By Rafael Torres.
Edited and enhanced in December 16 2023.
Edited, yet, every time I look at it.
This text, chaotic, extensive, and detailed as it is, is exactly the text I wish I had read years ago when I started treatment for Major Depression. It exists for the reader, especially those suffering from this same condition or living with someone who suffers from it. For this reason, the reader who does not fit this profile will constantly encounter words that seem to speak personally to them but do not make absolute sense.
The final lesson I will give right away: never give up. Suicide is not productive. It benefits no one and (who knows what we will find after death) possibly resolves nothing. No matter how deep the pain is and how discouraging or even despairing the thoughts may be, there is always a new medicine, a new therapy, a new treatment. This (the constant experimentation with medications, therapies, and treatments) has kept me alive until today. And it will continue to keep many others alive.
We, the depressed, understand each other. We know, or at least we think we know, what true pain is. The one that psychoanalysis so aptly calls the "pain of existence" A pain worse than any torture. The torture that comes from within.
Hi! I am Rafael Torres, 43, from Fortaleza, Brazil. I will share in this blog my thoughts on the subjects I'm better at. Depression and classical music. Below this huge text there is a comment box. Feel free to comment or to ask anything.
First, Some Clarifications
Drugs
In the terminology we use in Brazil, the term "drug" generally does not describe medications or pharmaceuticals. However, in some countries, such as the United States, the word "drug" can refer both to medicine and to the more harmful and illicit psychoactive substances. We will adhere to the current meaning of the word in Brazil: drug is a substance cultivated, synthesized, often illegally (but not always), or sourced from another country (trafficked) that alters the user's state of consciousness, for better or worse, and is forbidden.
The important thing here is that we know and differentiate some types of drugs. And in doing so, reduce our natural antipathy and repulsion for some of them while increasing it for others. We have:
Alcohol - even though it is not illegal, has characteristics that make its consumption dangerous and addictive. I believe the most correct social stance would be one of the two below: 1. Its ban (which would make it illegal, and it would start to be sold by dangerous and heavily armed organizations, confronting police forces, and the worst-case scenario, consumption would not be inhibited, not even subtly). 2. The legalization and regulation of other less harmful drugs (and only the less harmful ones), elevating them to the same status as alcohol.
Psycho-depressants or Depressants: like opium and morphine, widely used in the past. The former, as a recreational substance, and the latter, if we believe war movies, as a kind of anesthetic. But the most well-known member of this group nowadays is Heroin. It isn't harmless, though. This type of drug causes a decrease in brain activity, making the entire organism (and naturally, the person's own behaviour) slow. It causes addiction after consuming a few doses, has a high potential to render the user socially useless, and can lead to death;
Hallucinogens: can be synthetic, like LSD and Ecstasy, or naturally found in mushrooms, as is the case with Psilocybin, and in plants, like those that make up Ayahuasca tea (no, the plant is not called Ayahuasca, at least not in Brazil); Stimulant Drugs: Include Cocaine, Crack, Methamphetamine, and even Caffeine. These substances increase pulmonary activity, can provide a feeling of euphoria and decreased fatigue, and increase sensory sensitivity, causing, in certain cases, a state of alertness and agitation. Some of them are extremely harmful, easily destroying the life of the user and those around them and kill through overdose.
We all know the dramatic journey of a cocaine or heroin user. They become addicted quickly; need increasingly larger doses to achieve their expected effect; need increasingly frequent doses, too, as the effect lasts less and less time with greater use; their behaviour changes negatively; they become aggressive and hard to live with; after spending all their money on drugs, they start using other people's money (with or without the person's consent); finally, with increased dosage and frequency of use, the occurrence of an overdose, which can be fatal, becomes inevitable.
Drugs That Can Be Used Beneficially
(Beneficial for some people with compromised health, it should be noted.)
Substances with less harmful potential, but which alter the user's state of consciousness, have been studied by medicine, the pharmaceutical industry, and neuroscience since the 1950s, having detected promising materials for the treatment of Depression and other mental disorders. Several studies, some of which are listed below, indicate that non-addictive substances, like the Psilocybin found in a type of mushroom, offer greater therapeutic benefits than the most modern medications.
These studies increasingly eloquently show that some hallucinogens can dramatically improve the quality of life (potentially even saving the life) of people with Post-Traumatic Stress Disorder, Treatment-Resistant Depression, Chronic Anxiety, addiction to addictive drugs, and other Personality Disorders.
Psilocybin Effects
We do not know for sure how everything works. The Psilocybin found in hallucinogenic mushrooms does nothing on its own. Our bodies convert it into Psilocin, which is the true psychedelic agent.
It is also known that humanity discovered and has been taking advantage of its effects long before written history. In Spain, near the city of Villar del Humo, cave paintings around 6,000 years old were discovered, which probably depict Psilocybe Hispanica, one of the mushrooms that contain Psilocybin and is abundant in that region. The Mayans, even more devoted, dedicated actual stone sculptures to the Mesoamerican variant of the fungus. The Aztecs called it teonanácatl. Flesh of God. Siberian peoples have been using their mushroom, Amanita Muscaria, for ritualistic and religious purposes for thousands of years.
Common effects from ingesting Psilocybin, which begin to manifest in about 30 minutes, can vary greatly and depend on factors such as comfort, psychological state, and even the music being listened to. In studies conducted since the 1960s, scientists have found that the experience tends to be more pleasurable in people who have previously used hallucinogenic substances and is also more positive when done in groups of up to 5 people. Studies were conducted in groups and various dosages.
Returning to the effects. After a series of initial symptoms, which may include dizziness, nausea, and even vomiting, the person begins to have pleasant sensations and increased empathy. If administered in a specific dosage, at its peak, the individual experiences a mystical experience, which in its perfect state is the clear perception of belonging to the universe, of having learned something of extreme value about existence, communicated with the cosmos or with their deepest subconscious, as well as visual hallucinations (which the individual is fully aware are unreal and has the full capacity to differentiate them from reality), and in some cases, synaesthesia, a kind of confusion that occurs with the senses (the person thinks that certain music has the smell of rosemary or feels tingling in the hand when faced with the colour lilac, for example).
To the Beginning
A story my brother told me that has never left my mind: at school, the psychologist goes into the classrooms to introduce herself. Anyone in need of help, feeling different, sad, or angry can seek her out. To gain the students' complicity and sympathy, she uses several catchphrases. But the one at my brother's school dropped a true pearl: "A psychologist is not a doctor for the insane!" she states. "A psychiatrist is."
Total lack of preparation on the lady's part! But one thing was right in that situation: every school must have psychologists. Preferably well-informed ones. I laughed a lot when he told me, not foreseeing that soon I would be known to all the "doctors for the insane" in Fortaleza.
Research (some of which are listed at the end of the text) indicates that an hallucinogenic mushroom containing psilocybin, when compared, for example, to Escitalopram (one of its trade names is Lexapro), has a far superior and faster therapeutic effect than the medication in treating depression. I read a lot of information on this, but what I wanted was to provide a firsthand, first-person experience without the compromises of a report.
First, I will briefly summarize the treatment, I will try to explain in layman's terms how Depression and the medications work, and finally, I will delve into my experience, both with Depression and with the mushroom. Psilocybin, the hallucinogenic agent present in some mushrooms, has been tested worldwide as a treatment for people with Treatment-Resistant Depression (TRD), also known as Refractory Depression. The first thing you should know is that, like LSD, Psilocybin is not addictive. And, in the proposed dosages, does not cause significant side effects. The patient should administer (literally swallow) the mushrooms in the correct dosage, with the doctor's consent and preferably in a controlled, familiar, pleasant environment, listening to their favourite records.
I just cannot help the reader with acquiring the product. It is not legal. Or, to be less ambiguous, it is illegal. But the patient will not buy these mushrooms from a dangerous and armed trafficker. People who deal with this refer to themselves as "medicinal mushroom growers." They are illegal because authorities do not see that if they themselves, the authorities, regulated the commerce of these plants, making them legal (not just for medicinal use), the benefit to the country and to an entire working society that suffers from robberies, kidnappings, murders, and various other crimes would be immeasurable.
Yes, because the robber has a gun because he deals with the police since what he does, which is selling drugs, is a crime. And, in the end, those who buy the drug and fuel this disgusting chain are the same privileged youths who were robbed and on the same day were gifted a new, and better, cell phone.
So, returning to mushrooms without the aid of sociological rhetoric outbursts. After doing a fair amount of research, I decided to take Psilocybin, with the approval of two doctors. But at home.
I must say that I have no experience with recreational drugs, I find cocaine and heroin to be the most decadent things in the world. I don't judge those who like them, but they are really not for me. Once as we were walking on the sidewalk, my wife said: "Wow, that smells like marijuana!" I didn’t recognize it, because I have never been in weed appreciation circles. (Mental note: remember to ask my wife how she knows what marijuana smells like.)
This text will address:
My experience with Refractory Major Depression;
My quest for a cure or the best treatment;
The various existing treatments, noting that the text is aimed at people with depression or their relatives;
Explaining, to the best of my ability, what causes Depression;
And my experience with Psilocybin therapy. Step by step.
I came across various treatments that allowed even a person with a severe variant of Depression, like me, to lead a moderately dignified life.
I say this because the first thing some people think is that the patient wants to take a "drug" to "escape" reality. But although Psilocybin can be used as a recreational drug, my use was medicinal. And another thing. There are times when you do not "want" to escape reality. You need to escape it with all your might.
I do not recommend this treatment if you simply want to have a mystical experience, nor do I deny each adult the right to have one (experience). But here, the matter is different. If you are depressed, have tried everything, and nothing has worked, consider this option with your doctor.
Depression
I have had Depression from very early on—as a child—but it was diagnosed when I had a sudden and very severe crisis at 18 years old. It was Endogenous Depression (without an apparent reason), Chronic, Severe, and Refractory, meaning resistant to treatments. The part about "resistant to treatments" I discovered over time. Some antidepressants did have an effect, after the infamous 15-day waiting period (almost every antidepressant takes at least two weeks to start having a noticeable beneficial effect—and a myriad of unpleasant effects). But the positive effects would only last a few months, at most a few years. The "endogenous" part is that there was simply no reason for me to have entered into depression. Yes, there is Depression caused by an external event. Generally, it is easier to treat. But with me, no one had died, I wasn't suffering from bullying, I hadn't lost a job. Nothing.
We, my incredible parents and I, tried dozens of medications while I frequented the best psychiatrists in Fortaleza, the doctors for the insane. I remember always thinking how lucky I was to have a family that gave total support, was completely devoid of prejudices, that is, was very enlightened, and had money for doctors and medicines (some of them as expensive as you can't even imagine).
A very common thing is for someone to have depression and not seek treatment because their family is against it. Or, even, for religious reasons. It's one of the things that most infuriates me in the world. The apex of idiocy in its quintessence. One of my first doctors already came disarming me of any aversion I might have against medications: "Dependent? You are not dependent on medicines. You need them because they have something that your body should produce but does not. If you couldn’t see well, would you call yourself 'dependent' on glasses? Would that be a drama in your life?".
(Parenthesis: Neurotransmitters
This helped me see more clearly that what I have is a physical deficiency, and that to have a normal life, I need to replenish what is lacking, but which is not lacking in a healthy person. In those who have Depression, there occurs a deficiency of one or more categories of neurotransmitters (remember this word). Neurotransmitters are signalling molecules responsible for transmitting messages (technically, neural impulses) between neurons. Since neurons are separated from each other, there is a microscopic zone, but filled with activity, called a synapse. The neurotransmitters are responsible for linking information between them, released by one neuron and delivering the message to the next neuron, lodging themselves in the so-called postsynaptic membrane.
They are also responsible for the “quality” of the message. If the message passes through an abundance of neurotransmitters of the Serotonin type, for example, it may acquire a cheerful tone (let’s say it’s a thought) in a way that I cannot explain. If the thought passes through many dopamine-type neurotransmitters, it may become infused with sentimentality. In the case of Norepinephrine, it helps regulate the sensation of fatigue and exhaustion.
These are the three main types of neurotransmitters that are lacking in depressed individuals. There are others, of course, but the main medications focus on trying to regulate these three.
Let´s see:
Serotonin: responsible for regulating appetite, sleep, memory, learning, mood, and functions that assist the cardiovascular system, etc.;
Norepinephrine: regulates the release of Adrenaline, a hormone responsible for preparing the body for risky situations, emergencies, or that excessively stimulate emotions, among other things;
Dopamine: responsible for controlling movements, the sensation of pleasure, motivation, emotionality, etc.;
It is important to emphasize that, at least as far as I know, medications do not contain these neurotransmitters. They do not replenish them and science has not yet reached the point of synthesizing them. What the medications do is stimulate their production in the body. Or, more commonly, inhibit the reuptake of some of them, a process I will explain to the best of my ability.
What happens is that, for example, after Serotonin is released from one neuron to the synapse (the cosmic space between one neuron and another), it binds to the synaptic membrane of the next neuron (called the postsynaptic membrane), thus transmitting the message (it does not enter this next neuron and does not carry the message along several neurons). Once this function is fulfilled, the same neuron that released it recaptures it for a sort of recycling. This recapture is called neuronal reuptake in science. When this whole mechanism is dysregulated, it may be that Serotonin remains in the synapse, transmitting the neural impulse for a shorter time than normal in healthy individuals, becoming, basically, ineffective. Furthermore, the reuptake hinders the release of more Serotonin. With the malfunctioning of this specific neurotransmitter, the individual loses the functions it performs, which you saw above.
The medication that is possibly most suitable for treating the case of the hypothetical example above is a Serotonin Reuptake Inhibitor (SRI), or, more precisely, a Selective Serotonin Reuptake Inhibitor (SSRI) that, by preventing this reuptake, increases the availability of serotonin in the synapse. The difference between the two (SRIs and SSRIs) is that the former, by not being selective, can also inhibit the reuptake of Dopamine and Norepinephrine and other neurotransmitters, making a dispersed action, while the latter focuses exclusively on inhibiting the reuptake of serotonin, performing this function more effectively. SSRIs are the most commonly prescribed medications for treating Depression worldwide.
Among the better-known SSRIs, we have Escitalopram (marketed under the name Lexapro), Fluoxetine (formerly marketed as Prozac, but now found as a generic medication produced by several laboratories. Generic medications carry the name of the active substance, in this case, Fluoxetine), Fluvoxamine (Luvox, which has not yet had its patent broken, is marketed by only one laboratory, which makes its price dramatically high), and Sertraline (Zoloft and generics).
There are also Selective Dopamine Reuptake Inhibitors (SDRIs); Selective Norepinephrine Reuptake Inhibitors (SNRIs); Tricyclics, which are the oldest, from the 1950s, and increase the availability of serotonin and norepinephrine in the body but cause many unwanted side effects; Selective Serotonin and Norepinephrine Reuptake Inhibitors, which have a similar role to Tricyclics but, being more modern, cause fewer side effects; Tetracyclics, developed in the 1970s that resemble Tricyclics but act on a larger number of receptors (let’s go: receptors are the protein structures that receive the neurotransmitter in the postsynaptic cleft. They are important, even having the power to transform the impulse, the message brought by the neurotransmitter, but I won’t go into detail on the subject); and Monoamine Oxidase Inhibitors, which block not the reuptake, but the breakdown of neurotransmitters. Remember that I mentioned they go through a kind of recycling? This recycling begins with the degradation of neurotransmitters. The enzyme responsible for this degradation is of the type Monoamine Oxidase (MAO). Therefore, Monoamine Oxidase Inhibitors (MAOIs) inhibit its action, also causing na increase in the amount of neurotransmitters in the brain.
End Parenthesis)
It is unlikely that a doctor will get the medication right on the first try for a patient with depression. Because they have to rely on the accuracy, clarity, and lucidity of the description the patient provides of their symptoms. In the first consultation, the patient’s behavior, language, willingness to talk, and verbosity, which are still unknown, can have a misleading influence. They are also subject to error due to factors such as the presence of symptoms that are not related to depression, but which they cannot know.
In addition to the patient’s verbal report, there are also tests (or scales) with questions like “In the last 6 weeks, have you had trouble sleeping?”, “Have you had morbid thoughts?”, “On a scale from zero to tem, with tem being the best, what rating do you give your mood?”. This helps to create a panorama to determine what type of treatment (sometimes not involving medication) the patient needs. With more consultations, the panorama becomes clearer and more complete.
Important
I also want to make it clear that nowadays, poor people have several resources to treat depression: here in Fortaleza, for example, the University Hospital of the Federal University of Ceará is always selecting people for testing the most modern treatments. Often led by Dr. Fábio Gomes de Matos e Sousa, one of Brazil’s top psychiatry specialists. In addition, at Unifor, the Integrated Medical Care Center (NAMI) offers various free treatments to the community. Finally, the Unified Health System (SUS) provides medications, including antidepressants, free of charge.
My Experience
Now, let’s return to my story. Along with the medications, I also tried CBT (Cognitive Behavioral Therapy), which didn’t work well for me, and then TMS (Transcranial Magnetic Stimulation), which also had no effect. Finally, I turned to psychoanalysis, full of prejudices and impatience, knowing it was a long-term process. But the first therapist I went to was good. I resolved many issues with her, and I still hold on to what she used to say—that everyone could benefit from analysis. Eventually, I had to stop because weekly sessions were expensive, and I felt I was repeating myself, as if the process was running its course. Later, I realized that wasn’t the case. The need for analysis can be ongoing. I’ll go back eventually.
Over the 25 years since I was diagnosed, I’ve been through a lot. I share this because I believe it can help those going through similar agony.
Description and Episodes
In my first major crisis, at 18, the sadness was infinite. I couldn’t stop crying. Think about losing a loved one—that pain doesn’t compare to depression (at least not in severe cases like mine). To give you an idea, I lost two beloved grandfathers and didn’t feel a thing. A greater sadness overwhelmed the grief of loss. This sadness can be described as anguish, hopelessness, despair. You can’t stand your own existence. During a crisis, I’m convinced I’ll never come out of it, and if I do, it won’t be triumphant—at best, it will be barely.
I had floods of tears, sometimes in front of loved ones. People I didn’t want to see me cry. And for no reason, I assure you. The crying fits usually came from nowhere, though they could be triggered by something like a speech by a certain former president or a sad event. But even so, I always tried and will continue to try to hide the crying episodes.
My case is chronic, meaning I’ll always need to take medication. Don’t come at me with stories about how this is nonsense or a trap by the pharmaceutical industry. I have no patience for that argument, and I pity people who are prejudiced against medication, especially those who need it but are forbidden by their families.
If you have depression and refuse medication, you’re just feeding your neurological deficit. People with depression simply can’t fight against the insufficiency of one or more neurotransmitters, which are regulated naturally in healthy individuals. You shouldn’t deny medical treatment because you’re only adding more sadness to the world—and to those around you. But most of all, to yourself, as it leads to a very low quality of life.
Of course, medications are expensive and have various side effects, but they significantly improve the quality of life. In some cases, not mine, people use them for a few months and then stop.
I experienced these side effects. I’ve gotten used to them now. Headaches, dry mouth, almost surreal difficulty urinating, postural hypotension (when you stand up suddenly, everything goes black, sometimes causing fainting), and in many cases, it dramatically affects thought clarity, speech, and libido.
I often think about poor people who suffer from severe depression. I’ve always argued that Major Depression is a public health issue and that treatments should be widely available through the state. Many turn to drugs and alcohol—what would you do?
From the start of my major crisis at 18 (in 1999), I only thought about the need to sleep to ease the pain. I have insomnia, so I had (and still have) to take high doses of Zolpidem to knock me out. There was a time when this became unhealthy, an addiction, but I overcame it.
A doctor explained to me that Zolpidem, which I always used to sleep, is a nervous system depressant, and in the quantity I was taking, it was only making me more depressed.
A different doctor took drastic measures: I had to wean off Zolpidem, relying on Mirtazapine and Gabapentin, antidepressants with mild sedative effects. Zolpidem leaves the body in seven days. After that, the plan was to resume using it. It was the worst week of my life—limited sleep, terrible withdrawal symptoms, existential sadness, and a suffocating sense of drowning. I hated the doctor for a while, but what she did was correct and necessary.
Another doctor had to take drastic action: I would wean off Zolpidem. I had to sleep only with Mirtazapine and Gabapentin, which are antidepressants but have mild sedative effects. Zolpidem and any trace of it disappear from the body in seven days. After that, the plan was that I would go back to taking it. Once desaturated, my body would react better to a much smaller dose. It was the worst week of my life. I couldn’t sleep for more than a few hours. I was amid a terrible crisis, crying a lot, feeling an indescribable and limitless existential sadness, a clear sensation of drowning, gasping for air as if it could save me… I hated the doctor for a while. Not just because of the incredible withdrawal symptoms, which were many (and I strongly highlight lethargy), but also because she made me take a specific medication. I had recently attempted suicide, and that medication killed the possibility of trying again. Risperidone, the name of the thing. But the truth is that if it takes away your desire to kill yourself, it also takes away your will to do anything. You forget, lose track of the word “want.” Whether it’s getting out of bed, reading, watching anything, listening to music (my mom found it very strange that, while I was on this drug, I was never wearing headphones. Under normal circumstances, I always had headphones on)... My state, during that week, was of unbearable distress. As if I were inside a very hot pot. I couldn’t stay still, but I didn’t have the strength to get up, so I pathetically writhed in bed. I begged for things I can’t even remember and refused others that used to give me pleasure (like music, food...). But what the doctor did was right and necessary.
I believe that the great cosmic intention, the eternal human question, the reason we are here is to capture experiences, information, and sensations for the universe. For it. And, in the end, what it wants is to resolve duality. To know if, after infinity, positive or negative prevails, left or right, certain or uncertain. Or wrong. Whether good is stronger than evil, to put it in more human terms. All of our existence, of animals, of who knows what interplanetary life, all of reality, in short, has the sole purpose of helping it reach a conclusion of one bit. Yes, or no? Was it worth it or not? So, after that experience, I say: no universe, not all of human experience on Earth, none of it was worth it if someone had to go through what I went through in that week of 2017 and many others. Hours and hours writhing in bed with wide-open eyes, suffering, suffering, suffering… That was when Chico Buarque’s album Caravanas came out. I had no interest in listening at the time (which is very strange for me). I remember, at one point, not being able to stand it anymore and asking my mom to call the doctor. Anything she could think of to help me. She managed to take me off the Risperidone. Phew.
I even lost interest in Ketamine, which I’ll talk about later. Which, in the end, was good, because I went about 5 days without taking it, detoxing, and when I took it on the sixth day, it miraculously lifted me a bit. Just a little, but very welcome.
I’ve had a lot of weird things. I developed terrible migraines with aura. For those who don’t know, aura is a phenomenon that occurs in some people with severe migraines. In my case, the symptoms of this aura (which lasted a painful 20 to 30 minutes) were: I lost the ability to speak (in fact, I tried to say one word, but another incomprehensible one came out), and I lost movement in half of my body—this led me to the ICU for diagnosis, as I didn’t know it was a migraine at first, thinking it was a stroke. It’s been a few years since I’ve had these symptoms, thankfully.
Once, in a Baby Swimming class, I was in the pool with my daughter, two teachers, and about three or four other parents with their children. And my brain just stopped. I was holding Beatriz, and the last conscious thing I did was hand her over to the teacher. Then, already
I had days when sadness and anguish were so strong that they marked me until today. I remember a Cocoricó DVD that I used to put on for my daughter. I developed a distaste for it, even knowing that it is a good product. Palavra Cantada, Pingu, Pocoyo... The song "Rat, my dear rat," everything still causes me a mix of comfort and repulsion. We didn’t play Galinha Pintadinha for Beatriz very much thinking it wasn’t that interesting for her, but sometimes she would ask for it. Don’t even imagine what it’s like for a person with depression to have to listen to Galinha Pintadinha for hours.
Bia, my daughter, Flaviana, my wife, and my nieces are the brightness of my life. And my parents are the strongest pillars anyone could ask for. I try to spare Bia from my illness, but many times she notices. In any case, I am very clear with her (she's 13 years old) about everything, including depression and my certainty that she won’t have it—she has been seeing a psychologist weekly since she was very young. The psychologist is not for treating my daughter. It’s to help her develop emotional support for her entire life. We are sensitive.
As for my wife, after me, she suffers the most from my condition (my mother and father also suffer a lot). During the time I was on Zolpidem, she tried to hide the medication until we reached an agreement: I could take as much as I wanted, as long as it wasn't hidden, being understood that I was in despair. Sometimes I would beg.
The Zolpidem is more controlled now. I went through a detox from the apocalypse, but soon returned to taking it, albeit more cautiously. Considering that I used to take two boxes (40 tablets) a day and now take 6 tablets daily, I’m in profit (Edited on December 16, 2023: I am taking 15 tablets per day). It is still essential for me, because one of the worst moments of depression was (and still is) tossing and turning in bed unable to sleep. It feels like the pain comes magnified during those times. Nowadays, I take the medication (chew it and place it under my tongue for a few seconds to hopefully get it into my bloodstream faster) and fall asleep quickly. If 15 minutes pass and I haven’t slept, I ask for another one. Additionally, during the day, I take half a tablet in the morning and half in the afternoon. They calm me down, make my mind less confused, and reduce the persistent headache. I prefer taking these two halves of Zolpidem instead of taking benzodiazepines, like Clonazepam and Alprazolam. These have a calming effect, but leave me completely numb. Moreover, benzodiazepines have many undesirable side effects, can be addictive, and make you want to take more and more. In rare cases, you can die from them.
I underwent 12 sessions of Electroconvulsive Therapy (ECT) in 2011. The infamous electroshock, which in the 20th century was pushed onto any psychiatric patient. At that time, patients received an electric shock to the head without any anesthesia to try to restart the brain. It was so inhumane that the technique was almost abandoned, but some positive results led doctors to make it less traumatic and optimize it instead of abandoning it. In the 21st century, when I was treated, I did it in a hospital, I was anesthetized and sedated during the process and could go home shortly afterward. However, the memories of that year and the immediate years before and after are quite sparse and vague. The maximum side effect of ECT is to cause this type of amnesia. I graduated in music and don’t clearly remember college. Although I think I gradually recovered some memories (or settled for what I had), because at first, this memory loss bothered me a lot. From about 2005 to 2014, my memories are quite fragmented. And the worst part is that ECT didn’t help me at all (this therapy does help many people, mind you, I’m not contraindicating it). It was the last resort, and it didn’t work.
Almost miraculously, after the last ECT session, the doctor, who would become my main psychiatrist, had the idea to experiment with a treatment that was still in experimental status. The infusion of Ketamine, an anesthetic used (or that used to be used) in babies (in adults, it may induce hallucinations) and in animals. Everything was controlled; I would be admitted to a sort of cabin (by the way, the same one where I did the ECTs) and 1ml of Ketamine was injected into my vein, diluted in half a liter of saline, over 30 minutes. I reiterate that 1ml was a dosage calculated based on my weight, 90kg. It was a lifesaver. I felt good for weeks. The problem with this treatment is that the improvement, which is substantial, lasts only about 15 days. Then I would take it again. I did this about four times in the hospital. After that, I went a while without it, and the hospital where I was treated was sold to Amil, falling out of my doctor’s scope. But I managed to maintain myself for a few months. Eventually, I fell again and needed to take it weekly, now at home (I have an anaesthetist in the family). Gradually, the effect diminished (I am extremely resistant to treatments).
Today, I take the same Ketamine, but sublingually. Yes, I spend half an hour with 1ml of Ketamine under my tongue. About 2 or 3 times a week, currently. I get the product from veterinarian friends. Most of the time, it just gives me a bit of dizziness and slight improvement now. But there are times when, for some reason, it’s just having a good day and works wonders. I’ve lost count of how many times this treatment has saved my life.
But in the early times with Ketamine, I had hallucinations, a feeling of relaxation, dizziness (when I occasionally got up), a sensation of dissociation between body and mind, a feeling of being "one with the universe," "talking to the cosmos," "speaking with God" (in this case, I told Him that I didn’t believe in Him, to which He agreed). And later, when I started taking it on my own, as I still didn’t know how to dose it, I experienced (more than once) the dreaded Ketamine hole (I’ve researched this; in English, it’s called K Hole). It’s an experience that some people enjoy, even seek out (yes, Ketamine is used as a recreational drug, especially in the United States). But I never liked altering my mental state. I’ve never drunk alcohol. And still don’t. I never even got close to marijuana. I never thought I would live the ultimate experience of a hallucinogen.
The K Hole feels like a hole, indeed. It doesn’t matter if it goes up or down because that doesn’t exist anymore. It can be a tunnel. I reached a point of levitating in my mind and seeing my body below. Time was infinite. I was no longer me, but all of existence. I’ve seen this effect compared to the most dramatic accounts of near-death experience. It’s the complete dissociation between body and mind. In this state, it’s impossible to interact with other people. I find it unbelievable that someone would want to be like that on purpose because it’s, above all, an unpleasant experience. And it can be desperate; I have vague memories of darkness and despair in the K Hole.
It was sad when it lost its effect. In a desperate moment, around 2016 or 2017, I had no effect from the sublingual. So, I tried to inject it myself (never do this). I took a needle that I don’t even know if it was sterilized, put a bit of Ketamine in it, and injected it into my right hand. I think I didn’t hit a vein. So, I tried my left hand. And it worked. That was the last time I entered the K Hole. But I improved from the crisis immediately. The problem is that both hands got infected, became incredibly swollen and painful. I went to the hospital (I didn’t tell my family about my recklessness; I made up something about a fall), and inadvertently bumped my right hand, which was less swollen, against a corner of some counter. This opened a small hole in my skin. There was drainage right there in the reception. So much secretion came out! Actually, this was good because the left one I had to operate on to drain. I spent months with a hole the size of a plum in my hand, visiting a samurai Japanese stoma therapist to clean it (you could see a white tendon that the samurai would skilfully and unceremoniously rub with gauze) and to change the dressings.
Depression lives in a perpetual oscillation. A person runs the risk of thinking they are fine and, months later, having a relapse. The complete cycle of these oscillations can last more than a year (between being well, falling, and becoming well again). And, besides the oscillations, there are what I classify as micro-oscillations. These can last from a morning to a few months. The best scenario is to be at the peak of the oscillation and, at the same time, at the peak of the micro-oscillation. This is what I call 60%, because that’s roughly where my sense of well-being sits. Consequently, the worst scenario is the valley of oscillation along with the valley of micro-oscillation. Zero. It’s desperate, and your life collapses.
In one of the infinite valleys of the oscillation of depression, I remember waking up every night after having slept (by choice) on a mattress on the floor, pressed against the bed where my wife and daughter slept, feeling a cold that was out of this world. All the hairs on my body stood on end. And I was trembling convulsively. Prepared, I would lie down bundled up (I live in Ceará; two years ago was the first time I experienced temperatures below 22 degrees in Fortaleza!). A pair of jeans under a pair of sweatpants, a shirt, a long-sleeve button-up, a sweater, and two pairs of thick socks. But I would wake up. And not to go to the bathroom, but because of the cold, which no one else felt.
Eventually, I had to stop teaching and suspend my social life.
I remember, several times, during the recordings of the album "Jangada Azul" (Blue Raft), by the Argonauts—and recording is the thing I love most to do—I would ask Bob (Ayrton) to take over the production so I could leave early. Because I felt overwhelming anguish, loneliness, and sadness.
I am a very empathetic person, but most people find me, at least, unfriendly. Sometimes I think I’m smiling, and I’m not. I’ve looked in the mirror. What I think is a smile is actually a slight, almost imperceptible, muscle contraction of my lips... This has caused me many problems and the loss of many professional opportunities. I must have irritated a lot of people.
Forced withdrawal of medication
Finally, before talking about the mushrooms, I need to say that I had a health problem in 2021. It’s important to the story. At that time, I was relatively well, had a nice routine, felt more alive. But one day, without warning, without a phone call beforehand, gallstones appeared. But they led to a generalized infection, and I almost died. “Last year I died, but this year, so far, I haven’t.”
It went like this: one day, I felt extreme pain in my stomach, took a gas relief medicine, which helped a bit, but soon the pain returned. It was all over my belly. I slept that night thanks to Zolpidem, but woke up several times, with my parents and wife checking my temperature. I had a fever of 40 degrees (Celsius, it’s very high 104º F), which was not a good sign. But we still thought it was Covid. It could be, right?
Well, it wasn’t. In the morning, we went to the hospital, and the doctor said they would have to open my abdomen. I remember entering the operating room and remember when I woke up, thinking everything was fine. Gradually, my family told me, during visits to the ICU, that it had been almost a disaster. That I had been sedated and intubated for 4 days (now, about the extubation, which was horrible, I remember very well, but I didn’t think to ask why I was intubated in the first place). Because when they opened me up, everything was infected. They started removing the stones, but the doctor even told my father, who accompanied the surgery (he’s a doctor), that if I didn’t react to the removal of the stones, all he could do was close me up again and wait for death.
Strangely defying the doctors' expectations, I began to react, and the infection could be controlled. I had to take antibiotics for months, undergo daily dialysis sessions (my kidneys, which I now call “ruins,” were severely affected, now only having 39% of their original capacity). Some of these dialysis sessions lasted 4 hours, others 8 hours. After a week in the ICU, I moved to a shared room (at the time, the hospital was full of Covid patients). After a few more weeks, I managed to get a room to myself. During the room phase, I was always accompanied, either by my wife or by my mother and father. But where do I want to go with this? Here: I was taking a lot of antibiotics and other medications and treatments, so in order to avoid conflicts and undesirable drug interactions, I almost had to zero out the antidepressants.
At first, motionless (I could only move one arm, but with great difficulty) and dazed, it didn’t bother me much. I was groggy. After, I think, two months, I returned home, still immobile. I didn’t even feel depression. My brother-in-law got me a wheelchair to take me to the sessions, every other day, of dialysis. I had to be hugged, lifted, and placed in the chair. I did physiotherapy with a great therapist. I urinated into a bag, lying in bed, with my wife’s help. After another month, I was getting up and walking, albeit awkwardly.
And that’s when the torment began again. Depression regressed to a dangerously uncomfortable level within a few weeks. We began reintroducing the medications, but even when I was already taking the exact cocktail from before the surgery, I couldn’t reach the level I had been at before it, which was (let’s call it) “fairly good.” Let’s say, 60% of a sense of well-being. I went back on all the medications (I take 3 antidepressants in equine doses) and couldn’t return to the desired level. The “fairly good.” The 60%. Never again.
The Options - DBS and Psilocybin
This is where mushrooms come in. Because in this state, I only had three options: go crazy; undergo brain surgery for the implantation of a kind of brain pacemaker—the name of the technique is DBS, Deep Brain Stimulation; or try hallucinogens. LSD, Ayahuasca tea, or Psilocybin. The DBS surgery is extremely expensive, so I only had the going crazy or the mushroom options.
Science still doesn’t fully understand how hallucinogens help with psychiatric illnesses. There are factions that advocate for daily microdosing, in which the patient doesn’t feel any kind of delirium, or anything. Almost nothing, I mean. Another faction suggests taking a dose capable of causing a mystical experience twice. What some studies indicate is that this very mystical experience is linked to improvement. This second faction is more well-researched and grounded.
Don’t ask me how I obtained the mushrooms. My parents, my doctor, and I researched, and we agreed that I would take two doses, in consecutive weeks, of 3.5 milligrams of Psilocybin, which are present in about 3.5 grams of the mushroom itself. I improved. A bit. But not by much. When I later told my doctor that I had gone from 20% to 40%, he was blunt: try again. Because it is suspected that the effect can be cumulative. But I’ll stop here, at the third. Below, I describe the result of each dose.
1st Dose - (About 3.5mg)
I had no hallucinogenic effect. The taste of the mushroom is horrible. Some research says that the therapeutic effect depends on having a mystical experience, that you have to "travel" to have an improvement in depression. I read somewhere (and below, in the text, I’ve placed several links to articles on the subject, some of which are very detailed) the opinion of a doctor who said that possibly, upon entering the hallucinogenic effect, the patient found themselves in control of making decisions they previously deemed impossible. And they could see themselves in a new way and perceive life from another perspective. With the accumulation of these new experiences, the patient found themselves empowered (I felt guilty for using that word) and capable of simply deciding to rid themselves of depression. Or to escape the labyrinth of the mind and dodge it. In my case, I didn’t travel, even taking a medium to high dose. But lo and behold, two days later: poof, I woke up better. Much better, an overwhelming relief. I remember telling my daughter: "Bia, do you know what I am? Better!" (and the beautiful smile she gave in response). I took it on a Monday. By Wednesday, I had progressed, as I said, from 20% to 40% (of perceived well-being). But by Friday, I was starting to fall again.
2nd Dose - (3.5 to 4mg, I had no way to measure)
A week later, I ate the mushroom again. Same as before, I improved a little, but didn’t surpass 40%. I was already satisfied, because most studies talk about only two doses. But the doctor asked me to try again (the "try again"). At a slightly higher dose of 4mg. I explained to him that it was entirely possible that I had taken, in the first instance, those 4mg since I didn’t have a precise scale. I received 5 grams of the mushroom in a bag. I discarded what I assumed to be about 1.5g and took it. It was like this both times. So, if there was to be a third, I wanted to take a larger dose, one that left no doubt. But I didn’t want him to prescribe that dose for me. Professionally, it would be irresponsible. So, on my own (but, as I’ve been trying to explain here, it was due to a vast array of factors, and I don’t advise anyone to act without medical supervision), I did some more research, suspicious that I have resistance to the high from my use of Ket
A week later, I ate the fungus again. Same result as before: I improved slightly, but I didn’t get past 40%. I was already feeling content with that, since most studies talk about just two doses. But the doctor asked me to try again (the "try again"). With a slightly larger dose, 4mg. I explained to him that it was entirely possible that I had already taken those 4mg the first time since I didn’t have a precision scale. I got 5 grams of the mushroom in a bag. I discarded what I thought was roughly 1.5g and took the rest. That’s what I did both times. So, if there were to be a third time, I wanted to take a bigger dose, one that wouldn’t leave any doubt. But I didn’t want him to prescribe that dose. Professionally, it would be irresponsible. So, on my own (but as I’ve been trying to explain here, it was due to a multitude of factors, so I don’t advise anyone to act without medical supervision), I did more research, suspecting that I had a tolerance to the effects because of my use of Ketamine and the terrible experience with the K Hole, and I read about a guy who had a very intense experience after taking 10g of the mushroom. Remember, 10 grams of the mushroom contain, on average, 10 milligrams of Psilocybin, the substance responsible for the hallucinogenic effect. Don’t try this. I repeat emphatically: don’t try it.
3rd Dose – (9mg of Psilocybin, in 9g of the mushroom)
I found myself with a dilemma. Should I take 4mg? And if that didn’t work, should I gradually increase until I reached a dose that put me in touch with the cosmic soup? I didn’t want that. I wanted it to be the last dose for at least a year. Studies show that the benefits of hallucinogenic mushrooms last at least a year. But it could last much longer, nobody knows. They say a year because the studies usually follow patients for that period. The truth is, scientists don’t know for sure, for a variety of reasons. Research on hallucinogens is still very recent. Moreover, it’s rare for such a new and experimental field of research to be funded for more than a year. Going back to my experience. I took 9 milligrams of Psilocybin. This dose was, for me, more satisfactory. The same dose in someone else could lead to dangerous and complicated side effects. I took it while lying in bed, listening to this playlist. Elgar’s Enigma Variations seemed like the most magical and perfect thing in the world. The other doses gave me a huge headache. This one didn’t. But I also didn’t feel any hallucinogenic effect. Now I’m sure I have a cross-tolerance to this because of Ketamine. The fact is, I improved a lot. I felt a calmness, a peace, and a super pleasant relaxation. But I reiterate, this dose is not recommended, especially if you’ve never taken a consciousness-altering substance in your life. In truth, what I did was the exaggeration of all exaggerations. I took it because of the resistance to psychedelic experiences I developed from repeated exposure to Ketamine (and its infamous K Hole). The dose recommended by studies is always 3.5 milligrams of Psilocybin, or 3.5 grams of the mushroom. What I did was this crazy extreme, let’s say. It was an exorbitant amount, but I, having always done this carefully and studied it, had to take the risk. Mainly so I wouldn’t have to keep taking more and more. The truth is, I don’t like psychedelic effects, neither from Ketamine nor Psilocybin, and I’m sure I wouldn’t like recreational drugs either. I didn’t try Psilocybin for fun, but for the after-effect, which is to rebalance neurotransmitters. In short, that’s what the mushroom—or better yet, the hallucinogenic experience—does. Somehow, it mysteriously reorganizes the neurotransmitters, which is scientifically proven. Entire regions of the brain literally grow in size. This only works for people who have depression or some neurological illness because their brains are physically corrupted, deformed.
But no. I didn’t have significant improvement, in the end.
How I Am Today
I’m writing this text a few days after this reckless third dose (which I now see as irresponsible). I consider myself better. I’m more active, solving my things, I’ve gone back to composing and playing the guitar, and I no longer have crying fits. But I also haven’t had a remission. I’m still taking the meds:
Triple the normal dose of Fluvoxamine (300mg);
A surreal dose of Lisdexamfetamine (140mg);
45mg of Mirtazapine;
Sublingual Ketamine three times a week;
Zolpidem (up to 60mg a day);
A bunch of other meds whose names I can’t even remember.
All of this may lead you to think I abuse these substances. I don’t. These are called off-label prescriptions, where the doctor prescribes a dose higher than recommended in the package insert, for very severe cases that don’t respond to regular doses. Remember that I’ve been on this path for 25 years, not counting childhood and adolescence, when I wasn’t diagnosed but had severe crises. I knew where my grandfather’s four revolvers were hidden in the house.
My case is very serious. It justifies drastic measures. Only I know. I’ve tried everything—dozens of different medications in various combinations. And I know that many people in Brazil, Portugal, and the world suffer from depression this severe. To those people, I encourage you to talk to your doctor about these exotic methodologies. I’ve never done anything that wasn’t scientifically well-evidenced. Nor have I done anything without the supervision of my doctor and family. And I never started a treatment without extensively reading about it first. So, if you find yourself in a situation of emotional despair (especially if there’s no apparent reason), seek a psychiatrist. And no, they’re not a doctor for crazy people. They’re doctors of consciousness.
It’s always good to go to the doctor already equipped with information about these treatments. A good psychiatrist (like mine, who has become a good friend) knows everything that’s happening in the world of scientific research for the treatment of depression. A bad psychiatrist will tell you to meditate, exercise, and get some sun, even if your case is clearly more than just dysthymia or mild depression and qualifies for medication. If your doctor thinks it’s not your case, fine, to some extent. But then they should come up with a better solution. There are two types of incompetent psychiatrists: the one who immediately prescribes a bunch of medication after hearing only a brief description of your symptoms; and the one who doesn’t want to prescribe any medication at all because they think, “You’re so young, so handsome… go enjoy life!” If that’s what I wanted to hear, I’d call my aunt. Find someone else. Someone who takes your condition seriously.
I’ll just say one thing: don’t accept feeling bad. Depression is a chemical distortion, sometimes even a genetic defect. The quality of life for someone with it can range from low to unbearable. I’ve never settled, and I won’t. Thanks to that attitude, I’ve gone to the ends of the universe in search of improvement. And I’ve improved and worsened alternately at various times, but I’ve managed to escape the greatest problem in a depressive person’s life and that of their family: suicide. Not that I haven’t tried or thought about it, but sometimes, when I didn’t know what else to do, when the pain of existing was killing me, I’d go on the internet to research new treatments. There’s always something. And all I wanted was to read a text like the one you’re reading here. One that says, in the end, that before considering suicide, there are many things you can try to get better. And if you’re considering suicide, then it’s worth
My case is very serious. It justifies drastic measures. Only I know. I’ve tried everything: dozens of different medications and various combinations. And I know that many people in Brazil, Portugal, and the world have Depression of the same severity. To those people, I encourage them to talk to their doctor about these exotic methodologies. I never did anything that wasn’t scientifically well-supported. I also never did anything without the doctor’s supervision and my family’s support. And I never undertook a treatment before reading extensively about it. Therefore, if you find yourself in emotional despair (especially if there seems to be no apparent reason), seek a psychiatrist. And no, a psychiatrist isn’t a doctor for the crazy. They’re a doctor of consciousness.
It’s always good to go to the doctor already informed about these treatments. A good psychiatrist (like mine, who became a good friend) knows everything that is happening in the world of scientific research for the treatment of Depression. A bad psychiatrist will tell you to meditate, exercise, get sunlight, even if your case is clearly more than just Dysthymia or Minor Depression and could benefit from medication. If your doctor judges that it’s not your case, fine, to a certain point. Because then they should present you with a better solution. There are two types of incompetent psychiatrists: the one who immediately prescribes a bunch of meds after hearing only a brief account of your symptoms; and the one who refuses to prescribe any meds, because they think, “You’re so young, so good-looking… go enjoy life!” If I wanted to hear that, I’d call my aunt. Look for someone else. Someone who takes your condition seriously.
I’ll say just one thing: don’t accept feeling bad. Depression is a chemical distortion, sometimes even a genetic defect. The quality of life of someone with it can vary from low to unbearable. I’ve never accepted it and will continue not accepting it. Thanks to this attitude, I’ve gone to the ends of the universe seeking improvement. I’ve improved and worsened alternately at various times, but I managed to avoid the biggest problem in the life of someone with depression and their family: suicide. Not that I haven’t tried or considered it, but sometimes, when there was nothing left to do, when the pain of existence was killing me, I’d come to the internet to research new treatments. There’s always something. And all I wanted was to read a text like the one you’re seeing here. One that says, after all, that before suicide, there are many things you can try to get better. And if you’re considering suicide, then it costs nothing to try extreme measures to avoid it.
In the US you can call 988 if you are thinking if doing anything bad to yourself. You can also e-mail me (grupoargonautas@gmail.com) or text me via WhatsApp: +55 85 91117768.
Edited
December 16, 2023. The long-term result of ingesting the psilocybin-containing mushroom was not satisfactory. Little by little, but obstinately and relentlessly, the depression returned. Slowly, its effects, old acquaintances of mine, re-emerged and intensified until they became unbearable. The torture comes from within.
I am, however, moderately hopeful. My health insurance has agreed to cover the astronomical costs of DBS surgery, Deep Brain Stimulation. If I were to do it privately, it would cost more than 300,000 reais. But, thanks to my father’s persistence with the insurance company, his tenacity, and his belief in the possibility of significant improvement, the surgery will happen. And in less than a month.
Deep Brain Stimulation is done by implanting two electrodes and a neurostimulator in a specific, highly precise, and deep location of the brain. The electrodes, called Implanted Pulse Generators, produce high-frequency electrical pulses. For some reason, which medicine itself admits is obscure, the continuity of this electrical stimulation reorganizes neurotransmitters. Due to its characteristics, DBS has earned the nickname of the Brain Pacemaker. The therapy was developed for the treatment of Parkinson’s Disease, Tourette’s Syndrome, Chronic Pain, Focal Dystonia, Epilepsy, and other neuromotor issues. Since 1997, when it was approved in the United States for treating Parkinson’s, the results have exceeded expectations.
Slowly, DBS has branched out and specialized in neuropsychiatric diseases, even though it is still experimental. In fact, it remains experimental today for depression. Its efficacy is higher than any combination of medications (I take three types of antidepressants, Lithium Carbonate at twice its usual dosage, and medications to sleep).
For each disease to be treated, there is a different protocol, and the area of the brain to be stimulated is millimetrically defined through precise mapping done at the time of the implant. The electrodes aren’t left loose inside your precious brain. Wires come out of them and connect to a small device that stays outside the body and houses the batteries. These need to be replaced periodically, although this is yet to be determined.
So here we go. It’s another journey. Who knows, maybe the last one. Or rather, the second-to-last, one way or another. I sincerely hope this text clarifies, especially about Major Depression itself and the infinite number of treatments available, so that the reader who may be going through this feels encouraged not to give up.
By the way, recently I found this video, in which the Dr. Matthew Johnson talks about a certain "Heroic Dose" of Psilocybin.
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