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Comment by milchek | Hacker News Reader

Anecdotal, but about a year ago my wife participated in a psilocybin trial at a university here who were looking at patients with severe anxiety. It was her last hope after trying therapy, various supplements, as well as dietary and lifestyle changes, etc

It has been life changing for her, but one thing she tells people now is that what also helped was that it was facilitated with a trained therapist there during the session for guidance to make sure she didn’t “get stuck in a loop.” There was also many sessions pre dosing day to optimize the result.

She would highly recommend the treatment and hopes it becomes mainstream soon.

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The point of music during a psychedelic experience is to provide a reference for the passing of time and to help with progression of thoughts. Music guides you through your thoughts, avoiding loops, by providing a changing texture, melody, rythm, and story.

This is on top of the other effects of music, such as emotional effects.

For other readers, I would like to suggest no music, just a sunny day and quiet.

Music, television, people talking, etc. gives you an external clock and the timelessness of the experience, one of the greatest feelings, is lost.

I guess if you're just doing them for fun it's ok.

Yes, exactly - I should’ve added that she head a specific guided soundtrack as well, which the facilitators said was integral to optimal treatment, at least for this particular trial.

Taking mushrooms together with someone you love, who loves you, is possibly one of the most life changing experiences a couple can have.

Have you taken them with her?

I haven’t yet. It’s not easy to find the place or time to do so. The trial was great because everything was meticulously organised, such as the dose and - I guess - quality? I’d be worried about sourcing myself and messing something up there.

> "get stuck in a loop"

I feel that. Thought loops are scary and it takes someone to recognize them to get you out.

Trial eligibility required someone with documented evidence of treatment-resistant depression, with at least two prescription regiments in recent history.

Correct, screening was pretty thorough and there were a lot of sessions with therapists, blood tests, etc before they made the decision to allow her into the trial.

Technically, what is the approximate dosing regime?

How often, for how many days, how much (=how high?)?

Is this a therapy with an end or do you have to take mushrooms forever?

It’s also possible that the effect is purely pharmacological/physiological and the things you think or don’t think during the trip are entirely immaterial to its effects on depression and/or anxiety (which last days or weeks, whereas the hallucinogenic effects last only hours).

If I understand what you wrote correctly, Your wife did not try any traditional medication to treat her anxiety? Or is that included under "supplements"?

If so the term "lost hope" is not in my opinion accurate.

I am quite happy that it worked and it is a better alternative than medication, I certainly do not think that medication is the cure all, or optimal.

> If so the term "lost hope" is not in my opinion accurate.

What an absolutely asshole statement, which also shows an absolutely profound misunderstanding of suicide prevention and care.

Edit: Core belief of suicide ideation is that hope is gone. This is often (but not always) a perception. There may always be more things to try - but that's irrelevant to the person that is dead because they could not see another way.

He meant "last hope". That was the original phrase.

Ah, then I'll fix my statement!

> If so the term "last hope" is not in my opinion accurate.

What an absolutely asshole statement, which also shows an absolutely profound misunderstanding of suicide prevention and care.

Edit: Core belief of suicide ideation is that hope is gone. This is often (but not always) a perception. There may always be more things to try - but that's irrelevant to the person that is dead because they could not see another way.

Conventional anxiety medication is a lot easier to obtain than psilocybin.

You are right, there are many medications against anxiety disorder, and psilocybin not anyone's last hope if they haven't tried any of those other drugs.

> It was her last hope after trying therapy, various supplements, as well as dietary and lifestyle changes, etc

Last vs Lost makes no difference. Therapy should be understood to include medication.

Your statement really rubs me the wrong way; incredibly judgmental and just… shitty. Sorry to say.

Was she in placebo group?

Is it possible to have a placebo group when doing a study on psilocybin? Would participants in the placebo not notice the lack of psychedelic effects?

EDIT: In the original link it says the placebo group received a much lower dose, so that seems to be one way of doing it.

sounds like in that case you’re not testing the efficacy of high versus sober, you’re testing heroic dosing versus micro dosing.

There are also studies that test against placebo. There have been lots and lots of trials on these things with different designs that make different cost/benefit tradeoffs.

A difficult one with psychedelics is as-mentioned: people can easily "break the blind". But if you want to eliminate that problem you can instead do a micro vs macro dose, in which case you're measuring a slightly different thing.

Then again what if showing some funky hallucinogenic images/movies would have the same effect on some people? We surely know that people can go crazy (so have psychological effects) in cults and similar settings. What if intense visual/sonic/etc stimulation, visual distortions etc. together with messaging like "it will change your life and cure your anxieties" is the key in this therapy?

> intense visual/sonic/etc stimulation, visual distortions etc. together with messaging like "it will change your life and cure your anxieties" is the key in this therapy?

I sincerely hope this is not at all how any of this works. That sounds like a recipe for paranoia.

That isn't how these studies are being done... because yeah, it'd probably confound the results.

That's not so much a placebo as a head to head test of different effects? I think you'd do it in a new study entirely

One way is using niacin in high doses, also known as vitamin B3, as an active placebo to induce a sensation of heat and cause the skin to flush red, which is a typical reaction to tryptamines.

The rest is a regular placebo. It can be a really strong thing when you are feeling hot.

I suppose different trials do it in various ways, for hers there was a placebo group that was given a strong antihistamine. Participants in the trial were allowed to opt in for the real dosing day once the trial concluded. I suppose this was to entice people to join, as otherwise it was basically 50/50 if you would get the trial treatment you were looking for. Post trial dosing was obviously omitted from the results.

There was a placebo group that were given basically a very strong antihistamine which induced some drowsiness.

This particular trial, however, allowed participants who were in the placebo group to later opt in for the real dosing - obviously with those results omitted from the trial.

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