RIDING THE REDDIT WAVE

THE SELF MEDICATION OF STREET DRUGS TO MEDIATE MENTAL ILLNESS SYMPTOMS

By MEAGAN JOHNSON ADAM RIZK

So, I have an anxiety disorder and a few years ago I had my first experience with MDMA. It was intense, but ultimately great. My anxiety melted away and I was able to feel fully open and a part of the world. I was uncharacteristically at peace with myself and processed some past trauma without any judgement or fear. Only cons were that I couldn’t sleep that night and my jaw ached the next day. Everyone’s different, but my experience was healing. — u/fablekeeper [Reddit]

Tolerance is an issue, neurotoxicity is an issue, purity is an issue. I wouldn't recommend it, it won't work how you expect. 1 — u/LSDkid269 [Reddit]

With an increasing dependency on antidepressant medications, many who suffer from anxiety or depression disorders have turned to self-medicating with illegal substances, often referred to as “street drugs.” Faced with either taking life-long doses of selective serotonin reuptake inhibitors (SSRIs) or a single-dosage of MDMA, many patients have flooded the internet validating the wonders of the psychedelic. MDMA, also commonly known as Molly or Ecstasy, is a synthetic drug with a chemical structure similar to the stimulant methamphetamine. Other illegal substances are beginning to meet the historically unmet demand for mental health care and rehabilitation. Ketamine for bipolar disorder, MDMA for PTSD, and LSD for anxiety each appear to repair damaged brain circuits— creating new synapses in the brain. Hoping to mediate the symptoms of these common illnesses, research-backed by both the FDA and Johnson & Johnson have aided the resurgence of discussing these alternative treatments on internet forums such as Reddit. Yet, many are concerned this is simply solving a problem by creating another—marketing potentially dangerous psychoactive substances to those in an altered state-of-mind. Currently, little attention has been paid to how patients could safely obtain these “street drugs” or how patients could monitor their dosage without clinical intervention. From a national survey during 2011- 2014, in a single month 2.7% of persons aged 12 and over, 8.6% of males, and 16.5% of females took antidepressant medication. Thus, investigating the medical qualities of these select “street drugs” is rather salient.

In mice, ketamine has been shown to quickly improve the functioning of specific brain circuits involved in emotion processing and mood. Within hours, it appeared to restore faulty connections between cells in these brain circuits. One possibility is the “synapses are restored spontaneously once the cells in the circuit begin firing in a synchronized fashion.” Yet, researchers also commented: “What we can imagine is that ketamine always has this short-term antidepressant effect, but then if the synaptic changes are not maintained, you will have a relapse.” Although this potential downside has not been fully investigated, pharmacologists are trying to maintain the restoration of these brain circuits. As of March 2019, the Food and Drug Administration approved Spravato, a nasal spray based on ketamine for treatment-resistant depression; which has a high rate of dissociation in its users. Because of these side effects, including difficulty with attention and suicidal thoughts, patients must be monitored by a health care provider for a minimum of two-hours after the initial dose. According to the FDA, patients in stable remission and

continued treatment with Spravato plus an oral antidepressant experienced a significantly longer time to relapse into a depressive or manic state than those on the placebo nasal plus an oral antidepressant. Although this is a revolutionary break in the scientific community, these drugs, along with many others formulated from psychoactive drugs, remain dependent on traditional antidepressants and often struggle with the costs of complying to government regulations.

The personal accounts of the thousands willing to self-medicate with psychoactive substances to mediate their mental illnesses have largely culminated on Reddit, the social news aggregate. With relatively lax censorship guidelines, Reddit has become a foreground for discussing the tried and true effects of MDMA, mushrooms, and ketamine. Yet, there are broader ramifications to prescribing these “alternative antidepressants” to the mass. Websites like Reddit often leave professional advice out of this medical discussion, leaving the largely misinformed to their own devices. Although this is protected under constitutional free speech, Reddit and some of its subscribers are promoting drugs that have yet to be approved by the Food and Drug Administration (FDA): “MDMA greatly reduces or eliminates anxiety (temporarily, but could also have lasting positive effects). 100-150 mg is a good, safe dosage”, says one contributor. In fact, few have been clinically tried on human patients, albeit those patients likely did not have severe mental health issues as those suicidal or manic are often excluded from these psychological studies. There is no way of measuring the severity of one’s mental illness while using these forums. It might allow those with short-term, situational anxieties to believe their mental condition is analogous to those who have experienced long-term chemical imbalances. While connecting with many others about the potentially life-changing effects of these “street drugs” may be a therapeutic process in itself, approved drugs with such substances have a particularly limited potency. Again, without professional intervention, forums like Reddit cannot address what the appropriate purity or potency of these substances is safe for regular use.

Although some may suggest solving part of this issue lies in the censorship or increased monitoring of Reddit’s forums, these discussions quickly delve into limiting freedom of speech law tightly protected by the U.S. Constitution. By limiting Reddit, internet users and citizens of the technological age would be defining which content is enriching

and what is problematic. To add insult to injury, self-medication threads also construct a problem for the federal government who are already concerned with the prevalence of drug trafficking into the United States. This potential political nightmare is being amplified by the idea that 1) we are autonomous beings and 2) medical conditions can be potentially remedied by holistic or alternative options. Self-medicating is risky, especially among a population highly susceptible to addictive behaviors. Self-medication relies on the prescriber to be of sound mind to properly dose, which is unlikely within the depressive and/ or suicidal population. Even if antidepressant treatment research suggests distributing “street drugs” is too risky, scientists are actively overcoming the stigma attached to less traditional recreational drugs.

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Relieve Depression By Repairing Damaged

Brain Circuits. Retrieved April 23, 2020, from https://www.npr.org/sections/ health-shots/2019/04/11/712295937/ ketamine-may-relieve-depression-byrepairing-damaged-brain-circuits About SPRAVATO™. (2019, July 24). Retrieved

April 23, 2020, from https://www.spravato. com/what-is-spravato Illustration: https://twitter.com/thecarljung/ status/956284959928537088/photo/1