Alterations in glutamate and the experience of ego dissolution with psilocybin

In short, perhaps do more research on this topic because you're arguing against a position no one has taken.

This is far from "a never-ending psychedelic trip". If you follow the evidence for the most researched treatment protocol, this would involve a session every year or half-year.

What's actually happening (either in trials or by underground practictioners) is that the super-malleable/open to self-analysis mental states that can be induced by psychedelics can be a catalyst for significant long-term shifts in perspectives and thinking patterns.

An amazing book to give you a cursory understanding of the state of the field is How to Change Your Mind: The New Science of Psychedelics by Michael Pollan. It'll give you a good understanding of what psychedelic research may be able to achieve (and what it's achieved so far).

On a serious note, this isn't what GP is referring to. Generally psychedelics in the work day are self-limiting. A microdose that is more of a mesodose makes for some interesting Zoom meetings. People learn the right dose to get a boost without excess distraction/warping. Fadiman's research [0] suggests the best dose is well below the threshold of "trip" effects. So there's no risk of never-ending daytrips, unless one desires that thing. So why limit access?

Aspects of American culture have a strong stigma against "fun", euphoria, and to an extent, any effect beyond "restoring normal". eg nootropics are popular in young, hip crowds like HN, but kinda sketch among many MDs, from "I don't think these are safe" to "why do you need that?" It's a "if it feels good, stop" sentiment that runs as an undercurrent through American history and you can see signs of it in Protestant work ethic, Prohibition (of alcohol and cannabis), and of course the war on drugs.

Keep in mind, LSD and MDMA were very hotly researched back in the day, but when subcultures started associating them with parties, that's when things started getting the kabash.

"But addiction bad" - this would be a fair argument if it weren't for the near lack of correlation between DEA schedule and addiction potential [1], as well as the rapid action to ban analog drugs without any consideration to addiction potential. This is the fate of most Shulgin compounds, many exhibiting the typical rapid tolerance of psychedelics.

That leaves the theraputic dose. These are typically administered in a guided setting, either in the clinical sense, or trip-sitters/sherpas, in the informal. This is the best mitigation against trips that leave lasting psychological harm (the term "bad trip" is very loaded, as it doesn't distinct "hard lesson trips" from "no this actually messed them up long term"). If the concern is really "harm trips", then the solution is logically harm-reduction, not prohibition.

Wew, that turned out longer than expected.

Edit: added more

[0] - https://www.thecut.com/2018/05/microdosing-guide-and-explain...

[1] pdf - http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.868...

I don't think people give this enough consideration. Tripping on mushrooms might be enjoyable to some, but having it as a regimented treatment means you are losing a lot of time where you cannot be productive, cannot enjoy the company of your sober friends and family, etc.

And historically, that's exactly the way psychedelics have been used, for thousands of years. A shaman/guide would provide the medicine and help the people go through the experience, usually in a tight community where there's follow up and support.

Unfortunately that was suppressed, first by the Catholic Church when the Spanish arrived to America, and now more recently by making psychedelics illegal.

The idea of psychedelics being some sort of party drug is a problem of the current state of affairs, politically and culturally, where we have abandoned or forgotten their origins.

What does conscientiousness have to do with it?

You might need to travel or transit through a country which prohibits carrying them. Now you have to cancel the trip or go without the medicine.

> by all means come up with a one-time cure on your own

This is not helpful. People have the right to ask questions without being asked to devote a lifetime to develop some arbitrary authority (which would then in any case bias them to look for positive results).

Is that common in people suffering from mental ill health?

From the article: "...clinical trials with psychedelic drugs suggest long-term anxiety relief in patients..."

I'm not really sure what the context of your comments is, if you're not aware that this is what the entire thread is about.

How insensitive of you.

Yeah. Funny thing about that. You're generally prescribed as low of a dose as is feasible, so by the time you're due to take your ADHD meds, antidepressants, antipsychotics, or whathaveyou, the last dose has worn off (especially first thing in the morning) and you're liable to miss a dose. So you get a pill minder, and fill it weekly, so at least you can check to make sure you don't forget and double-dose yourself. Chances are, you're taking several meds, so you have a highly detail-oriented chore you need to succeed at once a week on a specific day. If that's a bad day, you might not be able to muster the motivation and that throws off the whole week. Or you get most of the pills in but accidentally miss a day or a whole week's worth of a drug because you're juggling a handful of bottles and you're only human. Phone apps sound great, but depend on you being near your pills and your (charged) phone at a specific time of day, which has all sorts of failure modes.

And then there's the uncontrollable shit. You pack for a trip out of town. You're only supposed to be gone for a week, so you diligently pack a week's meds. Your ride home flakes, flight gets cancelled or whatever, and suddenly you're S.O.L. Or, your bag gets rifled by luggage inspectors at the airport and they pocket the goods (I've lost a nice pocket knife that way), it's stolen by hotel cleaning staff, pickpockets, or whatever. Good luck getting your prescription filled in a different country.

And once you miss a pill, you might hit a spiral that lasts a week or longer before you get back on track. It's a fucking liability.

I have a permanent medical condition which calls for a somewhat antique medication. It is typically used "as needed," certainly not every day. I have had a regular prescription for over a decade and it has certainly improved my quality of life. I refill like clockwork, I am responsible about using it. It comes time for a refill and ... my pharmacist at Walgreens regrets to inform me that they cannot seem to get it, and that the manufacturer has stopped making it.

This is worrisome. I remember life before the medication. I dig through the FDA databases, locating every organization which has applied to make the medication and been issued an NDC (National Drug Code) identifier. Each organization is tracked down: are they still in existence? Have they been bought out and if so, by what other company? I discover buyouts, shutdowns, press releases saying that they are "exiting" some market. I make phone calls, I send emails, and, when no other contact information is available, I send letters with self-addressed stamped envelopes. Almost everyone who has ever made it has stopped or been stopped in one fashion or another. Meanwhile, I begin to canvass the distributors: McKeeson, Cardinal, AmeriSourceBergen. Are there any remaining in stock? If so, which pharmacies in my area do they work with? Most pharmacies have a single distributor. These are organizations who do not like to be contacted by the hoi polloi, and I have quite a lot of "How did you get this number?" conversations.

At last, a hit: someone has just started manufacturing it. Out of all of them, there's only one. I dutifully take this to Walgreens. After a few go-rounds, they cannot seem to get ahold of it. They suggest Walmart. I have to hassle my poor doctor's office, now in COVID-panic like everyone else, to move my script, which one required a special paper. Walmart swears they have it, they have contacted their distributor, they have bottles in stock. Wonderful. And it does not arrive, they call again, and it does not arrive, and they call again. Finally, they shrug and give up. Right!

I call CVS; they are sure they can get it. I transfer the script, again. Off I go to CVS. CVS says that, yes, it is in stock at their distributor. Similar to Walmart, after a few weeks, they cannot get it. The pharmacist has called the corporate offices and only knows that there is a "corporate block" on it and that, despite being able to submit an order for a bottle of pills which are present at a distributor, they will never ever arrive. I am disappointed, and, out of a little curiosity, I submit a letter to CVS corporate (again with the self-addressed stamped envelope to remove barriers to reply) asking just what this block is ... not that I ever get a reply.

I try a small, local shop. I wince at having to call my doctor to have the script transferred yet again. Surely they will try harder rather than giving me the brush-off you can so often get from large organizations. No dice. The dance is now familiar to me.

Armed with yet more research and NDC codes and distributor phone numbers, I approach my original pharmacy again. Another script transfer, with all of the pain entertained in moving something with a low Schedule number around. With the new information I have gathered and a great deal of persistence, they manage to obtain it. The head pharmacist tells me that the sole other patient on it will be relieved, and that he has never had to work this hard to get a prescription before.

By the end of this two month period, I had lost approximately twenty pounds and was clumsily knocking things over due to my coordination degrading. Finally, I managed to fall hard enough that I was still limping two months later.

The moral of the story is this: being conscientious does not guarantee availability. One can do all of the right things and still not have it on hand. Being dependent on a medication, even weekly, can be a burden, even if you attend to the situation quite closely. I urge you not to be quite so flippant about it.

"One time cure" is indeed not accurate, today, but as a shorthand it captures the promise of psychedelic treatments. A single session can give benefits lasting many months, and some people may remit entirely. This is why more research is needed.

>I'm sure the vast majority of people would prefer a daily pill that has no cognitive distortions.

These don't exist. Existing psychological medication, not unsurprisingly, often comes with severe cognitive distortions - far worse than a single psychedelic trip every few months.

I do think brains should be viewed as different from most organs when we describe medical intervention, they are plastic to a degree other organs are not. If a diabetic could simply 'mutate' their pancreas to function normally with a single intervention, I think most would prefer that to taking insulin all their lives, even if the one intervention was distressing.

Brains actually can change in very dramatic ways. Most are for the worse of course, and we instinctively avoid any change in our mentality, but they are times when it is actually preferable.

That's pretty much how every treatment, for almost anything, should be.

Unfortunately, in most professional services (not just doctors), the people providing the service just have a few "recipes" on how to solve certain types of problems and then they just prescribe that. If your problem doesn't fall into any of their predefined categories, then good luck.

The typical interaction is: you have an initial session/interview where you describe your issue, then they immediately diagnose you (unless they require some additional info - documents/exams), and finally they provide their predefined solution. They never observe you in your daily routine to see what's actually going on, they don't study you to provide a personalized solution.

It's as if programmers would never debug a program, only get told by someone what the issue is and then they provide some library/api/piece of code that deals with what appears to be the issue from the outside.

Seems like a bang-up business model, along with all sorts of other regular-meetings-with-the-professional therapies. Biologics on the pharm side, or just plain old therapy on the practitioner side.

Industry has plenty of practice with "every month or two" doses, so I wouldn't be so cynical in the attempts to remove the side effects. "Can you do it without getting high" is something that would greatly expand the audience and give people a better experience.

Very true. I used to fancy myself a psychonaut, then i got careless with 5-meo-dmt. Now i'm a teetotaler. Upon reflection i can't say i ever really liked tripping.

Then in time I met more and more people who regularly use psychs who were stuck in dogma. Recently I saw an interview with Dennis McKenna of all people who regularly trips (like his brother) and he just came across really disconnected like a dogmatic liberal like he was repeating what he had been told rather than thinking for himself.

It's been bothering me for a long time trying to understand it. I think the conclusion I have come to so far is that it opens your mind but only above whatever baseline you came from. The other thing is because the experiences have a feeling of being profound people who are not that open minded end up worshiping it and just fit themselves into that niche.

You gotta test. Don't dismiss the need to test.

I am sure I have overstated the risk, or maybe that is just my anxiety talking. I never had any actual plans to hurt myself, just overwhelming fear and dread to the point I wished it would end by any means.

Thankfully I have my wife to keep me accountable

Wish you well and I hope you have a fruitful journey :)

Agreed, but part of the problem is that they're often framed by their proponents as a miracle drug that can cure you of depression, anxiety, and fear of death. So people with those problems will often self medicate with them.

And for some people, it totally works. But it can backfire tremendously, and actually worsen those problems. There's a psychonaut meme that there's "no such thing as a bad trip, just a difficult one", but that's absolutely untrue.

I think psychedelics have incredible therapeutic potential, though, and I'm looking forward to a world where they are legal, well tested and researched, and usable in safe environments with trained and compassionate professionals.

But therein lies the crux of this kind of reasoning: those kinds of requirements are vague and highly subjective - what does "mentally balanced" entail? who determines that?

It would require a high level of self-awareness and even then, some woundings/mental illnesses may not be apparent until some sort of traumatic event (such as a bad trip). It's incredibly difficult to know ahead of time what kind of reaction someone is going to have to such powerful mind-altering substances and IMO although the advice of "set and setting" is important, it in no way will prevent all possible issues from happening.