey is quite inward, so patients do not require active support during the psychedelic experience [around 6 hours]. Sometimes they do require some hand-holding, or helping them to 'let go', or b…

Unfortunately it's hardly possible to do proper case control studies with psilocybin, since the psychedelic effects cause unblinding.

This is a problem with SSRIs as well; studies have found most people can correctly guess if they’re in the study group or control group.

A true double blind study would require a drug that has similar side effects via an unrelated mechanism, but nobody has attempted that as far as I’m aware.

There was this interesting one though where they deceived patients into believing they were taking an “active placebo” instead of an SSRI, and found that the benefits went away, which is very interesting and raises a lot of questions about the true efficacy of these medications: https://www.nature.com/articles/s41398-021-01682-3.pdf

Re: Psilocybin bests SSRI for major depression in first long-term comparison

#210

Post by jrflowers »

DiscourseFan wrote: post #82

Ok like most of you I’ve taken psychedelic drugs. I’ve had bad experiences sure, but I’m fine now. The issue is that what people generally say, like, “oh sometimes you need to encounter your demons,” maybe that will be temporarily traumatizing—in general people recover from that. The real issues are…more complex. More complex than any diagnoses in the DSM can cover. The brain is very complicated, and everyone’s brain…

For folks that are interested in anecdotes about psychedelics, I recommend reading Erowid expertise vaults as what gets volunteered here is very narrow and not representative of the population as a whole.

I would know, as my psychedelic mega dose stories are very different from this and also completely unique to me.

I’ve done 500ug of LSD and it was great fun. I scheduled a day off to rest ahead of time and was back to normal after that.

250ug of LSD + 1 full ounce of golden teacher psilocybe cubensis and had a somewhat spiritual experience, took a couple days before I wanted to resume normal life.

+ a dozen or more similar stories

There is a reason why “set and setting” is repeated so heavily when instructing people on how to use these substances. Any discussion of potential subjective benefits or harms of a psychedelic in the context of an experience without specific accounting for that is fundamentally incomplete.

That being said, if my experience sounds ridiculous to you, that’s because it’s unique to me, just as others’ are unique to them. There isn’t really much to be gained by talking about individual experiences other than it’s an entertaining topic of discussion. It gets everybody exactly nowhere closer to establishing the objective clinical value of these things, though.

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