18 April 2018

Why can't we have anti depressants that work?

I had another mental health episode recently. You wouldn't know anything was wrong to look at me; no talking to angels or strangers. But inside, I felt dreadful; an emotional flu, spiritual hangover, psychological gastro. Without going into gory details, in weighing up my options and desperately wanting to feel better, I considered heading to hospital. But I didn't, because aside from not much being in the mood for boiled carrots, I knew there was very little they could do to make me feel better. Sure, they could give me some valium to take the edge off and make me sleepy for a few hours, but that was about it.

Pharmaceutical treatments for depression are still stuck in the Prozac era of taking some pills, waiting three weeks and hoping for the best in the meantime; yet as I discovered there are other treatments which may well offer longer term cures; but the powers that be have decided we can't have them.

When it comes to antidepressants, we really haven't moved pharmacology much past the Prozac Nation era of the early 1990s. There have been minor developments, tinkering here and there, but SSRIs and SNRIs remain the fundamental pharmaceutical approach to depression. If someone suffering severe depression seeks medical help, the best they can be offered in most cases is to take these pills and hope there will be some improvement showing in a few weeks time.

There is some evidence that SSRIs are linked to increased rates of suicide, particularly in the early stages of treatment; whether this is because the drugs elevate energy levels before they improve mood, or due to another mechanism, is still a topic of intense debate in the psychiatric community.

Perhaps the worst aspect of modern antidepressants - aside from the fact that they don't actually make you feel better - are the absolutely horrendous side effects when you quit using the drugs. Symptoms of discontinuation syndrome include dizziness, confusion, fatigue and the brain zaps which will be familiar to anyone who's suffered from them (you know when you're falling asleep and feel like you're falling? I had that happen when I was walking down the street. It wasn't so great). Nearly half of users who tried to quit were unable to because of the severity of symptoms. My current primary medication, Effexor, causes withdrawal symptoms within hours; this is especially grim when I run out of pills near the end of the fortnight and have to wait a few days to afford to fill the script.

And when people stop taking them, they are still depressed.

So I kept searching for answers and found myself in forums for people who felt just as bad as I did. People struggling with severe depression, complex trauma, PTSD, able to openly share how bad things were and what they felt were their options. And of course the subject of suicide came up; someone said how they'd been dealing with the fall out from sexual abuse for decades, they'd tried every treatment available and now they were ready to give up. And someone said to them, I understand where you're coming from but before writing life off entirely, please try DMT. It will change everything.

N,N-Dimethyltryptamine (DMT) is a psychedelic compound found in the ayahuasca and other plants. It's been called the spirit molecule, an experience which cannot be expressed in words (although this very long and odd article from VICE tries). It's been used in South American spiritual ceremonies for centuries, and there's a tonne of testimonies online of people who have used them successfully to treat depression, anxiety and PTSD, but in Australia DMT is a Schedule 9 substance prohibited except for research purposes.

Many online commenters suggested one should travel to South America for the authentic ayahuasca experience under supervision of a shaman, but if I was able to afford an overseas trip I wouldn't be so depressed, so that's out. There are DIY groups holding ayahuasca ceremonies in Australia, but you have to know they right sorts of people to be invited, which I don't, and anyway it all sounds a bit too much like ponchos and white guys with dreadlocks for my liking.

What I would like, without having to break the law or learn Spanish or hear bongos, is to be able to take myself along to a nice, clean medical centre and access treatment that would actually make a real, tangible difference in the way I feel.

The Greens yesterday launched their policy of legalising cannabis for adult use, a sensible move long overdue (and I don't even smoke the stuff and still won't if it's legalised; I just never liked the way it made me feel). But overshadowed in the fuss is the Greens calling for more research amid concerns that Australians are missing out on a global renaissance of psychedelic drugs used in treatment for depression, addiction and in palliative. Australia is lagging behind on use of psychedelic drugs in psychiatry and there are no trials underway, with authors of an article published in Australian Psychologist advocating for the research into their use lamenting the conservatism in academic and research circles (remember when Australia used to be a forward looking, innovative nation? Now we can't even have decent internet let alone medical research).

Stephen Bright and Martin Williams write in Australian Psychologist that whilst a range of effective therapies have been developed for conditions such as obsessive compulsive disorder, panic disorder and phobias, current treatments for severe depression and PTSD are not as effective. Psychedelic drugs enjoyed a period of successful use in psychotherapy:

First synthesised by Albert Hofmann in 1938, LSD [...] led to a paradigm shift in psychiatry as numerous medicines were developed based on this new understanding of the brain. In the context of psychotherapy, LSD itself was also found to be effective in the treatment of a range of mental disorders, including addiction, anxiety, and depression. Just one or two sessions of LSD-assisted psychotherapy were found to produce profound, rapid, long-lasting positive effects with little need for further interventions, unlike psychoanalysis which involved years of therapy sessions.

But despite little direct evidence of ill effects, the recreational use of psychedelic drugs in the 1960s lead Richard Nixon to ban all use under the guise of the War on Drugs, despite the protests of psychologists and psychiatrists as to their therapeutic value. Moral panics were indulged, risks wildly exaggerated. We know now that the War on Drugs has been one of the largest and most expensive failures in human history, but as the rest of the world begins to wind back the prohibitions on therapeutic use of psychedelics, Australia remains stuck in moral panic mode.

It seems that there are drugs out there that when you take them, can make you feel better right away and offer some long term relief from symptoms of severe depression and trauma. Can we have them please? The war on drugs has had many terrible effects in four decades, certainly one of which is that people struggling with severe symptoms of trauma and depression cannot access real relief. For myself and others like me, any risks have to be weighed against the risk of the days when I don't know if I should board the train I intended to take at the station or jump under it. Let's get the trials going; I'll be the first one in line. 

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