LSD, Special K and Ecstasy for better mental health!

Image by Hugger Industries via Flickr

This story was published a few hours ago in Time magazine.

Is Ketamine a Quick Fix for Hard-to-Treat Depression? by John Cloud

I think the study authors would be a little more conservative in their reporting of the results however the people who end up in these experimental drug trials in the US are people with severe conditions where other treatments haven't worked and the prognosis is likely to be poor.

It follows another article written in Time magazine a fortnight ago.

Cloud, J. 2010, Ecstasy Shows Promise in Relieving PTSD

I also reported on LSD being used to treat mental ill health in an earlier blog post.

As Simon and Garkfunkel sung,

"Oh the times they are a changing."

How ace is St John's wort

Image via Wikipedia

Lots of people know the evidence for its usefulness in mild to moderate depression but the Mayo Clinic lists a huge range of uses (though the quality of the conclusions from the evidence is less strong).

Somatoform disorders, Anxiety, ADHD and OCD have lower quality evidence showing this herb can treat many disorders usually treated with stronger chemicals such as SSRIs.

I remember when I first came across St John's wort. It wasn't in relation to mental health directly. It was as a come down cure. After taking Ectsacy (MDMA though usually other compounds like MDEA) there is a period of low and it used to be pretty intense for me.

I looked for lots of treatments so I could keep on enjoying that drug and ended up finding lots of antidepressants, from drugs like 5-HTP (available over the counter), bananas, Marmite and, strangely, beer. Yes. A beer is a post-Ecstacy binge favourite for many clubbers though it's not used to combat the depression directly but used to help chill out during the Sunday comedown.

St John's wort is available over the counter. People who've tried antidepressants may be surprised at just how mild the side effects are and how nicer the effect can be. Many might ask their doctor why they're prescribed SSRIs instead of SJW. From what I've read in GP magazine doctors don't know what dose to use. This gap is probably because the BNF, the manual which doctors use to assess which chemical to use, doesn't have SJW in the CNS section as far as I am aware. My dad only has the Children's BNF lying around at the moment and the only advice there is that it shouldn't be used on kids because of the interactions (which are listed at length in the appendix).

In Germany it is commonly prescribed for mild to moderate depression and I've used the "sunshine herb" many a time for it's antidepressant action. The main side effect I notice is poor bladder control but that varies with time but this may be better with tablets rather than capsule pills.

Eureka? A solution to the problem of language in mental health

There is an ultimate division that will never be healed if any language is used to differentiate different human beings as long as mental health exists.

There are the mentally ill and there are the normal but a movement has pushed for the term mentally ill to become euphimised to mental health problem, difficulty, experience and other less bad terms. This will continue till there is no more mental health stigma.

What if the movement tried an alternative, just for a bit of fun. Why not rename normal? In an earlier blog post I changed the word to "automoton" referring to a mindless machine with properties akin to a robot rather than a human.

This levels the playing field. When presented with a choice between "mentally ill" and "mindless automoton" many wouldn't know which to choose because they have equally (and meaningless in my eyes) negative connotations.

It's sort of turning the problem on it's head and applying a little lateral thinking...sadly the latter is rarely seen in automotons but with help and therapy and medication (delta-9-THC or C2H5OH may be effective) many automotons can be assisted to become normal....I mean mentally ill.

There is a pleasant feeling of smugness associated with this thought. I think the meal I just ate helped and a little smoke with the dust from an old skunk baggie.

Miaow Miaow

The latest recreational drug is nicknamed Miaow miaow or Plant food. Its a new "research chemical" or "research ligand". It was developed by an Israeli enthogeon research company that designs legal highs. I haven't yet tried this drug but I think I need to.

Its soon to be made a Class B drug which flies in the face of expert opinion and is making the governments draconian drug policy all the more obvious for being prejudice rather than evidenced-based policy.

It is seen as a moral choice to say these drugs should be illegal. Many drug dealers must be rubbing their hands at the prospect of yet another new market for them thanks to the government.

The impact of making the drug illegal will not reduce its availability as is clear from the current drug situation in the UK. There is no drug problem as far as I am concerned because everyone can get them.

The UK government doesn't care about the lives of drug users however I and many other people do. By making them illegal it leaves the distribution purely in the unregulated hands of crime. A taxed, regulated system has so much potential for physical and mental health as
well as the social harms that come from addictions. The value for healthcare has already been demonstrated in the US for cannabis and more research into the other drugs will undoubtably lead to new treatments. MDMA, for example, could be used before ECT, high-CBD weed for psychosis before antipsychotics and alcohol and fun before antidepressants.

Drugs will have to be legalised one day but the political prejudice will be hard to breakdown. It's so high that they fire senior government advisors who don't tow the party line. It feels very Stalinesque to oust those with opinions that aren't of the group.

Addictions

Current treatment for addictions is to achieve a state of abstinence as an outcome. This is a poor outcome. An addict can learn to manage their addiction. Many do. Probably many more than those who don't manage their addiction. I fall into the latter but I'm getting better at it.

The choice I made was to not let the drug control me but I chose a difficult path. Teetotallers can't enjoy what they used to enjoy with treatment for alcohol addictions. With new addictions like internet addictions becoming part of the diagnostic criteria there is a need for a different treatment outcome. Or will future mental healthcare attempt to make 'teetotalling' internet users?

Addicts are normal people and normal people enjoy themselves with all sorts of drugs, from alcohol to work. Yes, even work is an addiction that, for some people, follows the same patterns as a drug addiction. Teetotalling 'work' addicts would probably pick up a drug addiction or be prescribed a legal one to cope with the boredom.

A friend of a friend was diagnosed with an alcohol and sex addiction. He subsequently got a diagnosis of depression while successfully abstaining from both his old medications that salved his inner pain. The doctors prescribed him antidepressants.

The example is elucidating I hope on a point. Take from it whatever you will.

Treatment can also involve a 'cold turkey' and for some people it is enforced against their will. It is inhumane to force this on anyone. It is also exceptionally traumatic for some people even if they choose to go cold turkey. In the use of psychiatric pharmaceuticals its recommended that levels of medication be tapered off when coming off however I don't know if this happens with non-psychiatric psychopharmaceutical or other forms of self-administered treatment for unhappiness/filling the whole in your soul. I've seen people brought onto wards so they could get alcohol addiction treatment and that meant they felt severely unwell and went through painful withdrawal symptoms that were unnecessary pain.

The stigmatisation of drug use means that there is no representation for them, no voice amongst the professional campaigners fighting for other mental illnesses. This is why such an unnecessarily painful way to treat alcohol and drug addictions is allowed.

I can see why dual diagnosis is stigmatised of course: I do it to myself. This is why its seen as a self harming behaviour. Its also been explained to me as a form of obsessive compulsive by a therapist. The therapist was ethical at least. He worked in a drugs and alcohol counselling service and he tried to help me manage my minor addiction rather than push me down the 12-steps programme.

I doubt many people can even see dual diagnosis and addictions as a mental illness like any other. The stigma is different to the stigma of mental ill health because its redoubled by the public stigma against addicts and against drugs. I suspect that I wouldn't be popular if I espoused an alternative understanding based on personal experience rather than hearsay, biased media stories and what their parents told them.

Science in politics isn't science

Its just another shitty use of science. Ignore that data that doesn't support the preconceived perception. Use the data when it supports a preconceived perception.

Its most obvious in drug policy in the UK.

http://www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=409670&c=1

Science is a very difficult pursuit. Evidence-based science may not always be the best paradigm but it works the highest number of times and more often than not comes up with the right answer.

Good science looks to defeat bias, prejudice, ignorant supposition and current thinking all in the pursuit of the absolute truth. Of course it is simply not enough to have the evidence - correct interpretation is vital. But that's all part of the struggle to find this truth.

In physical sciences this dogged determination to find the truth is clear. It may be easier than for social and soft sciences but the paradigm can be taken and its use practised in the harder to measure subjects.

It isn't in drug research. For a start its the most biased research I can think of though psychosanalogical (looking at wellness) research in psychosis is probably up there.

There is little to none high quality psychosanalogical drug research published, i.e. none considering drugs as enthogeons. What that means is that there are no studies accept by politicians that show the potential of illegal drugs for mental health and life, though there is an immense body of work on the internet of personal experiences. These positive experiences would be shared by vast swathes of the population who take drugs regularly.

It is interesting that the psychiatric profession love psychopharmaceuticals for (supposed) psychopathology but vilify illegal psychopharmaceuticals that have been used for aeons and are used recreationally today. None of the pro-drugs research ever makes it to commissioners and politicians probably because it is low quality though possibly because they wouldn't read it even if it was high quality. They'd choose not to investigate the potential of MDMA for therapy and treatment even though it has helped many people. (another post later on the potential of Ecstacy for mental health treatment).

Bias is the great evil of high quality research though seemed to be accepted and somewhat promoted by qualitative social research. Bias is usually the greatest cause of mistruth when scientific methods are used. Its why the gold standard is the Randomised Control Trial because the bias of knowledge of trial group caused results that were incorrectly showing treatments like insulin-induced comas (and/or seizures) to be an effective high risk treatment over less risky treatments in post-WWII Britain. In fact the modern gold standard is the double-blind RCT and the blind quality is another attempt to remove human bias that skews the results and can inflate them.

Publication bias is revealed through meta-analysis techniques which look at published and unpublished data and map out the studies using a funnel plot. Publication bias will mean that a treatment will look more favourable through the funnel plot, for example antidepressant studies that show lack of effectiveness compared to the placebo effect won't be published by drug companies. Recent meta-analyses and reviews have identify the publication bias and have suggested their lack of efficacy. This means the idea that antidepressants work more than the placebo effect isn't true though lots of single, published, high quality studies show them to be more effective.

A funnel plot isn't needed for the drugs research to see the immense bias is psychiatric and other scientific literature. Its not surprising of course. The stigma of drug use by the 'establishment' or those who are in power is very strong and rooted in Western history. An example of what happens to research in this area is the famous Harvard Psilocybin Project (http://en.wikipedia.org/wiki/Harvard_Psilocybin_Project) in the 70's. The battle between enthogens and mental health is once against seen, and unlike the Bible story its David that looses to Goliath.

Those who become policy makers often forget their experience of drugs and drug takers. Many have had a toke and may have tried other drugs. Most people hide drug use like they'd hide hearing voices. As people get older they may continue to take drugs or they may stop, but when asked to say if drugs are good or bad they'll forget their personal experience and go with the socially acceptable argument based on those who end up addicted or in crime. The memory bias means they'll forget all the good times they've had, all the great experiences and all the fun because the socially acceptable view is of a junkie with a needle in their arm robbing a grandmother. Its almost like its unacceptable to tell the truth about enjoying drugs.

At heart the UK's policy makers love drugs. That's why there's a tax-free bar right at the centre of the House of Commons - Annie's bar if I remember correctly. I'm sure a large amount of UK policy across a number of areas is done while politicians sup on a drug. Its a legal one and an accepted one as is much of the social ill of alcohol. After all, taxation funds education and rehabilitation.

And a dissenting voice like Professor David Nutt who points out the obvious is silenced and removed from a position on the UK's scientific advisory committee, one that he'd held for many years.

So many dictators would be proud to see their way of working is still alive in 2010. Criticism, free thought and the fucking obvious pointed out when it is contrary to the party line should be silenced. Evidence is only to be used when it is convenient and ignored when it isn't.

What someone thinks is 'right' is more important than real truth.