I don't want people self-medicating with psilocybin, just like I don't want people self-medicating with SSRIs.
Which is more dangerous?
Which is more dangerous?
You have to put effort into making an experience with psylocybin meaningful and helpful. It could go wrong very easily, especially for those who are in a difficult situation or headspace. (Speaking from experience.)
As for SSRIs? Safe, effective, with a handful of annoying side effects. Straightforward to use, low potential for misuse, requires sustained use for any intended effects. A doctor who already has familiarity with a patient's mild or moderate symptoms of anxiety or depression may very well just prescribe one if asked and if not contraindicated. Not that you should randomly start popping Prozac, but it's unlikely to hurt you if you did.
Ask your doctor, try the things that doctors currently believe are most likely to work first. If for whatever reason you choose to go beyond the current medical consensus, please stay safe and keep your doctor up to date.
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 preferable. But if I'm asked to compare their safety? The choice is obvious, weight gain notwithstanding.
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.
Leaving this link for others to pick up for more information: https://annals-general-psychiatry.biomedcentral.com/articles...
And yes, it's possible to misuse SSRIs, but taking an obviously oversize dose is still often a treatable situation. Combining them with depressants I think is a degree of misuse that is incomparable.
If SSRIs started as illegal drugs, with i.e. people starting them dodging medical supervision, I think the system would be telling us they are insanely risky and well beyond many scheduled drugs.
Really?
That is true of any meaningful experience
The danger with psychedelic drugs is very low
They wear off
I'm not sure that's a good metric though. Paracetamol is more dangerous than most highly regulated pharmaceuticals in that way.
Err.. no?
This is from the Dutch National Institute for Public Health and the Environment: https://www.rivm.nl/bibliotheek/rapporten/340001001.pdf
Page 19 onward has the charts. What do do we find at the very low end in terms of chronic and acute toxicity? Shrooms (“paddos”) and LSD.
It always blows my mind how anti-drug people will do a handwavey gesture to the authority of institutes like the FDA, but never actually check up on what actual research says.
> As for SSRIs? Safe, effective, with a handful of annoying side effects.
Except the multitude of ways you can put yourself into a serotonin coma.
I agree with your assessment that (first) use of psychedelics should be under proper guidance. But what you refer to, “going bad”, can sometimes be a traumatic past experience that people have stuffed away and by surfacing and processing it they can move past it. It’s not always meant to be kumbaya and flowers.
Educate yourself, then talk.
I'm also unfamiliar with the dose of SSRIs that would send you into a coma, but I'm fairly certain it's shockingly large. Happy to be informed otherwise.
edit to reflect parent edit: yes, I'm aware that breakthrough experiences can be helpful. I'm also saying they should not be your first resort.
The report also speaks to personal, social and populational damage.
> I'm also unfamiliar with the dose of SSRIs that would send you into a coma
Its not the SSRI itself, but rather anything that messes with your reuptake can put you into some deep problems. And of course the bog-standard grapefruit+medicine interaction.
> I'm also saying they should not be your first resort.
My point was that if we are talking drugs, yes, treatment with psilocybin should definitely be higher up the list than SSRIs. SSRIs would most likely be for life, daily. Psilocybin could be bi-annually or perhaps even as spot treatment only.
> So there's no need for your rude presumption that I find it generally unsafe.
Apologies for coming off too strong. I just feel that, reasonable as it is, the “let’s all just take a minute” attitude gives too much ammunition to conservative hoohas to stymie these alternate treatments for another few decades. Imagine if marijuana had been more accessible to people like this in the 80’s-10’s:
> What do do we find at the very low end in terms of chronic and acute toxicity? Shrooms (“paddos”) and LSD.
Breaking your mind doesn't count as toxicity. You're not responding to the point you tried to refute.
Hyperbole
Unless you either A) already have a predisposition to something like, say, schizophrenia, or B) take stupendous amounts, you’ll be fine. And vis a vis point B, in the older days there were people who did multiple LSD hero doses, without frying their brain.
No it’s not the best thing to do to brave huge waiting lists, call a hundred providers none of whom are taking new patients, pay a fortune out of pocket, and/or be faced with a distracted impatient person stuck to their screen who has 10 minutes for you.
And I live in Germany, not the US.
I'm not a nut screaming "It's all a scam, don't participate in modern healthcare!". Just noting that it's complicated, and the idea that going to a physician is always the best option should receive more scrutiny, because it's not black and white.
Case in point: 50,000 people died, with about 5 times as many suffering life-changing serious adverse events, from “rigorous research” on the safety of Vioxx. Yes, it has since been pulled from the market, which FDA apologists often construe as “system working as designed”. No, it isn’t, even in the least, when you go into the details.
Also: Purdue and OxyContin.
Regulatory capture of the FDA is decades old at this point. Ignoring that is not a rational or healthy position.
Do you not know anyone who has spent many years of their life doing something and are still rather poor at it? You probably do. You may even have such a skill yourself - I certainly do!
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 there to discuss getting zonked on LSD or something more "traditional" like Xanax
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.
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
To get a prescription for one of the the handful of drugs are are available and are considered to be effective. What else can you learn by just "popping in"?
> with a functioning healthcare system, not the US.
What do you even mean by that?
For example, it took literally two decades after it became well known that peptic ulcers were mostly caused by bacteria for the medical community to embrace giving anti-biotics for GI pain. To this day, there are still many American doctors who don't actually know about the Nobel Prize given in 2000 for this discovery, and claim it's "stress" and tell you to go home. Some claim they "know" but than try to "change your gut PH" and still refuse to give antibiotics due to "superbug" risk.
This is a "small" thing (GI pain is not small to those who have it) - but if the doctors are screwing up such a small thing institutionally, what else do they mess up on?
One is travelers sickness. Doctors in the USA do not want to perscribe front line antibiotics for it because of fear of superbugs - but they'll uncritically go eat their lunch at a McDonalds that same day, where they consume meat bathed in antibiotic slop which is more likely to contribute to superbugs then the amoxicillin that they didn't give you would have.
Or what about right now, when it's become clear that Ozempic is literally a super-drug. Every doctor on earth should be trying to give that stuff to literally anyone.
I can go to "third world countries" with deregulated health systems and get infinitely better care that I have real control over for on the orders of 1 USD (that's how much it cost for me in Thailand to get front line antibiotics for travelers sickness INCLUDING THE DOCTORS VISIT!)
Why do we still sell Neosporin despite doctors wanting it off the market (also for risk of superbugs)? Why do few people in America use Providone-iodine for wound treatment despite it being by far the best solution scientifically for it (and it stains yellow)? Maybe it's because we're stupid. There really aren't better explanations.
What about Circumcision? I'd straight up put doctors who do it in jail and many European nations would do the same. American doctors think circumcision is just fine, and long, deeply bitter swaths of medical ethics journals are dedicated to fighting over this again and again.
Or what about the widespread disagreement over even basic stuff like digital rectal exams? There's no agreement on if they are worth it because often sticking one's hand up the butt of an old man does more damage to them than finding out that they (like everyone else at old age) have benign prostate cancer?
Doctors in America have not earned their position of deference. The scientifically minded on HN who do their own research can and often do know how to treat certain conditions better than white-coats.