While Valium and Prozac are certainly problematic, replacing them with illegal drugs such as ketamine and MDMA still fails to adress the root causes of emotional pain.

In recent years, ketamine has gained significant attention from the medical community for its potential in treating depression. While being traditionally used both as an anaesthetic and a party drug, ketamine’s capacity to “fragment” consciousness, and thus allow the mind a break from self-hating thoughts, has shown promising results for patients in a number of studies.

In a very recent case, it’s also backfired catastrophically. Patients lost all motor coordination after doctors administered a new kind of nasal spray; they also suffered unpleasant side effects such as low blood pressure and “psychotic-like effects”, which could imply hallucinations and paranoïa. Despite this failure, the medical staff remains positive ketamine could still be used in an efficient, safe way to treat anxiety, and plan to explore its full potential through further trials.

The idea of administering recreational drugs under medical supervision to treat depression is far from uncommon. In an essay published on Aeon on 15th May, 2017, neuroscientist Marc Lewis and researcher Shaun Shelly argue that the “stigma” against illegal drugs such as MDMA, ecstasy and ketamine should be lifted so that people get safe access to those substances. The idea is that they should be much more likely to help than anti-depressants, whose unpleasant side-effects and lack of success with most patients is now well-documented.

If we’re going to treat psychological suffering as effectively as we treat pneumonia and broken bones, we’d better think outside the box of antidepressants that stupefy, and anxiolytics that dull the senses. We might start by exploring the options that human nature gravitates toward when left unfettered: drugs that help different individuals feel good in different ways. Stripped of stigma or the prospect of arrest, moved out of clandestine labs and back alleys, and prescribed with sensitivity and compassion, these drugs can do a lot of good.

The reasoning, however, is a tad too optimistic. Yes, ketamine do have effects that are very interesting for patients from the point of view of depression. Psilocybin also has potential in this regard. But even so, it’s important to remember what we’re dealing with here. Drugs are extremely volatile, capricious substances whose effects tend to vary between individuals depending on different factors. While a given drug will technically operate in a precise way (MDMA and ecstasy will release a truckload of endorphins, for instance), how the individual is going to react isn’t easy to predict or control. Drugs are all about altering brain chemistry, and brain chemistry is by nature tricky business.

Which is why a lot of people are absolutely crazy about ecstasy, while others dislike its effects. Ecstasy has the power to transform one’s world into a sweet pink bunnyland of endless lollipops; to another, it may feel unpleasant because they feel they’re not in control. Personality and whatever drugs have been tried before play a big role.

In any case, ecstasy and MDMA are probably very ill-equipped to help people suffering from anxiety and depression. When you’re perpetually plagued with circling thoughts of misery and self-loathing, a brutal release of endorphins is likely to have a major impact, and not in the good way. Imagine being a stressed, self-hating wreck, suddenly offered a glimpse of Heaven through the mere ingestion of a tiny little pill. All of a sudden, your fears and doubts vanish; your being seems divine and wonderful; socializing becomes a piece of cake. No doubt that you would feel happy, the happiest you’ve ever been. No doubt this experience would transform you.

For a little while.

Effects of MDMA tend to decline roughly three to four hours after ingestion – what’s known as “coming down“. It’s associated with feelings of irritability, tiredness, and melancholia. If you have your life more or less in order, it doesn’t necessarily have to be bad. A lot of people experience comedown with no issue whatsoever. They’re generally content in life, they have friends, family, passions. Drugs aren’t an escape; they’re an extra to have a bit more fun. Since they weren’t running from anything, they greet reality back with open arms. At worse, they’ll feel tired and sad the party is over. *

The picture may be totally different for depressive people. We’re talking about troubled individuals coming down from an all-encompassing state of bliss and returning to a reality they don’t want to be in. People whose already unhappy brains are now out of endorphins, and thus very likely to distort reality to make their problems seem worse than they already are. People who now see the already sad state of their lives in sharp, violent contrast to the blinding happiness they’ve just experienced.

I can’t pretend to know what people suffering from depression should feel when they come down from their high. But there’s a very real risk it could make their situation a thousand times worse. Once again, MDMA distorts reality. We’re not simply talking about feeling sad. We’re talking about drastically altered brain pathways. That means potentially feeling like shit, like the very concept of existence itself is totally meaningless. And if anonymous testimonies are any clue, it’s indeed what happens.

I don’t think it’s responsible to prescribe euphoriants such as ecstasy and MDMA to individuals suffering from psychological issues, because the quick high those drugs provide, no matter how pleasurable, may come at a similarly high price. These people can’t afford to endure a harsh comedown.

What about ketamine and shrooms then ? Could they help ? Maybe they could. Ketamine is certainly a seductive candidate : it’s fast and apparently very effective when it comes to curbing suicidal thoughts. It’s an anaesthetic, not a euphoriant, and as such it doesn’t merrily bring you to the seventh heaven only to drag you down by the hair four hours later. There’s technically no “high” to “come down” from. When you’re on ketamine, everything is mostly just weird. There’s no reflection on the past, future, the nature of the self, no ruminations of any kind. There’s no real thinking going on at all. Ketamine may be one of the purest ways to experience the “denial of the self” theorized by Buddhism.

But even so, I’m sceptical as to wether medical authorities should invest considerable time, resources and efforts in this direction. Is it really fair to call a drug “the most important discovery in half a century”, or “the greatest opportunity we have in mental health” ?

Anti-depressants were considered a breakthrough once. A high number of drugs have been hailed, in their time, as a crucial discovery in treating certain illnesses. And many of them are well-known today for their harmful side effects, which have only been made apparent with time. For decades, patients have been treated as little more than guinea pigs.

There’s no reason to think ketamine is different. We simply do not know what the long-term effects on the brain could be. We’re talking about an extremely powerful substance that breaks down both sense of self and motor coordination : it’s not far-fetched to suggest regular doses could have nasty effects on the human psyche (and body) in the long-term. And, studies or not, it’s not hard to spot those effects already. Have you been on the forums where long-time ketamine users talk about their painful and recurring kidney stones ? It ain’t funny, Marie.

Should we really take the risk to subject patients to yet another unknown chemical substance with potentially harmful repercussions ? Especially if said substance, rather than a cure, is merely supposed to alleviate symptons ?

This is another serious issue : drugs aren’t a cure. In a way, doing drugs to relieve emotional pain is akin to taking aspirin when you have a migraine : the migraine may be gone, but whatever caused it is still there, lurking under the surface. Aspirin won’t make the tumor go away. In the same vein, drugs won’t make the root causes of emotional suffering go away. They act instead as a smokescreen, distracting us from the real issues.

Oddly, there is a point in their essay where Lewis and Shelly seem to agree with me. They make clear their rejection of traditional anti-depressants such as Prozac, not only for their unpleasant side effects, but how they avoid adressing the “real problem” :

Instead of worrying so much about addiction, which tends to correct itself when life becomes tolerable, maybe we should worry more about the sources of emotional suffering. Depression not only hurts, it kills. Anxiety drives people to intractable isolation and fertilises stress-linked diseases. Yet the idea of prescribing opioids, cocaine, ketamine, ecstasy and other illegal drugs to help people feel ‘better’ is, currently, heretical. Are we concerned that people might feel too good? We’d rather stick to antidepressants of minimal therapeutic impact, not because they guard against addiction – they don’t – but because of a puritanical aversion to supplying unearned happiness and, along with it, a deep-seated belief that people who suffer emotionally should just get over it.

Addiction is a side issue. Emotional suffering is the real problem, and it’s complicated. In today’s world, the pressure to meet the expectations of success lead to anxiety, a sense of failure, guilt and depression. Inequality leaves people feeling inferior, envious and sometimes desperate. Depression and anxiety are umbrella terms that obscure enormous diversity in the causes and consequences of emotional pain.”

While the premise of their argument is entirely correct (that what matters here is emotional suffering and its complex, often societal causes), the conclusion is downright confusing. Let me get this straight : in a world where we often choose to handle emotional suffering by giving depressive people potentially harmful drugs, the solution would be to… give them different kinds of drugs ? How is that “thinking outside the box” ? Sounds like more of the same to me.
While Prozac and Valium are undoubtedly problematic (though they can also be beneficial to some people), it would be a mistake to distinguish between “harmful legal drugs” and “potentially beneficial illegal ones”. In the end, drugs are drugs. It doesn’t matter whether they’re legal, illegal, “stigmatized”, “glorified” or what have you. We’re talking about substances that provide temporary relief from emotional distress by messing up your brain chemistry. Key word here : temporary. It’s not going to last. The nice feelings will be gone at some point, leaving the patient back at square one. In exactly the same position as she was, because the root causes of her issues won’t have been adressed.

Taking ketamine or psilocibyn won’t change the conditions of people suffering from inequality, nor the pressure to succeed imposed by working environments. They won’t change the horrendous levels of female objectification in the media nor the violence women are subjected to at the hands of their husbands, fathers, or uncles – all factors that lead to depressive and anxious disorders.

Yes, emotional suffering is complicated. Very complicated. Sometimes the traumas that give rise to negative thoughts are obvious; other times, less so. Finding out both the precise causes of depression for each individual and effective treatments that take their personalities and needs into account is far from an easy matter. The fight against depression has to take place both at the individual and societal  level, on all fronts. At a personal level, there’s cost-free psycotherapy sessions, yoga classes and creative activities, to name a few. But more broadly, it’s crucial to analyze harmful social structures, promote campaigns against bullying, child abuse and misogyny (and educate qualified staff to handle these issues), revolutionize the media, publish books, TV shows to reach the public and change mentalities, reflect on new ways to relate to one another, redefine what work means as a component of our identity… and so on. It’s important that we take a good, honest look at each other and ourselves and ask : why do we live in a society where depression is rampant in the first place ?

All of this takes time, of course. Societal changes are slow, if they happen at all. And I understand that people need relief from their symptoms now. Everyone deserves a holiday. Everyone needs to be able to function somehow normally in everyday life. Drugs can help alleviate painful symptoms – anti-depressants, despite their shortcomings, have been helpful to a number of people. That being said, let’s remember that it’s all they can offer : symptom relief (and again, it tends to vary between patients.) That’s why calling ketamine the “most important discovery in half a century” is going too far. Ketamine isn’t the most important discovery in half a century because it’s not a cure. It’s not going to change anything.

 

I don’t believe rejecting the “puritanical aversion” and “stigma” against illegal drugs  is a fight we should prioritize, nor that illegal drugs are a crucial element missing from this conversation. This is a false debate. What’s missing is, as Lewis and Shelly themselves put it, a focus on the “sources of emotional suffering”, and particularly the social causes. We can’t invest so much hope in drugs.

 

Paradoxically, drugs may have the best effect on those who are already doing okay, those who have their lives more or less in order, who have a tight circle of loved ones along with joyful passions and a sense of purpose; they’re probably the ones who can best enjoy whatever interesting experiences psychedelic substances have to offer, because they don’t have previous traumas they’re trying to escape from, and they’re not using drugs to numb themselves to emotional pain. To really make the most out of shrooms and ketamine, maybe what you need is a clear head.

 

 

 

* Of course, people can’t always be easily categorized as “doing well” and “bad”. Sometimes, individuals who are otherwise content with their lives can experience a very harsh comedown (depending on what they ate, what exactly was in the pill, how the music was, whether they fought with their mum two hours before, etc.) But it’s certainly true that depressed individuals are more likely than others to experience comedown as psychologically painful.