Wednesday, 22 May 2024

I've seen people self-medicate with psychedelics and the effects worry me

A 19-year-old patient, instructed by voices brought on by drug use, attacked a elderly man with his own zimmer frame. 

Once admitted onto my ward, she doubled down.  

She was convinced that psychedelic drugs – magic mushrooms in particular – were her only cure. But it was taking drugs including psychedelics that had brought on the illness and caused her violence. 

As a medical doctor specialising in psychiatry, this is just one of a handful of patients of mine in the last year who have developed some of the most serious mental illnesses as a result of psychedelic drugs. 

Unfortunately, my colleagues tell me similar stories too. 

Psychedelics are an exciting possible new treatment for mental illness, make no mistake, but they create powerful experiences that can also cause harm, particularly when taken in the non-clinical settings. 

Mental illness around the world has reached a critical point. One such illness is depression, now reported to be the most disabling illness on the planet, more than joint problems, heart failure or cancer.

But it is just one mental health condition among a collection of ghoulish friends that haunt many of us. The most villainous is psychosis – in which people are persecuted by hearing and seeing things that are not there and become wrapped up in impossible beliefs.

For example one patient hears demons speaking to him, while another believes that Satan is standing outside his window at all times. 

Besides genetic predispositions and trauma, these illnesses are driven by sedentary lifestyles and isolation born from technology and lockdowns; drug use also contributes. 

Scientists and psychiatrists are grasping for straws of hope to ghost-bust these ghouls. But it is not easy. 

Enter psychedelics: drugs like LSD – the one that the Beatles sang about – and psilocybin, the active ingredient in magic mushrooms. They’re different and – in many ways – safer than other street drugs like cocaine or amphetamines. 

But they’re certainly stranger. They cause changes in people’s perception and can cause hallucinations. Emotions become more intense and changeable. At higher doses, the patient’s sense of self falls away. Crucially, after some hours, they return to everyday normal life experience.

Early evidence suggests psilocybin might be effective for many mental health problems, including cigarette and alcohol addiction, OCD, anxiety disorders, and anorexia nervosa.  

For depression in particular, evidence is accumulating for it to be approved and licensed for medical use in the UK. It has already been approved in Australia, by means of a fast-tracking process.

But this means it has been tested on fewer people than other, less desperately wanted medications would need to be approved.

Is this hasty? Scientists and doctors hope not.  

When compared to traditional antidepressants, psilocybin is statistically as effective for depression, but it crucially appears to have fewer side effects. There is reason for excitement, but not for hype. 

This hype is already happening though. 

From unfiltered glowing reviews on social media to punchy positive pieces in the news, it’s everywhere. But non-scientists don’t hear the careful notes of caution the serious scientists always include. 

Roads to hell are paved with good intentions – and here they proudly proclaim these drugs are ‘safe’ without knowing what that means. This is doing some people harm, as medical validation bleeds into more reckless recreational use. 

Meanwhile, when scientists say they are ‘safe’, they mostly mean safe in clinical settings, safe as far as we know, in the short or medium-term, or safe for people not at risk of illness. 

While psychedelics might help patients with some mental health conditions, they can worsen or even cause psychosis. 

Over the last year, I treated a young man whose 14-year battle with personality disorder began when he ate psilocybin truffles in Amsterdam on a lads’ holiday. 

Or there was the young man who drank mushroom tea to try to treat his depression. He said it helped at first, until 30 days later he was found wandering the streets believing he was God. 

Many more patients ask me without prompting if they should take these drugs. All of them for illnesses for which there’s no scientific consensus yet that they will work or be safe. All of these people are desperate for help, and vulnerable to promises of a panacea. 

And plenty of people purvey them as a panacea, with only blind optimism about their effects.  

Challenging experiences can be therapeutic, it’s true. This is the heart of therapy. But too much challenge causes damage. 

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Platform is the home of Metro.co.uk’s first-person and opinion pieces, devoted to giving a platform to underheard and underrepresented voices in the media.

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Psychedelic experiences are astonishing, but they are equal parts dark as well as light. Plenty of people are traumatised by them, and recreational users will rarely work through that difficulty with a good therapist after the experience. 

The best researchers, like those mentioned above, emphasize the science and balance the conversation. Others, like Jules Evans at the Challenging Psychedelic Experiences Project, work to ensure we don’t ignore the darker side of psychedelic experiences, and the harm these can do. 

So will psychedelic medications bear flowers or thorns? 

Flowers are likely. But we should be wary of the thorns that come attached, especially from recreational users self-medicating, or emboldened by messages about them being ‘safe’ without really appreciating what scientists mean or before all the evidence is in. 

Careful of the hype. 

Jonathan is a doctor, psychedelic researcher and science communicator. See him at New Scientist Live on October 7th at ExCeL London.

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