Since they were launched in the late 1980s, antidepressant 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 antidepressants, and prescriptions have risen 35 percent in the last six years. The antidepressant market was initially a bonanza for some Big Pharma companies, although patents have long since passed, so the roughly $17 billion 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 that antidepressants are not perfect. SSRIs relieve some symptoms in about 40-60 percent of people with depression, but only get around 35 percent 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.
READ: California Governor Signs Bill to Streamline Psychedelics Research
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:
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“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 recent tweet 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 and antidepressants (and all pharmaceuticals) 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 froan Ecstatic Integration 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 and other antidepressants, such as SNRIs can lead to “pill shaming” — i.e. the demonizing of antidepressants (and other psychiatric medications) as very risky, unnatural, unspiritual, a tool of evil Big Pharma and so on. The adverse effects of these meds 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, in turn, can lead to a destabilization that is amplified by psychedelics.
Pill Shaming in Psychedelic Culture
Dr. Erica Zelfand is a psychedelic harm reduction expert and Executive Director of Right to Heal. She says she often notices people within the psychedelic culture shaming those who take psychiatric medications.
“I absolutely have witnessed and continue to witness a very troubling pattern of pill shaming in the psychedelic industry. And among psychedelic fans were people who use psychiatric medication are deemed as bypassing their problems, or using a crutch, or otherwise choosing a path that is not very noble. You know, even talking about psychiatric medications, I recently saw somebody put the word medications in quotation marks when they were talking about psychiatric medications. That’s incredibly disparaging, and incredibly disrespectful to the people who use these medicines.”
Colette Condorcitta Schmitt, owner of Condor Medicine, said she has seen the same thing.
“It has been my experience as a member of psychedelic healing culture for 13+ years that the perception of antidepressant medication, in general, is highly stigmatized in the community. There is a pervasive attitude that if you are taking antidepressants, it inherently means you are less than, you don’t need them, you are not “healed” enough, and you are not “doing the work”, etc. I could give lots of examples for this from working in retreat centers, supporting ceremonies, my own experiences taking antidepressants at different times, and catering to many clients who come to me from having seriously unsupportive to dangerous experiences with other coaches and facilitators before me.”
We asked psychonauts on Reddit if they’ve experienced pill shaming. The responses varied from people saying “yes, and we should shame SSRIs,” like this one, for instance:
“If by ‘pill shaming’ you mean a growing awareness of the predatory, exploitative, and manipulative nature of pharmaceuticals and the several industries that profit from its use/abuse, than I’m you’re huckleberry.”
…to comments like this:
“It is certainly very common in many psychedelic groups/circles to shame those that take pharmaceuticals, as well as a misunderstanding of pharmacology in general leading them to believe that anything synthesized in a lab is ‘toxic’ and ‘harmful,’ always in vague terms, and that anything ‘natural’ is good for you, again in vague terms. It’s really stupid and anti-scientific.“
…or this:
“I feel like people who are ‘enlightened’ look down on me for taking pills. I went off 8 weeks before the aya retreat but had such bad social anxiety during the retreat that I realized how much I needed the pills. I had hoped Ayahuasca would cure me so I wouldn’t have to take pills but I was wrong. I think within the psychedelic culture there is strong anti-western medicine sentiment. And because I take pills I am ‘not in touch with the universe’ and not spiritual enough. I get lectured on how I should be meditating instead of medicating.”
New Age / psychedelic culture evolved from Romanticism and shares a tendency to fetishize “the natural” and the “Noble Savage” while seeing the modern, civilized, and man-made as corrupt, materialist, and bad. One sees this attitude in the political campaign of RFK Junior, for example, who thinks psychedelics should be legalized, while people on antidepressants should be sent to “wellness farms” to be weaned off them.
Psychedelics are often portrayed as the antidote to America’s reliance on medication when, from another point of view, it’s the same discourse: “There is a mental health epidemic, you are sick! You need help urgently! Help us lobby the government and insurance companies to give you the drugs that you need and deserve now now now!” That was the rhetoric around SSRIs, and it’s a similar rhetoric with psychedelics (along with some added arguments about spiritual evolution and ending the war on drugs).
Psychedelic advocates seem blind to these parallels. Recently on Linkedin, an industry acquaintance posted a long diatribe against the over-selling of medication to Americans, warning of “rushed introductions, limited testing,” “severe side effect like mania and dependency and potential long-term issues…The mental health industry is massive…Drug manufacturers sponsor symposiums and pay for endorsements, fueling concerns about potential conflicts of interest…I believe we need a paradigm shift.”
This acquaintance sells ketamine therapy. Everything they said about antidepressants is just as true about the booming ketamine industry.
Ceremonies and Trials Too Require Coming Off of SSRIs, which Can Lead to Destablization
The anti-SSRI sentiment in psychedelic culture — while it may be justified in some ways — can have serious consequences. It is quite common for retreats and guides to encourage clients to come off SSRIs and other antidepressants before ceremonies — the argument is it can completely blunt the effects of the psychedelics, both the chemical effect and the spiritual effects. It’s also true that there is some evidence SSRIs could interact badly with ayahuasca, though there aren’t many cases of “serotonin syndrome” following combinations of SSRIs and ayahuasca.
But coming off SSRIs quickly — in a few weeks or, say, two months — can lead to destabilization.
Emma is a veteran from US Special Operations who went to an ayahuasca retreat run by a veterans charity last year, in the hope of finding healing from PTSD and liberation from years of medication.
“I had been on a cocktail of medications for around 13 years, but I was stable,” she told me. “I was actually doing really well. But I was being told that ‘if you do ayahuasca, then you won’t have to take these meds anymore.’”
Emma had a very challenging ceremony, which left her in a profoundly destabilized state for months after the retreat. “I was emotionally off the chain like I had never experienced before,” she said. “I felt like I wanted to get out of my own skin.” We can’t know what in her extended difficulties was an ayahuasca reaction and what was SSRI withdrawal.
READ: SSRI and LSD Interactions, Plus Shrooms and More
Emma went back on Prozac to stabilize her emotions. “I had this really immense feeling of failure for having to start my medication again, because the veteran charity who organized the retreat had said during one of the meetings after the retreat, ‘if you were on meds before, and you feel like you need to get on it again, I guess that’s OK.’ And it just makes you feel like shit, like you’ve failed.”
Dr. Erica Zelfand, a primary care provider (PCP) or a general practitioner (GP), used to work for a psilocybin retreat compay that required people to stop their medication before coming to the retreat. “I’ve seen it not go well for people,” she said. “Many of those clients then became patients of mine. After they got home from the retreat, a month or two later, I would see them, and they would tell me that they were doing so poorly they actually felt like everything that they had accomplished on the retreat had been completely lost, that they’re even worse than before they went on the retreat, that if they could go back and do the whole thing over, they wouldn’t have even gone on the retreat and wouldn’t have even taken the psychedelic because this is how much harm that they feel has been caused to them.”
Dr. Zelfand explains that asking people to get off their meds before taking psychedelics can inadvertently harm people. “We are asking them to become destabilized [by getting off their meds], then further destabilizing them with the psychedelic,” she said. “This can have disastrous outcomes. I clean up those messes made by uninformed facilitators on a regular basis. When that destabilization occurs, it doesn’t correct in a week or two, this is a long process to restabilize these people. And putting them right back on the medication that they stopped taking can feel like a defeat for them and can be very discouraging for them.”
People can also experience post-SSRI withdrawal and destabilization during psychedelic clinical trials, which typically ask participants to come off antidepressants and other psychiatric medications, such as mood stabilizers, anxiolytics, and neuroleptics, before the trial begins, so they can test the effects of the psychedelic drug alone.
Earlier this year we wrote about Heather, who experienced severe extended difficulties after taking part in a Braxia trial of psilocybin for depression.
“Right from the beginning, there were issues,” she told me. “First, they wanted me to taper off my medication on my own and I felt very uncomfortable about that, so I had to push to get a Braxia psychiatrist to help create a tapering plan. Even then, the process was very fast — under two months — given that I’ve been on medication for most of my life.”
She was clearly destabilizing prior to her second dosing session, but the session went ahead. She ended up developing Hallucinogen Persisting Perception Disorder (HPPD) and other long-term problems — and became so hyper-sensitized she wasn’t able to go back on SSRIs. “It’s like I’ve been in the ocean using floaties for decades, and now all of a sudden the currents are really strong, I don’t know how to swim, and I don’t have access to my floaties,” Heather said. “It was devastating. I could barely function.”
Possible Solutions
There may be possible solutions to the risk of post-SSRI destabilization among psychedelic retreat or psychedelic clinical trial participants. One solution, suggested by Dr. Zelfand, is to encourage people to stay on their medications. “My party line on the topic of SSRIs and psilocybin is this: Do not go off your medication (it’s a different story for ayahuasca and MDMA). I think that a big mistake that the psilocybin field does is it underestimates how deep somebody on an SSRI or other psychiatric drug can go with this medicine. Folks on these substances can go deep, they really can and the work can be profound. And the risk for having a ‘bad trip’ seems to be lower than among those who are not taking SSRIs.”
I asked Dr. Zelfand about instances when SSRIs blunt the effects of a psychedelic dose completely in some cases.
“Then you give them more mushrooms. That might mean 10 grams of dried mushrooms, that might mean 16 grams, the highest dose I’ve ever given somebody was 23 grams. If a person needs a higher dose to break through, so be it, give them a higher dose. This is the reason that I am critical of Oregon implementing a maximum dose for psilocybin because that maximum dose is a completely reasonable maximum dose for somebody who is not an SSRI user, but for an SSRI user, they might need more.”
READ: MDMA-Assisted Therapy is Less Effective if You Take Antidepressants
Psychedelic researchers are also increasingly testing to see if psychedelic treatments still work while people stay on their SSRIs. Professor Guy Goodwin of Compass Pathways, a leading psilocybin therapy organization, says that Compass trialled psilocybin-for-depression in one group of participants on SSRIs, versus another group off them. “The intensity of experience was essentially the same, which was a little unexpected,” he said. “The response at three weeks was actually slightly greater, if anything, which is neither here nor there, because it’s a small sample. But that was the observation. And there were no serious adverse events in that study.”
In another study — a Small Pharma trial of DMT for depression — the antidepressant effect of the psychedelic was actually greater for the group on SSRIs than for the group not on SSRIs.
Even if trials are encouraging people to come off SSRIs, they should be aware that post-SSRI withdrawal and destabilization could not only impact their results and raise their adverse event rate, but also severely harm their participants.
Ultimately, we need to be pragmatic, avoid psychedelic fundamentalism, exceptionalism, and anti-drug stigma of any kind. No chemical is morally surperior or purer than any other. Whatever works.
“I have seen cases where psychedelics could heal somebody in a way that a psychiatric medication could not. But I’ve also seen the opposite be true,” Dr. Zelfand said. “I’ve seen people who were stubborn, who wanted to heal a specific way with psychedelics, and it didn’t work. Finally, that person was willing to try pharmaceutical medication. More than once I’ve seen this happen where that patient then comes back with tears and says, ‘Why didn’t I do this sooner? Why was I so judgmental of these medications? This medication has given me my life back.’ It pains me to hear that. Because who are we to judge which path to healing is the right path for a person. This is where the fanaticism can become very toxic. 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.”
*This story originally appeared in theEcstatic Integration newsletter.
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DoubleBlind Magazine does not encourage or condone any illegal activities, including but not limited to the use of illegal substances. We do not provide mental health, clinical, or medical services. We are not a substitute for medical, psychological, or psychiatric diagnosis, treatment, or advice. If you are in a crisis or if you or any other person may be in danger or experiencing a mental health emergency, immediately call 911 or your local emergency resources. If you are considering suicide, please call 988 to connect with the National Suicide Prevention Lifeline.
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