‘If we are poisoning people against certain paths to healing because we think that some paths are more virtuous than others, we may be doing harm to folks’ - Dr Erica Zelfand
In this article we will explore the following points:
Psychedelics are often pitched as a superior alternative to SSRIs for the treatment of emotional problems
This can lead to SSRI-bashing or pill-shaming rhetoric in psychedelic culture
People are sometimes encouraged to come off SSRIs too quickly before ceremonies and trials, and this can lead to destablization
Possible solutions - combining SSRIs with psychedelics or slower tapering off?
1.Psychedelics are often pitched as a superior alternative to SSRIs for the treatment of emotional problems
Since they were launched in the late 1980s, anti-depressant selective serotonin reuptake inhibitors (SSRIs) like Prozac have become incredibly popular in developed countries as the leading treatment for what has been described as an ‘epidemic of mental illness’. Today, one in four adults in the UK are now on anti-depressants, and prescriptions have risen 35% in the last six years. The SSRI market was initially a bonanza for some Big Pharma companies, although patents have long-since passed so the $17 billion or so in annual SSRI profits is now shared among many companies, and Big Pharma has largely focused away from the mind-altering drug market. The only big new mental health drug to come to market since the 80s is Johnson & Johnson’s ketamine nasal spray.
The problem is, SSRIs are not perfect. They relieve some symptoms in about 40-60% of people with depression, but only get around 35% to remission, and rates are lower for PTSD. They can also have high rates of adverse effects, including emotional flattening, lower libido, and in very rare cases sudden suicidal ideation. People often take them long-term, and in some cases withdrawal effects when you come off SSRIs can be quite unpleasant. And a lot of their effect is placebo, as with most mental health treatments.
Advocates and sellers of psychedelic drugs, including MDMA and ketamine, pitch them as a much-needed alternative and superior competitor to SSRIs.
For example, in Australia, psychedelic therapy was legalized in 2023 thanks to the tireless campaigning of an NGO called Mind Medicine Australia, founded by Peter Hunt and his wife Tania de Jong. They persuaded the TGA, Australia’s drug regulator, to approve MDMA therapy and psilocybin therapy for PTSD and depression by emphasizing the superiority of psychedelics to SSRIs.
Peter Hunt, in his evidence to the TGA, noted that one in seven Australians are taking SSRIs, but recovery rates are low while ‘common side effects include insomnia, psychosis, blurred vision [and] sexual dysfunction’ (psychosis is not, in fact, a common adverse effect of SSRIs). Meanwhile, there was little mention in Mind Medicine’s evidence of psychedelic adverse effects. Instead, Mind Medicine consultant David Nutt assured Australians: ‘no one has ever come out of a psychedelic trial for depression feeling worse’ (which is not true either). Mind Medicine executive director, Tania de Jong, continued the dissing of SSRIs in her now-legendary song, Shroom Boom:
‘Why can’t I get out of bed. It’s not because I am dead.
And yet the pain never stops…antidepressants and side effects…
So I tried magic mushrooms and now I’m feeling so great.’
In Europe and the US, the leading investor in psychedelics is Christian Angermayer, who has said of SSRIs, ‘to be blunt, they’re pretty shitty, and come with many side effects’. Meanwhile psychedelics have ‘practically no downside’, they have ‘no risk’, according to Angermayer.
Psychedelics are marketed as superior to SSRIs because, supposedly, you only need to take them once to find remission from chronic emotional problems, unlike SSRIs. Plus they’re natural and spiritual, while SSRIs are artificial, soulless, and peddled by evil Big Pharma.
Here, for example, is a tweet this week from Arizona state senator TJ Shope, who is hoping to legalize psilocybin service centres in Arizona.
Psychedelics are championed as mind-opening, heart-opening, soul-opening and even libido-enhancing, while SSRIs are portrayed as shutting you down, diminishing your experience, deadening your soul.
Now, it may turn out psychedelics are a superior treatment to SSRIs for many people. We do meet people who say they found almost miraculous healing through psychedelics after having tried SSRIs for years. This, for example, is from one reader:
I used to be in therapy for years and on SSRI’s back in 2009-2014/15. The SSRI’s didn’t seem to do anything and just made me a zombie. Even after multiple attempts to find “the right doses.” Eventually I quit on my own initiative and had a hellish withdrawal period. About 2 years ago, I had my very first experience with Psilocybin Mushrooms. It changed my life instantly. I quit drinking alcohol and smoking cigarettes the very next day with ZERO effort. Since then the use of psychedelics cured my suicidal depression, PTSD and OCD COMPLETELY. After a lifetime of severe misery and helplessness: I finally am able not to just hold a job, but have a successful career and make good money. I got a GF and am finally able to maintain a healthy relationship. I got a nice home, friends, hobbies and overall a happy life. I also changed from an angry atheist to a very loving spiritual person as a “side effect” of psychedelics as well and that makes me very fulfilled and happy.
This is awesome! And we’ve heard other similar stories.
However, here’s the risk of this rhetoric.
Sometimes this promotion of psychedelics versus SSRIs can lead to ‘pill shaming’ - i.e the demonizing of SSRIs as very risky, unnatural, unspiritual, a tool of evil Big Pharma and so on. SSRI adverse effects are talked up, while psychedelic side effects are minimized or not mentioned at all. This can encourage people to come off SSRIs too quickly and hope for a miracle cure from psychedelics, which can in turn lead to a destabilization that is amplified by psychedelics. More on this below, with some examples, and some possible solutions.
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