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Depression
The Lysergic Acid ‘Solution’ for Depression?
A book review of A Really Good Day, by Ayelet Waldman
Posted January 15, 2017
The Lysergic Acid ‘Solution’ for Depression?
A Really Good Day, by Ayelet Waldman
A review by Lloyd I. Sederer, MD
What does a 50ish-year-old Harvard Law graduate and UC Berkeley professor, former public defender, accomplished fiction and non-fiction writer, and wife and mother of four do after becoming increasingly unable to bear the misery of a serious and chronic mood disorder? She has explored and exhausted, without adequate effect and with too many side-effects, every medical and alternative medicine treatment to be had. Her mental illness is destroying her life, her marriage and wreaking havoc with her kids. She is feeling suicidal. She is a "law abiding citizen" who rarely drinks. But she is out of alternatives and the future looks hopeless.
She drops acid. Yes, LSD.
Literally, she dropped drops of acid, not 100 micrograms on a blotter but 10 micrograms, 2 drops under her tongue, of an LSD solution - every fourth day. The title of Ayelet Waldman's new book reveals the results, namely A Really Good Day.
As a psychiatrist, I appreciate both the value and limitations of mental health, and addiction, treatments. We have so much yet to achieve - in terms of drug effectiveness and the reduction of their unwelcome effects (like weight gain and insulin insensitivity, sedation and loss of libido). My field needs novel treatments, ones that target different neurotransmitters and enhance both brain cell growth and the web of neural circuits that drive how we feel, think and behave.
I have read with great interest the emerging research on psychedelic drugs emerging from major medical centers (like NYU, Hopkins, UCLA and the Imperial College of London), especially psilocybin - magic mushrooms (http://www.huffingtonpost.com/lloyd-i-sederer-md/-lsd-psilocybin-and-ke…). But research on LSD, after thousands of papers and a dozen books, more or less ceased, except for anecdotal reports, once possession was criminalized in the US in 1968 and then made it a Schedule I FDA drug, which prohibited its manufacture and distribution (and thus research) without a special license. Psilocybin, however, is available as a natural compound from mushrooms that grow in the American southwest, is used in Native American and other religious ceremonies, and does not have the same degree of misinformation and baggage that LSD has collected over many years.
Waldman, with the rigor and obsessiveness of an academic and writer, read everything she could seeking something different to help her. She came to know Dr. James Fadiman (himself a former student of the 60s Harvard LSD proponents, Richard Alpert – who became Ram Dass - and Timothy Leary). Fadiman had been writing and speaking about the therapeutic potential of microdoses of LSD. Waldman learned it was safe, very safe, with few unwelcome side-effects (especially if pure and given under emotionally safe circumstances).
But it was illegal, not to be had though its microdose use was not rare - including among Silicon Valley souls seeking to improve their creativity and enhance their job performance (and as an alternative to psychostimulants like Adderall and Ritalin). Waldman started asking around, friends of friends and neuroscientists, and one day in her mailbox was a tiny, cobalt blue bottle with instructions from a “fellow resident” of Berkeley, CA, who signed the note “Lewis Carroll”. She now had a supply of acid, enough to carry her for up to 10 doses, 10 micrograms every fourth day. Still cautious, she obtained through the Internet a test kit to determine if it was LSD, not a toxic compound pretending to be acid. Indeed it was, in very dilute form.
She decided to take her first dose and record her responses, including mood, physical sensations, conflict (her irritability had generated a lot of family distress), sleep, work productivity, and pain (she had chronic pain from a frozen shoulder). The book takes us through the next 30 days of her life, ten cycles of dosing herself with microdoses of acid.
Each day's report is far more than a journal of drug effects. The reader is treated to an incredible perspective on the history of drugs in this country, the neuroscience of psychedelics and stimulants, the injustices perpetrated against people of color because of the criminalization of psychoactive drugs, how to talk with your kids about life (including drugs), the powerful public health concept of “harm reduction”, and so much more as this public defender, law professor, student of history, and wise and suffering person could impart. And with a good supply of humor to boot.
She had no hallucinogenic experiences; the dose was too small. Nor did she get “high” in other ways such as euphoria or intense physical sensations. Instead, she felt “normal”, generally free of the despair that prompted her to try LSD in the first place; she had considerably more optimism, flexibility and resilience than she had known in a very long time. The dosing day could be a bit “edgy”, with some minor physical problems of nausea or dizziness, but was typically highly productive and conflict free. The second day seemed to be the best in her view, where she says she was “easygoing”, hopeful and with good work focus and production (as a writer). Not a great sleeper to begin with (especially with shoulder pain) her sleep duration often was lessened on most nights but did not seem to impair her daytime functioning. The third day, two days out from dosing herself, she remarks at the end of the book, was when she felt “my best self”. She did not lose weight nor did she exercise more or less. Her pain lessened shortly into the 30 day trial but frozen shoulders can absolve on their own after a while.
Her husband, a Pulitzer winning novelist, and her children attest to the remarkable improvement she demonstrated. When Waldman finally told her kids she was on a “medication” they said they were not surprised and were clear that she was a happier and “nicer” person. In other words, she had a lot of “really good day(s)”.
A case report of one like this does not make for scientific proof. But LSD worked for her. Anecdotal reports from on-line communities and in lay publications also tell stories much like hers. Not a death has been reported (LSD has a huge margin between usual doses and what might be deadly) and with microdoses there are no bad trips. People with psychotic illnesses, like schizophrenia and schizoaffective disorder, should beware of drugs that can mobilize their underlying illness. But promise exists for psychedelics helping those with severe depression, OCD, addictions (including smoking), and end of life anxiety and despair.
Waldman did not seek to obtain more LSD. As a former public defender who had represented people with drug charges she had seen what bad can come from trying to obtain drugs illegally. She was opposed to the “war on drugs” (http://www.usnews.com/opinion/blogs/policy-dose/articles/2016-04-19/sub…) and unwilling to be its victim. So, she stopped taking LSD after 30 days. How long ago that was is unclear (mindful as she is about statutes of limitation). But her book Afterword suggests that some of the benefit persisted, as has been reported with psilocybin, LSD, ayahuasca, and other hallucinogens. Aldous Huxley said this a long time ago, as an author and a user, that the “doors of perception” can be permanently changed for the better.
Unfortunately, good, current scientific research on LSD remains shut-down. Anecdotal reports, some beautifully and intelligently delivered as is Ayelet Waldman’s A Really Good Day, are all we have. But maybe they will open for some more doors of perception as well as the doors of research. We need more trustworthy information on which of these drugs work for which problems and with what side-effects and dangers. Until then, if a blue cobalt vial that proves to be diluted LSD appears in your mailbox you may still be tempted to try it.
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Dr. Lloyd Sederer is a psychiatrist and public health doctor. The opinions offered here are entirely his own. He takes no support from any pharmaceutical or device company. @askdrlloyd
