[nicoffeine]

Low doses may also prevent Alzheimers from progressing.[1][2] Ayahuasca/DMT[3] and psilocybin[4] may have similar effects.

It's fascinating that a monthly visit to your local shaman may still be more safe and effective for depression, anxiety, and cognitive decline than anything western medicine has been able to produce.

[1] https://www.forbes.com/sites/abbierosner/2020/02/21/microdos...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463489/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343205/

[4] https://www.beingpatient.com/could-psychedelics-help-treat-a...

[bb88]

It is also true that when we could have been exploring psychedelics back in the 60/70's, but they were made illegal mostly as a political backlash to the counterculture -- thus pretty much stifling the last 50 years of research on them.

"Punching-the-hippy" politics aside, the political leaders told us there was nothing beneficial ever about those drugs, and we typically believed them, even lumping scientists who wanted to study them in the same camp as the "UFO Cranks".

So the question is, is it western medicine that's the issue, or the lack of science based politics?

[Enginerrrd]

Honestly a fair number of studies have been done and the problem with all that stuff is there's always been a relatively high rate of complications and adverse outcomes. Responses/experiences are hard to predict.

I get that in some people it can be a wonderful thing, nearly a miracle cure. I've done plenty of psychedelics myself, but I always find the insistence by proponents that any harm done is the fault of the user ("poor preparation", "not the right setting", "inexperienced guide", etc, etc) to be really disingenuous and unscientific. Like, there are legit some people that really won't respond well to this as therapy.

Now, conventional pharmaceuticals and therapy have the same issues, but the reality is psychedelic therapies have never been a clear favorite.

[gavinray]

This is something that needs to be heard more.

I'd taken psychedelics perhaps 50-60 times before I had one out-of-nowhere bad experience that caused more harm than all the good I'd gotten out of them in my life.

I'm not against psychedelics after this either, huge supporter, but people like to pretend traumatic experiences don't have a chance of occuring.

[zadler]

What was the cause of the bad experience?

[gavinray]

This is such a difficult question -- I honestly wish I knew the answer outright and could give it to you.

I don't think I can do that much, but what I can do is offer some theories and context.

(Note: I wrote at length about this experience, and my general experiences with both psychedelics + MDMA here: https://news.ycombinator.com/item?id=22991744)

I'll write the following under the assumption that you/the reader don't have experience with psychedelics. There are some things you can put into words for those unfamiliar, and a great many other things you cannot.

---

Psychedelics are a fundamentally neutral substance. What I mean by that is, that they and the experience, are neither good nor bad. As hippy as it sounds, "they are what you make of them".

This quality, if you ask me, boils down to one property: Psychedelics are enhancers. If you feel beautiful and happy and lively, you feel REALLY beautiful, happy, and lively.

If you start to become frightened/anxious of something, or are in a frightening situation, you become REALLY frightened.

And this becomes further amplified by a second property of psychedelics:

Rather than the usual business of "Some external occurrence or sensation happened, and here is my one thought/reaction to it." IE "Wow, that statement was rude, what a jerk." Or "Man, that dark alleyway looks kind of scary, I think I'll not go that way."

Your subconscious and free-association become stronger respective of dose, to the point where they can become runaway.

No longer is the equation "1 external action = 1 internal processing response", but some small experience can set off a chain reaction of internal association tumbling down a bunch of different paths.

Dark alleyway -> Oh that's scary -> That's the sort of place monsters would be -> Monsters, oh those are terrifying -> Murder is terrifying -> I don't want to be murdered -> There's probably a monster in that dark alleyway -> Dark alleyway, that's so terrifying -> You know what's probably in there, a monster? -> A monster would murder me -> I don't want to die -> Die.. death...

It becomes a looping, inescapable schizophrenic sort of experience where you've also lost enough short-term memory to forget you've been going in loops like this for what feels like years.

And because things are so ENHANCED, the amount of screaming terror, dread, etc you can feel is beyond any thing you can comprehend. Time is slowed to a crawl, this can continue for eternity.

Now, if that all sounds awful -- just imagine this whole scenario, but filled with the most intense happiness and love you can imagine. That's what MOST experiences are like, generally.

---

What happened that night is I started getting anxious and fell into a dark place in my mind and got stuck there for an eternity instead of a happy place, to put it shortly.

I also won't pretend I probably didn't have a lot of subconscious trauma from a really messed up childhood and likely other mental issues/insecurities.

[yomly]

Agree. I have passed up opportunities to take LSD on several occasions as I knew my emotional state baseline positive enough. The time I did do it was at one of the happiest times of my life and it was a fun experience.

The time element of a deep LSD trip can make it very challenging. Being stuck in your thoughts for 18 hours is not for the light hearted

[pmoriarty]

"Psychedelics are a fundamentally neutral substance. What I mean by that is, that they and the experience, are neither good nor bad."

There are a significant number of people who view the psychedelic substances they use as teachers, as sacred, as emissaries of gods or other supernatural beings, or as those beings themselves.

Though such views are often dismissed as superstition or magical thinking by many who consider themselves part of "advanced", "civilized" societies, and who view these substances more as neutral tools, such societies' confrontation with these substances is relatively young, and I suspect that as they gain more experience with them their views will change.

Use of these substances have already been the wellspring from which multiple religions have come, and the potential for them to spawn more major religious movements, and with them a much more deferential attitude towards and view of these substances, will only grow as their use increases.

[evo_9]

I don't disagree with this; I do wonder however if this is more related to the black-market nature of this drug. Aka, inconsistent 'manufacturing' processes, etc. Meaning if it were legal and had a process in place to assure the correct chemical composition, if that would still happen.

Thinking about this further - have bad trips been observed in clinical studies where the the LSD was created in a controlled, ideal lab setting?

Would be interesting to know if this was or wasn't the case; could indicate a bad trip is an unavoidable potential side-effect, or if it is a specific reaction to poorly created LSD.

[saiya-jin]

I've seen really bad trips from literally just weed, the same I smoked and was as A-OK as possible. I mean really bad stuff, like blood flowing down the walls around us, they are coming for us panick etc.

Its not the substance purity, but some people are a mess, and sometimes they don't realize/admit it. Some become mess with frequent use. Those definitely shouldn't play with stronger stuff, whatever that is for them.

[Enginerrrd]

>Meaning if it were legal and had a process in place to assure the correct chemical composition, if that would still happen.

It will. I'll stake my life-savings on it too.

>Thinking about this further - have bad trips been observed in clinical studies where the the LSD was created in a controlled, ideal lab setting?

Yes, actually, the results here are the ones usually criticized by psychonauts for causing bad trips due to "bad settings" or "poor preparation". There's a bit of truth to that, but the bad trips are always going to happen.

[bb88]

I do absolutely agree on that.

What would be nice is that you get the benefits of the drug without any of the "bad trip" experiences, in a controlled way.

[pmoriarty]

If you look at every trip as a learning experience, even a bad trip doesn't have to be all bad.

Now, I wouldn't wish my own bad trips on anyone, but I've found I learned far, far more from them than I did my good trips, so in that sense they were actually beneficial.

Also, the term "bad trip" may be a misnomer. They might be more fittingly called "difficult trips" or "challenging trips". It is possible to draw meaning and even wisdom from such trips.

[Enginerrrd]

>If you look at every trip as a learning experience, even a bad trip doesn't have to be all bad.

For some, maybe even most, but it would be irresponsible to assume that it would be the case for everyone, and this is exactly the sort of blaming the victim of the bad trip for "doing it wrong" that I was talking about. Somehow it's their fault for having a bad trip, or for looking at it wrong and failing to "correctly" integrate it into their worldview.

Humans are a diverse group. That line of thinking just doesn't work from a clinical perspective.

[pmoriarty]

Blame was the last thing on my mind when I wrote my comment. I was merely trying to provide some suggestions that would maximize the odds of having a productive experience and good integration afterwards.

Yes, things could go wrong even if one takes every reasonable precaution, is in the best frame of mind, etc. That's why having helped from experienced people you can trust is a good idea, but even that offers no guarantees.

There are no guarantees in life for anything. You could break your neck climbing a ladder to change a lightbulb. People can and do suffer severe accidents (including severe brain damage) skiing, driving, or crossing the street.

Yes, you should be aware of the risks and look both ways when crossing the street, but you could still suffer some accident even then. For some the risky activity is worth it, for others not. For those who think it is, it's helpful to educate oneself and take reasonable precautions. No blame necessary or intended.

[mxxx]

In Michael Pollan’s recent book there’s quite a few people who point a substantial amount of blame for this at Tim Leary. Great read for those who are interested in the history of psychedelics and their role in therapy. It’s called How To Change Your Mind.

[bb88]

It seems like Tim Leary came across more like a cult leader than a scientist, frankly.

[rv-de]

> So the question is, is it western medicine that's the issue, or the lack of science based politics?

How about lack of science based medicine?

https://news.ycombinator.com/item?id=24383819

[GuB-42]

As a side note, LSD is a product of western medicine, psylocybin an DMT, while both present in nature have been characterized by western medicine and you are linking to western medicine papers.

Western medicine, which I would rather call scientific medicine is not against psychedelics and natural remedies, but instead of telling you to eat the funny shaped mushroom, it will study what exactly is in that mushroom, extract the good stuff, remove the bad, maybe try to improve it. It will then test it, with accurate dosing and if everything goes well, produce a treatment that is similar to what the shaman did but better.

I'd say the only thing the shaman has over a registered doctor is that he can spend more time with you, and hopefully have a positive influence on your lifestyle. But it is not a shortcoming of scientific medicine, in fact, it recognizes it. It is more about doctors being too few and overworked.

[AstralStorm]

Funny thing though, we use ergoloid derivatives in western medicine too.

These are alpha-blockers for treating migraines or hypertension. There are psychotropic drugs based on these as well, and a bunch of discredited nootropics.

Now, high BDNF on its own is not a good or bad thing. It is released both when injuries and when growth happens...

I would be very careful recommending a shaman, unless you happen to have evidence for how well traditional approach to treatment works compared to recent drugs or current mental health treatments, or a precise description of what those people do, as it's more than just "take this drug and go home". We could use such studies for sure, and not for cultural appropriation!

We lack sufficient data to recommend for or against. (Partly because countries virtually banned research because "drugs" are "bad". Others are trying to hold it exclusive for their culture, which is wrong too. I think they should stand to gain from it if it works.)

[bashallah]

Shamans do not give you drugs and send you home. That’s a drug dealer.

Shamans are more like tour guides. Walking you through your own experience.

[AstralStorm]

This might be important, like a form of therapy based on counselling, thinking or talk seems beneficial for success of drug based psychotherapy. Whether it is better, we should learn properly and not assume. If it's not, we're wasting time. (Or perhaps it works better for true believers, that's an important thing to know as well.)

It is good to remember though that these approaches exist, and to let them be practiced safely and openly. As well as researched without interrupting it.

A tour guide does specific things. We could know what makes for a good or bad one.

Is a person who fakes the practice as good as a native life long taught shaman? Which kind of shaman is best? Is tailoring the experience needed and in what way? Etc.

[mcgt]

Wouldn't the data we have on mental health show that contemporary wisdom on its treatment is failing? Given spikes in rates of anxiety and depression over the past century, among other adverse effects, this isn't an unreasonable conclusion to make.

That said, maybe it's more important to look at how these have been dealt with in the past than the data we have in the present.

[AstralStorm]

Not one to the exclusion of other.

The spike can just as well be caused by bad environment we made for ourselves, ecologically and psychologically.

The problem is, we really do not know what we're doing when dealing with mental issues. Typical western approach is only slightly better than dosing people with random psychedelic substances of mostly unknown effects. The science done in field of psychotherapy is low to non-existent quality. Methodologies are in their infancy.

Of course something barely effective will fail.

[bb88]

> This might be important, like a form of therapy based on counselling, thinking or talk seems beneficial for success of drug based psychotherapy.

While I don't doubt there is some human component to this, what I worry about are interactions with standard prescriptions and OTC medicines.

[AstralStorm]

Of course. Ergoloids have a long list of side effects, which is why they're considered outdated or third line treatments for many illnesses. But not others, say for severe migraines, they're still best or first line available agents.

Those risks are always weighted against benefits.

[acituan]

> It's fascinating that a monthly visit to your local shaman may still be more safe and effective for depression, anxiety, and cognitive decline than anything western medicine has been able to produce.

I get the romanticized enthusiasm but let’s not crap on scientific process that easily. Sure there has been political pressures that stagnated psychedelic research, but for a while western medicine has been trying to work this out in a replicable and safely administrable manner. Shamans don’t operate under those limitations, hence the apparent “superiority”, with all associated, undocumented risks.

To get to the point of this paper, there are “western” substances that help with BDNF and cognitive decline too, eg. lithium, which is not as psychoactive and has a perfectly well documented risk profile (not saying risk free).

[ianai]

Any studies for the Stamets stack of psilocybin, lions mane, niacin?

I’m intrigued by lions mane because it’s legal, of course.

[AstralStorm]

Psylocybin is just barely tested, but some results are promising. Niacin is irrelevant thus far. Lion's mane is also promising but benefits seem very limited and small.

The "stack" is insane as we do not understand what each of the components does separately or in any combination and the rationale for including one of them is based on discredited ideas.

[api]

Western medicine did produce it, or at least started to catch on. Then the war on drugs moral panic hit and all that research was shut down.

[jackmodern]

I take 1-2 doses per month (in the 25 microgram range) with 2.5-5mg THC (via mint edible) and that has done wonders for me both in terms of mood, acceptance, and empathy towards others around me. I don't know if it will fix someone with severe issues, but for me it is sort of a maintenance thing that keeps my cognitive health flowing in the right direction and my overall sense of well being positive. It's certainly not for everyone, but definitely a net positive for many.

[nurettin]

visit to your psychiatrist will get you addicted to ritalin and valium. Visit to your local shaman will get you addicted to acid and shrooms. Your local dealer will get you addicted to meth, heroine and coke. Your choice.

[https://omitted.useless.links]

[ashtonkem]

Claiming that acid or shrooms is addictive like heroine or cocaine is a big “Citation Needed” moment.

[nurettin]

Yes this guy says two things are addictive, so he must have said that two are alike in their addictiveness. I really don't know what you need, but I'm pretty sure I don't have it.

[ashtonkem]

Heck, saying that LSD is addictive at all is actually a really strong claim, which you didn’t support.

[celdon25]

I've met no less than three people who have claimed to have had a psychological addiction to LSD at one point.

[jackmodern]

In over 12 years of using psychedelics intermittently, I have never met a daily user of any of them. It's just not possible. I have met people that abused them slightly for sure, but not like the other drugs you listed. Those are all extremely high risk in the daily abuse category of addiction. This simply isn't a fair comparison. Fiendy/physically addictive drugs =/ Psychedelics