What is known about persistent depression after psychedelic use?
March 21, 2023 9:54 AM Subscribe
I had a bad psychedelic mushroom experience a few weeks ago, and it seems to have triggered a serious and worsening depressive episode. I have a bipolar 2 diagnosis, but before this trip my symptoms were pretty well managed on Lamictal/Seroquel/lithium, and now they're almost as bad as they were pre-meds. What should I do? Could I have done permanent damage? What are the odds my meds will go back to working? Would prefer evidence-based info, but anecdotes are better than nothing.
(Yes, I've contacted my psychiatrist, though I don't think she knows anything much about psychedelics. And yes, I have definitely learned my lesson. I was never a frequent drug user, but I'm moving them from "once or twice a decade" to "never again until I die, no matter what.")
(Yes, I've contacted my psychiatrist, though I don't think she knows anything much about psychedelics. And yes, I have definitely learned my lesson. I was never a frequent drug user, but I'm moving them from "once or twice a decade" to "never again until I die, no matter what.")
This might be a longshot, but did the psychedelic experience adversely affect your sleep in the weeks afterward? If so, your depressive symptoms might be secondary to the sleep issues.
posted by alex1965 at 10:42 AM on March 21, 2023 [1 favorite]
posted by alex1965 at 10:42 AM on March 21, 2023 [1 favorite]
Anecdotally, I've heard of folks for whom psychedelics did trigger lasting damage (the instances I heard of had to do with schizophrenic type symptoms, not depression.) These are minority cases obviously but I've heard more than one.
I looked and found this article specifically about psilocybin and people with BPD, but it looks like its data is based on a web-based survey, so make of that what you will.
posted by fingersandtoes at 11:22 AM on March 21, 2023 [3 favorites]
I looked and found this article specifically about psilocybin and people with BPD, but it looks like its data is based on a web-based survey, so make of that what you will.
posted by fingersandtoes at 11:22 AM on March 21, 2023 [3 favorites]
All of what I'm about say is *purely* anecdotal, but...
By nature, psychedelics play tricks with your neurotransmitters, and these drugs generally tend to react poorly with people that have existing neurochemical issues - like bipolar or depression. Given your diagnosis, it's not surprising that you had a bad trip and a rough recovery. I've known many "neurotypical" people to often suffer from a period of depression after a psychedelic experience.
Like Res0ndf7 said, our brain chemisty and function will want to even out after an experience like this, even though it may take weeks. Exercise, sleep, proper diet, decrease stress, etc.
Back in the day we used to take 5-HTP supplements to help recover from psychedelic adventures, but I have no idea if that actually helped. I think permanent damage is unlikely, just be extra nice to your brain for a few more weeks.
posted by gnutron at 11:23 AM on March 21, 2023 [1 favorite]
By nature, psychedelics play tricks with your neurotransmitters, and these drugs generally tend to react poorly with people that have existing neurochemical issues - like bipolar or depression. Given your diagnosis, it's not surprising that you had a bad trip and a rough recovery. I've known many "neurotypical" people to often suffer from a period of depression after a psychedelic experience.
Like Res0ndf7 said, our brain chemisty and function will want to even out after an experience like this, even though it may take weeks. Exercise, sleep, proper diet, decrease stress, etc.
Back in the day we used to take 5-HTP supplements to help recover from psychedelic adventures, but I have no idea if that actually helped. I think permanent damage is unlikely, just be extra nice to your brain for a few more weeks.
posted by gnutron at 11:23 AM on March 21, 2023 [1 favorite]
Hi, I'm a biomedical researcher. I think you're going to get a skewed, self-selecting bias in the anecdotal responses you get here (e.g. people will have some reason for reporting a story of highs or lows that motivates them to post, but fewer people with meh stories will feel that same motivation).
In all likelihood, there's no such thing as "permanent damage" in terms of your brain's fundamental mechanisms for responding to medication and generally functioning. Unless you've taken heroic doses under strange circumstances or are using many types of substances at the same time, there just isn't much evidence of anything remotely like that in the literature. Wht's there suggests that you may exacerbate your symptoms for a time but that is a temporary state (and, to the comment above, it oes seem worth understanding how your sleep routines are and if they can be improved/encouraged while you're feeling unwell).
The paper linked by fingersandtoes is going to be a good point of reference for you (as it will lead you to other publications from the same authors/affiliations, such as). Your psychiatrist is fully capable of carrying out a lit review and consulting other professional resources about this. Feel free to do some of this reading yourself, but lean on your psychiatrist to dig into it so that you can lessen some of the worrisome burden of trying to look this stuff up.
Hang in there.
posted by late afternoon dreaming hotel at 12:02 PM on March 21, 2023 [25 favorites]
In all likelihood, there's no such thing as "permanent damage" in terms of your brain's fundamental mechanisms for responding to medication and generally functioning. Unless you've taken heroic doses under strange circumstances or are using many types of substances at the same time, there just isn't much evidence of anything remotely like that in the literature. Wht's there suggests that you may exacerbate your symptoms for a time but that is a temporary state (and, to the comment above, it oes seem worth understanding how your sleep routines are and if they can be improved/encouraged while you're feeling unwell).
The paper linked by fingersandtoes is going to be a good point of reference for you (as it will lead you to other publications from the same authors/affiliations, such as). Your psychiatrist is fully capable of carrying out a lit review and consulting other professional resources about this. Feel free to do some of this reading yourself, but lean on your psychiatrist to dig into it so that you can lessen some of the worrisome burden of trying to look this stuff up.
Hang in there.
posted by late afternoon dreaming hotel at 12:02 PM on March 21, 2023 [25 favorites]
This is anecdotal, but if it's at all comforting, I know someone who experienced this and it wasn't permanent - it maybe took them 4-6 weeks before they felt back to normal.
posted by coffeecat at 1:02 PM on March 21, 2023 [1 favorite]
posted by coffeecat at 1:02 PM on March 21, 2023 [1 favorite]
I know someone who experienced this and it wasn't permanent - it maybe took them 4-6 weeks before they felt back to normal.
Yes, me, too, if another anecdatapoint helps at all. I got a little bit of overhang and my friend with depressive tendencies got a lot. It was terrifying for her and her friends and family for a few weeks, but she rebounded to her previous state and is fine now and has been fine for decades--all this experimentation was back in the 80s/early 90s.
I'm moving them from "once or twice a decade" to "never again until I die, no matter what.")
ME TOO, goddamn! It will wear off, is the overwhelming likelihood--it did for me and for my friend, but dang, is it ever not worth the scares. Be kind to yourself and don't self-recriminate if you can help it. It's good to have an adventuresome spirit and the capacity to learn from experience, and you've got both.
posted by Don Pepino at 6:31 AM on March 22, 2023 [2 favorites]
Yes, me, too, if another anecdatapoint helps at all. I got a little bit of overhang and my friend with depressive tendencies got a lot. It was terrifying for her and her friends and family for a few weeks, but she rebounded to her previous state and is fine now and has been fine for decades--all this experimentation was back in the 80s/early 90s.
I'm moving them from "once or twice a decade" to "never again until I die, no matter what.")
ME TOO, goddamn! It will wear off, is the overwhelming likelihood--it did for me and for my friend, but dang, is it ever not worth the scares. Be kind to yourself and don't self-recriminate if you can help it. It's good to have an adventuresome spirit and the capacity to learn from experience, and you've got both.
posted by Don Pepino at 6:31 AM on March 22, 2023 [2 favorites]
I can echo the two anecdotes above, including the ~4-6 weeks timeline.
posted by deludingmyself at 8:14 AM on March 22, 2023
posted by deludingmyself at 8:14 AM on March 22, 2023
For future reference (for others, since you're done with monkeying with your brain), a hit of nitrous will almost never fail to turn around/derail a bad trip. Bezos help too if you have some on hand, but that's more "stop tripping" -- nitrous is like a reset button.
posted by nixxon at 2:17 PM on March 22, 2023 [1 favorite]
posted by nixxon at 2:17 PM on March 22, 2023 [1 favorite]
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There's really no definitive research on this specifically, we don't understand the brain well enough for someone to provide you with a solid evidence based answer on how long psychedelics can affect brain chemistry.
The brain tends towards homeostasis and wants to be stable though. I would think of the bad trip as a chemical "brain trauma", which according to literature can take several weeks to several months to heal from. I would hold off doing anything to shake things up further for at least 3 months as long as you're not in immediate danger of self harm or any other drastic consequences. The fact that your BP2 means your nervous system is already pretty fragile so any other stuff you try might just make it worse.
Double down on exercise, meditation, de-load stress, eat well and all other nervous system soothing activities.
After a couple months if things aren't trending better I would just go back to your psychiatrist and treat this as a breakthrough depression episode and treat accordingly to what they say-- but these kinds of things really can take awhile to recover from, a couple weeks may just not be long enough.
posted by Res0ndf7 at 10:39 AM on March 21, 2023 [4 favorites]