LSD, ketamine, psilocybin, CBD: from recreation to self-medication

“For me, mainly it’s a tool to practice mindfulness.”

Fred, 25, a radio producer from London, is telling me how magic mushrooms have made their way into his daily routine. When he preempts a bad day, a small amount of the psychedelic drug is his fix.

“It’s coaxed me into letting go of a lot of tension and baggage,” he says, describing how psychedelics have helped him unpick ongoing fears and anxieties, some of which stemmed from his grandmother’s death aged 13. ​“But it’s also made me more self-aware. I do more of the things I know will improve my mental health, like breathing exercises, yoga, cutting down on weed… I listen to my body more. ”

It’s not the typical attitude towards drugs you’d expect from a young guy in the city, but Fred is far from alone in his sentiments. As our generation ploughs through an era defined by unhappiness, uncertainty, work stress and burnout, conversations about the best pills or after hours are being replaced by earnest discussions about which drugs can help us feel better, not only for a night out but every single day.

Intertwined with a burgeoning wellness industry, a heightened awareness of our psychological wellbeing and resurgence of interest in the non-toxic, cognitive enhancing potential of psychedelics, Fred is part of a growing number of people engaging in what you could describe as ​“conscious drug taking” – dabbling and experimenting with substances for therapeutic, rather than recreational purposes. At the shallow end, this has millions dropping CBD into their coffee every morning. At the deep end, it has people self-medicating with ketamine, LSD and psilocybin in order to support their mental health or manage a mental illness.

But for many, there’s a blurred line between therapeutic and recreational use. As well as taking psychedelics specifically for mental health, Fred considers his experiences taking LSD in clubs as therapeutic in its own right: ​“like movement therapy, if you will.”

Another person tells me they regularly take 2CB while clubbing in order to bring on an emotional release: ​“Something about the combination of the substance and the repetitive music means I eventually break through the shell holding in the emotion and I keep crying and crying,” they say. ​“It might or might not happen… but I’m partly aiming for that to happen.”

Many more describe their gradual shift towards the occasional use of psychedelics in place of more traditional party drugs like ecstasy or cocaine, driven by an awareness of wellness and the mind.

“I guess I’m using more hallucinogens recreationally, but I’d prefer to use them for my mental health over prescription drugs too,” said one person who has also used psilocybin to get through a period of depression. ​“Mushrooms feel like they open a small door to my subconscious and give me a stream of thoughts and feelings that are healing and helpful. It’s like self-therapy.”

While it’s a movement that’s hard to quantify – its illegality means it primarily exists in conversations within social groups or online communities – it hasn’t gone unnoticed by academics like Dr Toby Lea, a social sciences lecturer at UNSW Sydney and a Humboldt Foundation research fellow, who has just completed a survey of 2200 people doing exactly this.

“It’s really hard to say how common these practices are,” he tells me. ​“But I suspect it is becoming more popular. In the past decade, there has been an increase in clinical research on psychedelics and the findings have been really impressive. People read about it and think they’d like to try it.”

This ongoing clinical research includes trials in the US for ecstasy as a treatment for PTSD; studies by John Hopkins University showing how psilocybin could reduce depression; the development of a treatment for depression using ketamine; and, in the past year, the launch of the first placebo-controlled study into the effects of microdosing with LSD by the Beckley Foundation.

It paints an optimistic vision of future treatments for mental illness, but researchers encourage caution. ​“I wouldn’t want members of the public thinking they can treat their own depressions by picking their own magic mushrooms,” Dr Carhaart Harris, from Imperial College London, who has conducted UK studies into psilocybin, told the Guardian. ​“That kind of approach could be risky.”

Still, as Lea has found, it’s a risk many people are willing to take. Of 2200 people surveyed, half had microdosed – taking small doses of psychedelics on a regular basis – and half had taken a standard dose. Lea is yet to conduct a detailed analysis but he says the results were similar across the board; 65 – 69% of those taking psychedelics for depression said they found it very helpful compared to standard treatments for mental health, while only 25% found counselling very helpful, with just 6 – 7% feeling the same about antidepressants.

“Someone is less likely to go down this route if they haven’t taken psychedelics before,” says Lea. ​“But these are people who are at the end of their tether with regular treatments.”

In September 2017, Charlie, a PHD student from London, was in the midst of a severe episode of depression, enduring suicidal thoughts most days. Realising he needed help, he booked an appointment with his GP and was promptly prescribed 20mg of the SSRI antidepressant Citalopram. It stopped the suicidal thoughts, but the impact on his daily life was punishing.

“I was fatigued most of the time,” he says. ​“I also felt emotionally neutral and that would lead to destructive behaviours – I’d go out and get really drunk just to feel something different to that baseline. It also really effects your sex drive – I couldn’t ejaculate on it.”

Charlie went online and began researching alternative treatments for depression. He hadn’t taken LSD before (though had tried 2CB) and, after speaking to a friend who had been in a similar situation and found it effective, he decided to try microdosing.

“When you’re so desperate for help,” says Charlie. ​“And someone offers you an alternative, it’s very difficult to distinguish between that and a doctor saying: ​‘Hey why not try this other type of antidepressant? I don’t know if it will work but you might as well give it a go’.”

While Charlie wasn’t concerned about the short term risks – LSD is among the safest, least toxic drugs you can take in a physical sense – he was wary of the potential risks of taking it in the long term, which remain largely unknown. And while high doses of psychedelics present a risk of panic attacks, paranoia and even temporary psychosis, small doses can also result in anxiety. The Third Wave, an online resource with detailed researched backed guidance on responsible psychedelic use, does not recommend microdosing for those with schizophrenia, psychosis or anxiety disorders.

Charlie approached his self-treatment methodically, in keeping with established guidelines. This means buying LSD from a trusted source – and then testing it with a Reagent kit – dissolving 100 microgram tabs into water and then using a measured dropper to dose, starting with 2 – 5 micrograms and steadily working up until a dose is found that feels effective without bringing on the psychedelic effects of the drug.

“Once I was on a 12 – 15mcg dose,” says Charlie. ​“Which I was taking every three days, I noticed my interest in life returning. I could rationalise things more, found joy in my friends, wasn’t seeking self-destructive behaviour, enjoyed my work and was becoming more creative. It wasn’t a cure-all moment, but these feelings began creeping back into my life again.”

Besides one seminar spent in fits of giggles after believing a cake someone had brought in resembled the tutor (“I was in a rush that day and I think I accidentally double dosed…”), there were no noticeable side effects.

Charlie was able to taper himself of the Citalopram and by summer 2018 he felt able to stop microdosing too. A year on he remains in a ​“pre-depression level of mood”.

But is it really so simple to fix a mental illness on your own? For Dr Ben Sessa, who is at the forefront of research into how psychedelics could be integrated into psychiatry and is currently leading the UK’s first clinical trial for MDMA therapy, it’s not.

“Mental wellbeing is not just some state, a button you press,” he tells me. ​“It’s a lifelong process. It’s about everything. Your friendships, partner, children, childhood, community, the food you eat, your hopes, dreams… it’s madness to think you can just read something on a blog, buy some LSD and cure your depression. But the question is: how do psychedelics compare to existing treatments and do they have a place in modern medicine?”

For Sessa, psychedelic therapy is not simply about taking a drug. It should be facilitated under expert supervision. His MDMA trial, which is for people with alcohol addiction, involves an eight-session course, only two of which are under the influence of the drug. Though he recognises the powerful anecdotal evidence for microdosing, Sessa points out there have been no randomised placebo-controlled trials to back it up. He can, however, empathise with the sentiment driving many to reach for alternatives.

“People are sick of existing psychiatry”, he says. ​“I like psychedelics because I don’t like psychiatric drugs. I don’t think it’s healthy to take antidepressants for years. If it’s possible to take LSD or a psychedelic once or twice in a therapy session and not need it again that’s a much smarter, more focused way to use medicine to get better.”

For now, however, few will be able to gain access to this kind of treatment legally. Sessa hopes to have a licence for the UK’s first psychedelic treatment centre within two years, but while this kind of therapy remains unlicensed, the only option for someone who has decided to go down this path is to seek out an underground therapist, register for a research study, or go it alone.

Around the same time Charlie was emerging from his period of depression, Frankie, 27, also from London, was reaching a crisis point of their own, dealing with a mental health breakdown in the middle of last year.

They were prescribed SSRIs but struggled to get through the 2 – 3 month adjustment period, which led to Frankie experiencing suicidal thoughts. While Charlie used LSD to support him, Frankie turned to a drug they’d used recreationally for a decade; ketamine.

“I would go into these spirals of suicidal thought, having really visual images of my own death,” they say. ​“I’d take some K and it would zoom me out. I’d be looking down, telling myself: ​‘you are in loads of pain right now but you won’t be in the future’. It helped me see things in perspective.”

Compared to other psychedelics, ketamine (a dissociative anaesthetic) is less of a household name when it comes to the realms of mental wellbeing. Yet while it is likely to be some years before LSD or psilocybin are available on the NHS, ketamine is already being used legally in the UK as an off-prescription drug for the most severe, treatment-resistant cases of depression. In the US the FDA has just licensed a ketamine-related drug – the first novel non-regulatory drug to be approved for depression in three decades. One of the drug’s key features is that it’s fast acting. It was a need for something that could have an immediate effect that led Frankie to turn to it alongside their prescribed treatments and therapy.

“When you have a really awful spiral you just want to take something, anything,” they say. ​“Non-prescription drugs are often the ones you can take as and when, get the effect immediately and feel better. For me, they meet very different requirements.”

However, ketamine is a drug that can cause serious side effects when used chronically, from memory loss to bladder and kidney damage. Though they haven’t experienced physical side effects, after taking it regularly for many months, Frankie is psychologically dependent and has to take it in small amounts regardless of their state of mind.

“It’s a small price to pay,” they say, adding that they are now trying to wean themselves off it. ​“I don’t think there’s something inherently wrong in being dependent on a drug because I’m dependent on antidepressants too. There were times when it stopped me harming myself and I wouldn’t have been able to do that with what was prescribed to me. The benefits outweigh the costs.”

Frankie also paints a bigger picture of the prevalence of this behaviour; most people they know that are dealing with mental illness are also self-medicating, something they attribute to a comfort with taking recreational drugs, a dissatisfaction with the help available on the NHS and the difficulties in getting an appointment with a specialist psychiatrist. ​“A lot of people I know do it because they feel they know their mental health better than their GP will,” they say.

The fact that so many are taking matters into their own hands suggests a need for more openness around this subject between patients and clinicians. While Frankie (and others I’ve spoken to) have felt able to tell their therapist about self-medicating and found them supportive, others have not. None felt comfortable speaking to their GP about it. ​“If you are known to be using illegal drugs it can make it harder to be prescribed drugs in the future or access care,” says Frankie. ​“Which is dangerous – not telling them could put you at risk of an interaction.”

It’s another instance in which prohibition is leading to potentially risky outcomes, one reason which led to Lea to conduct his research.

“It’s really important to find out what people are doing because it can take many years for a drug to go from clinical trials to a market,” he says, adding that most people he surveyed hadn’t discussed psychedelics with a health professional. ​“And people are still going to be using these substances to manage their mental health problems in the meantime.”

The different experiences of people using drugs in this way represent a broad church. For some, psychedelics are a replacement for conventional treatments, for others a supplement to it. In these cases it highlights a desperate need for better access to specialist mental health care and, as many professionals in the field would agree, a new set of treatments.

However for many more, who may not be suffering from a serious mental illness but are seeking new ways to reflect on their life, behaviour and self, it’s something in between – evidence of the far-reaching impact of the psychedelic renaissance and a return to an age of spiritual exploration in the face of challenging times. Whether this is hopeful behaviour – or escapist – is up for debate. Psychedelics may be mind-opening drugs, but this generation is hardly chasing Nirvana – it simply wants to get through the day.

*Some names have been changed.