‘I don’t feel like I’m fully here’

Depersonalization after psychedelics

Post-psychedelic derealization has been in the news, due to the Alaska Airlines pilot who thought he was in a dream two days after taking magic mushrooms and tried to crash the plane he was on. Can psychedelics really affect people two days after they take a drug, people wondered? Yes, they can affect people for years, at least in their own estimations, in ways they may find positive or negative.

Below is an account of a woman who experienced suicidal depression and insomnia after an ayahuasca trip, and who still reports the symptoms of depersonalisation and derealization four years later.

We should say at the outset that most people say they feel psychedelics made their life better. This project focuses on harms and risks. Perhaps 10% of people report experiencing post-psychedelic difficulties, and in most cases these pass in days or weeks. But not always. As psychedelics become more widely available, we need better research, information and support for those who experience short-term, medium-term and long-term harms.

Aisha is a Turkish-American lady in her mid-20s who lives on the West Coast of the US and works in media. She has experienced depression and anxiety since her childhood, but managed it and considers herself a strong, independent and ambitious woman.

She heard that psychedelics can give people ’10 years of therapy in a night’ and decided to give it a go. She had tried a low dose of magic mushrooms before and it was a pleasant experience. Aisha researched the risks. She says: ‘I read the first ten pages on Google about psychedelics and psychedelic therapy, and it was all about the benefits.’

In December 2019, she decided to visit a retreat centre near Cusco in Peru, and attend a two-night ayahuasca retreat. She says:

There was one shaman, a shaman’s helper and a nurse. They were nice people. The shaman and the nurse didn't speak English. The shaman seemed around my age, like 24. I called him the electronic shaman because he was always on his phone. 

The first ayahuasca ceremony, nothing much happened to Aisha. The second ceremony she thinks the shaman upped her dose.

It started to hit me. I started crying, screaming, shaking uncontrollably. I started having visual hallucinations. I tried to get out of there. I went to the restroom because that was the only place there was light. An overwhelming sadness and panic went through my body and I didn't know where it was coming from, so I didn’t know how to fight it. I kept going to the restroom and they tried to calm me down and I said ‘can you please take me to a hospital?’ I forgot who I was, who my family was. I felt I was dumb for doing this, and now I'm dying. And then I finally went back into the ceremony space, and they tried to hush the spirits away or do some kind of spiritual stuff. And then I lost all sense of time and space.  I felt like I died and they left me there. I thought I was there for two months alone in the dark. 

But then finally she came down from the trip. The shaman asked her if she was OK, and then went back on his phone. The small group had a post-ceremony debriefing but Aisha didn’t talk and just wanted to get out of there. She says:

I think the scary part started afterwards. I thought it was possible I would have a difficult trip, but I would still learn a lot from it, and then no bad side effects would happen afterwards.

In the days immediately afterwards, she felt exhausted. She took a flight to Florida, where her brother lives and her parents were visiting. She says:

Three days after the ceremony, I woke up crying, shaking. I couldn’t eat anything, and usually when I’m anxious I love to eat. I told my family I had gone to an ayahuasca retreat. My parents are doctors and usually they know what to do to help, but in this instance they didn’t. They were Googling ‘psychedelic side effects’ and there is very little research. My brother asked a Peruvian friend, who said I should smoke some weed.

Aisha decided she would feel better if she just went back to her own apartment in Los Angeles, where she hoped she would be able to sleep better (she struggled to sleep while staying at her brother’s). She took a red-eye flight back to LA, and couldn’t sleep on that either. She started to experience suicidal thoughts on the flight. She felt in a dream-like state. She says:

When I got to my apartment, I didn’t recognize the room I had lived in for three years. It didn’t feel like my house, my bed. 

She still couldn’t sleep and the suicidal thoughts became more insistent. She called a friend, and together they went to the emergency department of a nearby hospital. The doctor there listened to her for five minutes, diagnosed her with drug-induced psychosis, and recommended she be checked in to a psychiatric ward. This, she now feels, was a big mistake.

There were way more intense cases than me there. I was sharing a room with a schizophrenic lady who would wake up at 4am screaming and punching the walls. It made me have panic attacks. The staff would check in with me for five minutes a day to prescribe drugs. I felt like I was going insane. I remember the TV was showing the movie Suicide Squad. Who shows that in a psych ward?

After three days she told the staff she felt better and was checked out. In fact, she was at her lowest ebb. ‘I was in such a bad condition. I couldn’t sleep for four nights straight.’

Her mother took a flight from Turkey to pick her up and take her back. In Istanbul, Aisha and her family began trying to find a solution. She saw several psychiatrists, and was (mis) diagnosed as suffering from bipolar disorder. She took anti-depressants for the depression and sleeping pills for the insomnia, which eventually helped. And she took exercise, walking every day even while sobbing. She says:

Seven months later, my insomnia started to clear up, and my depression also started to improve. There would be days when I didn’t cry. But I still felt exhausted, and I still felt derealization.

She says it’s difficult to describe and people don’t always understand, but she tries to put it into words:

It’s like everything is a dream. You know when you're jet lagged, and you're just a zombie. That's my whole life. I don't feel like I'm fully here. I went to my old high school, and I didn’t feel like the person who walked those halls.  I’m almost always really tired. I used to have way more energy to do things. And then nothing really affects me, or sparks joy. I’m from Istanbul, and seeing the Bosphorus used to give me joy, but it doesn’t any more. That might not seem a big deal but as humans, the reason we’re living is to feel happy, to feel at home, to feel we belong.

We are still learning about what is presently called ‘Derealization and Depersonalization Disorder’. It appears to be an evolutionary response to very frightening situations. The emotional or limbic system gets switched off, leading to extreme dissociation from the self and environment, as a protective mechanism. Sometimes, people get stuck in this response for days, months or years. It can be triggered by many different things but it’s usually a traumatic event, drug-induced or otherwise.

In our PLOS One study, we asked if people had experienced difficulties lasting longer than a day after psychedelics. We received 608 responses from people who said yes, and then thematically analysed their descriptions. 15% were themed as ‘derealization’ (feeling you’re in a dream or the world is unreal) and 15% were themed as ‘depersonalisation’ (feeling disconnected from your self). Here are two examples of the latter theme:

•     ‘I spent a long time looking at myself in the mirror, feeling like my soul was missing. Like i was a hollow shell of myself and like I had already died.’

•     ‘I felt like my mind had been shattered into a million pieces, like my mind was no longer connected to my body, afraid that I was having a psychotic break, im still not 100% right but I’m so grateful just to be back in my own reality’

Derealization and depersonalization symptoms can be transient and clear up of their own accord (the Alaska Airlines pilot is reportedly no longer suffering from it) but sometimes it stubbornly remains. I experienced it myself for some time after an unpleasant trip, and what struck me about Aisha’s story is the feeling of estrangement and what Germans call Unheimlichkeit, uncanniness or (literally) feeling estranged from home. One could connect this to Aisha’s situation as a first-generation immigrant, but some non-immigrants (like me) also experienced DDD after psychedelics.

Aisha tried many different methods to cure the condition. In Turkey, she visited spiritual healers. She also contacted MAPS (the US psychedelic organisation) where a kind lady offered her integration sessions for free. Aisha really appreciated her kindness, but the sessions didn’t help with the DDD. She tried an online cure called the DP Manual, but it didn’t also didn’t help. She tried EMDR (Eye Movement Desensitization and Processing) ‘which is helpful but not the cure for me’. She says anti-depressants were ‘very helpful for the depression but derealization - not so much’. Vitamin B has been helpful for combatting fatigue but doesn’t help the derealization. Meditation and Qi-Gong have been helpful but again haven’t resolved the derealization symptoms.

She says:

At this point I give in that this will be my life from now on. What hurts the most is that most people don't believe me and think I must have done it wrong and I am exaggerating the situation. I posted about my situation on Reddit psychedelic groups, and while most people were supportive, some said I must have done it wrong, or I didn’t do my research, or I started too fast. Others said that the medicine was trying to teach me something. I would have preferred a gentler teacher. I was trying to fix myself and grow, and I feel like I took ten steps backwards.

We are still learning what might help resolve Derealization and Depersonalisation Disorder when it lasts for years. I interviewed Dr Anthony David, head of University College London’s Derealization Unit, for the story below, who said they aren’t sure what the cure is but Cognitive Behavioural Therapy can help people learn to live with the symptoms.

Depersonalization, derealization and psychedelics

As to what might make such difficulties less likely – if DDD is a trauma response, then we need to think how to try and prevent challenging psychedelic experiences from being traumatic, and perhaps warning people with mental health conditions that psychedelic trips can lead to intense difficulties lasting months or even years, particularly in non-medical settings but sometimes in clinical settings as well. Shouldn’t accurate information on the risks show up on the first page of a Google search for psychedelics?

*****

Here is another interview with someone who experienced post-psychedelic DDD lasting years.

DMT, derealization and depersonalization

This is a UK charity for people who experience DDD.

Here is an article that Aisha found very helpful about another person who experienced prolonged post-ayahuasca difficulties.

If you’re in a post-psychedelic crisis now, you can reach out to Fireside Project, a free support line, or ICEERS’ free support centre. MAPS has a list of psychedelic integration resources in the US, including therapists, and the Institute of Psychedelic Therapy has a similar list for the UK. Feel free to contact me as well, and I can try and direct you to helpful information or organisations.

After the paywall, some more of this week’s psychedelic stories for paid subscribers, including a snafu in the Massachusetts psychedelic bill, and a powerful testimony of a challenging psychedelic experience from a participant in COMPASS’ psychedelic trial.