Impotence and weight gain are not just "annoying" side effects. They seriously impact your life. Just putting that out there.

I guarantee you the number of people who have died from SSRI misuse is higher than the number of people who have died from psilocybin misuse. I'm not referring to things a person may do in a given state, I'm talking about effects from the drugs themselves. I'm not aware of a single recorded person who has taken any dose of psilocybin, and died from "psilocybin overdose". While it may be uncommon, it is possible to overdose on SSRIs.

So are you okay with people choosing their own dose of SSRIs?

> Psylocybin? Easily?

Err.. no?

This is from the Dutch National Institute for Public Health and the Environment: https://www.rivm.nl/bibliotheek/rapporten/340001001.pdf

Page 19 onward has the charts. What do do we find at the very low end in terms of chronic and acute toxicity? Shrooms (“paddos”) and LSD.

It always blows my mind how anti-drug people will do a handwavey gesture to the authority of institutes like the FDA, but never actually check up on what actual research says.

> As for SSRIs? Safe, effective, with a handful of annoying side effects.

Except the multitude of ways you can put yourself into a serotonin coma.

I agree with your assessment that (first) use of psychedelics should be under proper guidance. But what you refer to, “going bad”, can sometimes be a traumatic past experience that people have stuffed away and by surfacing and processing it they can move past it. It’s not always meant to be kumbaya and flowers.

Educate yourself, then talk.

I really wish we would retire this chestnut already. As if there’s a reasonable grownup option here and everything else is playing with matches.

No it’s not the best thing to do to brave huge waiting lists, call a hundred providers none of whom are taking new patients, pay a fortune out of pocket, and/or be faced with a distracted impatient person stuck to their screen who has 10 minutes for you.

And I live in Germany, not the US.

That's not clear cut. There clearly exist plenty of combinations of "situation + physician" where this is not the best thing to do. To claim otherwise may as well be religious dogma.

that's easy to say when you forget about the state of healthcare.. everywhere, actually. I was going to say the US but in other countries it's not like you can just pop in for a chat about taking shroomies, either.

I'm not sure having a ten minute meeting with a stranger who has a PhD in internal medicine is going to yield useful strategies for curing the existential dread underpinning your depression whether you're there to discuss getting zonked on LSD or something more "traditional" like Xanax

The US government severely restricts research on Schedule 1 drugs like psilocybin. Physicians don't have the data they need to inform patients.

Why? I mean it certainly depends but as far non severe mental health issues go physicians are just going to checklists since there is hardly anything else they can do (besides long-term therapy).

The idea that doctors aren't constantly "off base" and must be deferred to uncritically is pretty terrible.

For example, it took literally two decades after it became well known that peptic ulcers were mostly caused by bacteria for the medical community to embrace giving anti-biotics for GI pain. To this day, there are still many American doctors who don't actually know about the Nobel Prize given in 2000 for this discovery, and claim it's "stress" and tell you to go home. Some claim they "know" but than try to "change your gut PH" and still refuse to give antibiotics due to "superbug" risk.

This is a "small" thing (GI pain is not small to those who have it) - but if the doctors are screwing up such a small thing institutionally, what else do they mess up on?

One is travelers sickness. Doctors in the USA do not want to perscribe front line antibiotics for it because of fear of superbugs - but they'll uncritically go eat their lunch at a McDonalds that same day, where they consume meat bathed in antibiotic slop which is more likely to contribute to superbugs then the amoxicillin that they didn't give you would have.

Or what about right now, when it's become clear that Ozempic is literally a super-drug. Every doctor on earth should be trying to give that stuff to literally anyone.

I can go to "third world countries" with deregulated health systems and get infinitely better care that I have real control over for on the orders of 1 USD (that's how much it cost for me in Thailand to get front line antibiotics for travelers sickness INCLUDING THE DOCTORS VISIT!)

Why do we still sell Neosporin despite doctors wanting it off the market (also for risk of superbugs)? Why do few people in America use Providone-iodine for wound treatment despite it being by far the best solution scientifically for it (and it stains yellow)? Maybe it's because we're stupid. There really aren't better explanations.

What about Circumcision? I'd straight up put doctors who do it in jail and many European nations would do the same. American doctors think circumcision is just fine, and long, deeply bitter swaths of medical ethics journals are dedicated to fighting over this again and again.

Or what about the widespread disagreement over even basic stuff like digital rectal exams? There's no agreement on if they are worth it because often sticking one's hand up the butt of an old man does more damage to them than finding out that they (like everyone else at old age) have benign prostate cancer?

Doctors in America have not earned their position of deference. The scientifically minded on HN who do their own research can and often do know how to treat certain conditions better than white-coats.

With SSRIs, the dangers are long-term.