Hva er ketamin og ketamin-assistert terapi?

Ketamin er et legemiddel som opprinnelig ble utviklet som et anestetikum på 70-tallet, men som de siste årene har fått økende oppmerksomhet for sin terapeutiske effekt på depresjon, PTSD og andre psykiske lidelser. I motsetning til tradisjonelle antidepressiva, som kan ta flere uker før de gir effekt, virker ketamin raskt og kan gi lindring etter bare én behandling. Mekanismen bak dette er ikke fullstendig forstått (som med det meste her i verden), men ketamin påvirker NMDA-reseptorene i hjernen og ser ut til å fremme synaptisk plastisitet, noe som kan bidra til økt fleksibilitet i tanke- og følelsesmønstre. I tillegg, fordi ketamin har en ganske annen mekaniske enn klassiske psykedelika og MDMA, kan behandlingen utføres selv om man går på antidepressiva

I Norge gis ketamin hovedsakelig intravenøst (IV) i kontrollerte kliniske settinger. Behandlingen foregår ofte på private klinikker eller i sykehusregi, hvor pasienten mottar en lav dose ketamin via infusjon over en bestemt tidsperiode. Ketamin-assistert terapi (KAT) kombinerer denne farmakologiske effekten med psykoterapi, der pasienten får støtte fra en terapeut/lege før, under eller etter infusjonen. Ketamin kan indusere endrede bevissthetstilstander, som kan gjøre det lettere å bearbeide vanskelige følelser og skape nye perspektiver. Ketamin varer i ca. 40-60 minutter og det anbefales ofte å sette opp en plan for 4-6 behandlinger over 3-4 uker og deretter månedlige over 4-6 måneder.

Hvor er ketamin tilgjengelig i Norge?

Per mars 2025 er Sykehuset Østfold (Kalnes) eneste offentlige tilbud for ketamin-behandling i Norge for pasienter med behandlingsresistent depresjon. Det foreligger plan for å utøke dette til flere sykehus i Norge i 2025/26. Behandlingsresistent vil si pasienter som har fått en depresjonsdiagnose og ikke responderer godt nok på konvensjonell behandling som psykoterapi og antidepressiva. Man behøver i så fall en henvisning fra en fastlege, noe man kan be om. Sett deg godt inn i denne behandlingen før du spør legen din da det fortsatt er mange leger som ikke vet om denne mulige behandlingen. Man kan søke til tross for at man ikke bor i Østfold, men de som bor i Østfold prioriteres med tanke på venteliste.

Utover offentlig tilbud finnes det også en rekke private klinikker i flere byer i Norge, blant annet Oslo, Trondheim og Bergen. Dr. Lowan Stewart er en amerikansk lege som flyttet til Norge etter å ha startet New Mexicos (delstat i USA) første ketamin-klinikk og er en pioner som har kjempet for å få dette inn i det norske helsevesenet. Han har reist Norge rundt og holdt foredrag for helsepersonell og andre som er interesserte i mange år. Han startet Axon-klinikken i 2018 som Norges første ketamin-klinikk, han har vært med på å starte den offentlige ketamin-behandlingen ved Sykehuset Østfold og vært primus motor i å utvide dette tilbudet til flere offentlige sykehus i Norge.

Ketamin er per i dag (og antageligvis en god stund framover) eneste lovlige behandling i Norge som ligner psykedelika-assistert terapi. Privat behandling er ikke billig, men både forskning og rapporterte resultater viser gode resultater. Jeg har selv snakket med flere av mine klienter som har testet ketamin-assistert terapi og fått veldig mye ut av det.

Innlegget Ketamin-assistert terapi i Norge dukket først opp på psyn.no.

1. Utfordringer med dobbeltblind design

Et av punktene for avslag var at deltakerne kunne gjette om de fikk MDMA eller ikke. En av de største utfordringene i studiene var å sikre at deltakerne og forskerne forble “blinde” for hvilken behandling som ble gitt. MDMA gir tydelige fysiske og emosjonelle effekter, noe som gjorde det lett for de fleste deltakerne og terapeutene å forstå om de fikk MDMA eller placebo.

Forsøk på å løse dette, som å bruke lave doser MDMA som aktiv placebo, førte til andre problemer. Deltakerne som fikk lave doser, opplevde ofte ubehag, og resultatene deres var dårligere enn de som fikk placebo. Dette understreket vanskeligheten med å balansere blinding og terapeutisk effekt, noe som ble et sentralt fokus for FDAs kritikk. Dette har MAPS (nå Lykos) diskutert med FDA i flere år og de kom fram til en løsning de begge mente var så god som mulig.

2. Endringer i regulatoriske forventninger

I starten av prosessen hadde MAPS og FDA kommet til enighet om hvordan studiene skulle gjennomføres. MDMA-studiet til MAPS fikk status av FDA som «Breakthrough therapy», som gjorde at MAPS og FDA skulle samarbeide og justere protokollen fortløpende for å sikre raskere godkjenning. Men da nye personer tok over ledelsen i FDAs psykiatridivisjon, ble flere krav endret. For eksempel ble det innført strengere krav om at ledende terapeuter måtte ha MD- eller PhD-titler, og at en lege måtte være fysisk til stede under øktene i stedet for å kun være tilgjengelig, som det var før.

Disse kravene hadde ingen klar støtte i forskningsdata for å forbedre sikkerhet eller effektivitet, men virket heller som et uttrykk for forsiktighet. Disse endringene økte kostnadene og forsinket prosessen ytterligere.

3. Negative medienarrativer

Mens MAPS og Lykos fokuserte på samarbeidet med FDA i siste fase før innlevering, valgte de å gå inn i en “stille mediefase”, som gjorde at de unnlot å imøtegå kritikk i media. De trodde det var plankekjøring og at media ikke kom til å påvirke FDAs vurdering. Kritiske artikler, spesielt fra en organisasjon som kaller seg Psymposia (og som også er uttalt negative til kommersialisering av psykedelika) fremmet tvil om studienes design, terapiprotokollene og sikkerheten til MDMA, til tross for solid klinisk dokumentasjon som viste det motsatte.

En stor tabbe var å ikke fremheve positive nyheter i denne perioden, som den nederlandske statskomiteens vurdering av samme data. Komiteen i Nederland konkluderte med at MDMA-behandling var effektiv og sikker, og anbefalte at den skulle brukes i kontrollerte omgivelser for PTSD. Uten slike positive motnarrativer dominerte kritikken det offentlige bildet.

4. FDA og skepsis til psykoterapi

FDA godkjenner medisiner og har ikke aldri før godkjent en protokoll som kombinerer medisin og psykoterapi. MDMA-assistert terapi er avhengig av en spesifikk terapeutisk protokoll, som FDA viste seg å være ukomfortabel med å vurdere. Byrået stilte spørsmål ved om terapien alene kunne forklare resultatene, til tross for flere tiår med data som demonstrerer MDMAs unike terapeutiske potensial.

Denne misforståelsen av samspillet mellom substansen og terapien ble en sentral faktor i avslaget.

5. Offentlig skepsis til kommersielle samarbeid

MAPS møtte kritikk for sitt samarbeid med Lykos, en kommersiell enhet opprettet for å finansiere og skalere kliniske studier. Kritikere hevdet at MAPS hadde “solgt seg ut,” og denne mistroen bidro til å svekke tilliten til prosessen.

Dette samarbeidet var imidlertid nødvendig for å møte de økonomiske kravene til godkjenningsprosessen. Slike kostnader – vanligvis milliarder av kroner – overstiger vanligvis det som kan hentes inn via donasjoner alene. Likevel ble partnerskapet ofte misforstått som et etisk problem, og dette svekket offentlig støtte.

6. Politiske og byråkratiske hindringer

Til tross for betydelig fremgang med å redusere stigma rundt psykedelika, eksisterer fortsatt kulturelle og politiske barrierer. Enkelte medlemmer av FDAs rådgivende komité uttrykte bekymring for de bredere samfunnsmessige konsekvensene av en slik godkjenning.

I tillegg virker det som om lavere nivåer i FDA er mer tilbøyelige til å avslå kontroversielle behandlinger, delvis av frykt for å ta ansvar for potensielle negative utfall. FDA har fått mye kritikk de siste årene, blant annet for godkjenning av Alzheimers-medisinen Aduhelm og den smertestillende medisinen Vioxx, som ble trukket fra markedet etter at det ble avdekket økt risiko for hjerteinfarkt og slag. I tillegg har de fått sterk kritikk for håndteringen av Oxycontin-krisen i USA. Økt institusjonell forsiktighet bidro også antageligvis til avgjørelsen.

Veien videre for MDMA-assistert terapi

Avslaget er et tilbakeslag, men det er ikke slutten. MAPS og Lykos vurderer allerede hvordan de kan adressere FDAs bekymringer og gjennomføre nødvendige tilleggsstudier. Samtidig gir den internasjonale utviklingen håp. I Nederland har myndighetene allerede beveget seg fremover med anbefalinger for bruk av MDMA-terapi i kontrollerte omgivelser og Australia har allerede godkjent både psilocybin og MDMA for strengt regulert klinisk bruk.

Beslutningen understreker også behovet for offentlig utdanning og kulturelt engasjement. MAPS og andre i feltet må arbeide for å gjenvinne kontrollen over fortellingen i media og sikre at både publikum og politikere forstår den solide dokumentasjonen som støtter MDMA-assistert terapi og den livsendrende effekten den kan ha.

Veien til godkjenning kan bli lengre enn forventet, men målet forblir det samme: å gjøre MDMA-assistert terapi til en allment tilgjengelig, evidensbasert behandling for PTSD. Så nå fortsetter reisen, ikke bare i laboratoriet, men også i den offentlige sfæren, der kultur og vitenskap møtes for å forme fremtidens medisin.

Innlegget Hvorfor ble ikke MDMA-assistert terapi for PTSD godkjent av FDA? dukket først opp på psyn.no.

Innlegget Livet bak tankene – hvordan finne seg selv dukket først opp på psyn.no.

Innlegget Hvordan støtte noen som gjennomgår psykedelisk terapi dukket først opp på psyn.no.

My First Journey: Beneath the Codes

Imagine wearing your shoes two sizes too small your entire life. Suffering, adapting, negotiating with yourself, bargaining with the discomfort, learning to compensate (often in ingenious ways). At times, even managing to forget about it – but fleetingly. Always fleetingly.

Then, one day, imagine finding a way to pull those ill-fitted shoes off for the first time.

Until that moment, maybe you didn’t know they were ill-fitted; it’s your feet that were too funky. Maybe the shoes were useful before; maybe they met your childhood needs perfectly well, but you’ve outgrown them since then. Or maybe you didn’t realize they were shoes at all; maybe you thought they were a part of you. An intrinsic, unavoidable part. Either way, you haven’t taken them off for ages. Now, they’ve been tossed to the floor. And there you are, stunned by this new-fangled lack of suffering, which turns out to be so natural to you. 

This, simplified and condensed, was the essence of my first psychedelic experience with Oskar. I’m calling it an experience, not a trip, because tripping has a hint of a joyride to it. Experiencing is more about discovering and exploring something entirely new.

Three aspects accompanied those metaphorical shoes coming off: 

• The sense of immense relief, both physical and mental;
• The realization of all that discomfort having been – imagine that! – optional, evoking both deep gratitude and profound sadness;
• Outright dread at the mere thought of, sooner or later, having to stick your unfurled feet back into their old prison again.

But let’s unpack this a little bit. If you’re like me, you’re an adult who thinks of oneself as somewhat educated. Maybe even – who knows? – highly educated. And if you’re here, you’re also plagued with something that doesn’t do you any good, something that perhaps causes nothing short of agony, and you can’t seem to fix it. You’ve tried all kinds of ways: old-school medications, various sorts of therapy, different meditation techniques, even attempting to reason it all away. You’ve read the books that tell you to transcend turmoil through willpower, develop more discipline, adjust your thoughts, rise above it all, and so on. All those self-help podcasts, too. You know, the usual, if you’re a seeker.

But nothing has quite worked in the long run, so you might have concluded that you’re broken. Broken so fundamentally, so intrinsically, that there’s no way around it. Just you and your predicament, until death do you part. Or, in line with your wiring, you might have concluded something else entirely. Say, that all the others are broken. Or the world itself, really. Either way, you aren’t in a particularly happy place.

Then, one way or another, research on psychedelic therapy comes your way. And you, being nearly as educated and science-oriented as you like to think, study it. You study it well. You see the numbers, you contemplate the results. And you think – admit it, you think, or you wouldn’t be reading this – “well, what if?”

But then you say: no way. I’m not doing this. I’m not contacting some random dude and then faking it for a few hours, only to return to the same shitty place again. I may be miserable, but I’m smart. I know better than trying to cheat my way out of the inevitable. Who does that?

Well, this is a story of who does that, and how it goes, and where a psychedelic guide fits into it all. There’s plenty of advice on and discussions of psychedelics on the internet, but there don’t seem to be many coherent, complete, first-timer stories of therapeutic sessions from start to finish. This one might be long, and geared towards individual struggles that may not speak to you. But it’s also honest. It’s the kind of “virginal journey” chronicle I wish I had come across when I was contemplating whether to make the move and reach out to Oskar.

How it began

It’s been decades in the making, of course. But in a way, it began a few winters ago, the day I found the man in the snow. 

Frost had all but consumed my quiet street in Oslo that December. Most neighbors were away for the holidays. The world was still. It was a perfect time for a stroll. 

So, just before Christmas, I set out on a walk through this winter wonderland – and come upon an elderly neighbor lying in the street, snow shovel at his side. At first, it looks as if he’s opted to take a nap and make snow angels, except that it is no break. He’s struggling to breathe. His face has gone white, and his chest is making irregular, convulsive movements. 

At the other end of the street, a woman with a dog stops to watch, turns around, retreats quickly. An older hiker approaches from the trail. She stands and calls to the gentleman in the snow: “Hei hei! Hei hei!”. Through these frantic hei’s I dial 113. Then, I’m on my knees. Snow begins to melt around them, moisture climbing up my jeans as I press at the fallen man’s chest. One two three four, one two three four. I’m probably doing it wrong, but I keep at it.

His face is close to mine. If I glance sideways, I see his blue lips, and the way his tongue jolts between them. He’s looking at me, but his eyes grow dim; he’s looking through me. Once in a while, on four, the man in the snow gasps. Otherwise, he is still and pale. So, so pale. Blueness begins to spread from his lips to his face when the ambulance finally arrives.

They cut off his clothes and insert needles. They administer CPR – the professional way. The right way. As they take him away, I glance down at the darkness of my jeans, all wet at the knees from the snow. Darkness begins to envelope everything else, too. In the following days, as Christmas comes and goes, I think of the man in the snow. I feel that I cost him his life. Or, well, failed to save him. Hell – my inept, untrained first aid efforts probably killed him.

When his daughter finds me and comes by with a lovely bouquet a while later, she brings the good news: actually, her father made it. He’s at the hospital, being well taken care of. I helped him. And, amidst rejoicing, I catch myself thinking: oh, thank g-d he survived – in spite of me.

Which pretty much sums up the issue, if you think about it. When I thought that he didn’t make it, my wiring signaled that I was at fault. It would transmit at this frequency for years to come, leaking guilt and regret into a mental space that’s already oversaturated with them. But as soon as I learn that he survived, it switches gear: now, clearly, I had nothing to do with it. What a fortunate accident. It’s probably despite my involvement, too.

These aren’t things I think; they are things that emerge instinctively, at gut level. And they don’t seem quite right. Rationally, I recognize that it’s neither balanced nor, well, all too logical. But it defines and dictates my life in the most visceral ways. This wiring needs redoing. I’d known it for a while, but that winter’s events on my snowy street become the most palpable illustration yet.

Such are my ill-fitted shoes.

*

It is from the man’s daughter that I hear about MDMA therapy for the first time. She happens to be a trauma therapist. So, when she visits with beautiful flowers and good news, we talk trauma. Only weeks earlier, at a regular ultrasound, my doctor could not locate my baby’s heartbeat. Death is still all around me, tangible, when my elderly neighbor falls into the snow.

Afterwards, his daughter sends me links to MDMA research and its striking results in trials with trauma patients. She also tells me, for the first time, about Oskar. I read through all those pages diligently, but stop there. It takes me months to reach out again and ask for more information. During those months, things continue to spiral downwards, as they tend to do. Successes are mere accidents. Misfortunes are logical and much deserved. The worse the misfortune, the more it makes sense that it has struck me. 

When the full-scale war erupts at home and my beloved hometown burns under shelling, I open Oskar’s page again. I study the photo of a young, long-haired dude.

“Right,” I think.

Then I look at his list of services. Preparation – guidance – integration. 

“Right,” I think.

Then I glance at the prices.

“Riiight,” I think.

… It will be two years after I found the man in the snow that I’ll finally send a message to Oskar and schedule a phone call that will change – well, no, not everything. But quite a bit.

Before

After talking on the phone and deciding to go ahead together, Oskar and I met online twice in preparation for Day X once the date was set. It was a chance to ask questions, discuss expectations, gauge each other’s inclinations and disposition – and, well, share concerns.

Man, did I have a bunch of those. I was worried. Not nervous (I’m good with new experiences, from skydiving to solitary wanderings around Svalbard), but – worried within the blueprint of my wiring. Excited, too, sure. But as Day X approached, I could hardly count the ways I could see failing it. Which, as you may have already guessed, is my meanest inner monster. 

I mean, where do I even begin? I could disappoint and fall short of expectations, my guide’s as well as my own. Not even sure which of the two would be worse. For instance, everyone seems to have some sort of epiphany during a psychedelic journey. What if I, quite simply, don’t? This would only serve as proof of what I already know: yeah, kinda broken. Stuck having to struggle for what comes naturally to others.

Or, what if I feel nothing? Literally: what if I don’t react to the medications, due to some chemical inconsistencies I can’t even pretend to understand? (Later, Oskar will share that in his years of trip-sitting, he did meet one person who did not respond.)

Even worse, what if I get sick or end up with oddball physical reactions? I visualized myself vomiting uncreatively in some corner for eight hours. Indeed: what if things get embarrassing? I mean, if your brain is temporarily not there – it’s not there, right? – what if you get high and go “ohh your eyes are so deep and your hands are so soft” to the nearest living being, which happens to be the unfortunate trip sitter? It doesn’t help that our culture is full of stereotypes of ridiculous tripping people who do exceptionally dumb things. 

Ironically, while wondering if my brain will get disabled in some way, I also wondered if it would be omnipresent. “One of my concerns is that my mind overrides everything, analyzing and narrating things instead of experiencing them,” I confessed to Oskar after one of our prep talks. “Even through strong physical pain, the mind is present, judging and making observations about it. So I’m worried that it will get in the way of our experience, too.”

“There are some things we can try throughout the day,” he responded, “but mostly it’s about waiting it out and letting your defenses feel safe and in control.” Over the course of those days, he responded to everything I brought up in a way that was sympathetic, but confident; knowledgeable, but non-judgemental. Okay, I told myself, sounds like he’s got a toolbox we can use in flawed cases. Good. Flawed case incoming.

The night before, predictably, all these thoughts and doubts peaked. I couldn’t fall asleep on the uncomfortable mattress and lumpy pillow. The time kept ticking away: 2 am. 3 am. 4 am. 5 am. Dawn. My meeting with Oskar is at 9; no way I’ll be rested, which will surely affect everything. So I lay there miserably as the familiar serpent of self-doubt stirred around in my chest: wow, things are already going wrong, and I haven’t even started. I can’t seem to fix this. It’s happening once again: everything is unfolding exactly as I’d feared.

During

Our culture mythologizes psychedelics. In the media, they’re almost as stereotypical as childbirth scenes, with a clichéd list of predictable elements presented as mandatory. A case in point is, say, the characters of True Blood when they ingest V. You know the deal: running naked through happy fields, frolicking around in the sunlight, while actually drooling glassy-eyed in bed. That sort of thing.

In reality, with MDMA, as it turns out, you’re absolutely there. Let me correct this for individual experience: as it turned out, I was absolutely there. I met up with Oskar at 9, chatted a bit over coffee, and took the pills at 9:34. Don’t ask; I just noticed the time (cue apprehension about not responding to them). We talked a bit more, and then headed slowly to the room upstairs. “Do I just lie down here?” I asked, feeling silly and uncertain. “Mm,” he replied. 

As days will turn into weeks afterwards, I’ll find myself missing the calm reassurance of those attentive mm’s. But for now I lay there, listening to Oskar talk about life while the minutes ticked away, wondering when I might feel something. Anything, really. “Uff,” I thought. “I might not be reacting to this at all. Yikes. How do I tell him?”

And then… Well, then there was the take-off.

Oskar had actually used the take-off metaphor when we talked earlier. He explained: it can be bumpy on the way up. Then it evens out, and you recognize: “Oh, ok, now we’re above the clouds.” This image was invaluable when I started to feel, well, nauseous. And lightheaded, and kind of sweaty. Imagine the onset of influenza, except spiced up with the unknown. Oh, wait, is this when I go gag in a corner as planned? 

“Trust, let go, and what?” I double-checked the mantra I’d seen in the prep files.

“Be open.” Right. I kept forgetting this third part of it. Be open, okay. Trust, let go, be open. This, or go fulfill the pukey scenario. So I chose the first option, and laid back. I mean, I was already lying down, of course. But it’s not the same thing as lying back. I realize that now. Fine, I told my body, and exhaled. Fine. I can’t fix or control this. Let’s take it as it comes.

And then, the bumpiness retreated. I could feel it just – go. Exactly like when you fly through the clouds on the way up in an airplane. I’m an anxious flyer, so I know all about that. Just as I accepted it, the nausea faded. In its place came lightness. In the body, sure, but also in the mind. So the mind grew sad, because it instantly knew how temporary this would be.

“It’s weird,” I told Oskar, staring at the ceiling while feeling inwards. “For a moment, such a state of bliss, and then some kind of darkness. And … pukiness.” 

“Mm,” he nodded. “So you get to a better place, and then –  gone.”

“And fear,” I observed after a moment. He responded:

“They’re both part of life.”

It was a comfortingly normalizing response, and one you couldn’t really argue with. So I went ahead and “laid back” about the sadness and the fear as well. 

From then on, as our metaphorical plane evened out above the bumpy clouds, I felt more and more… myself. No, really. That’s what it was. I felt myself. I knew who I was, where I was and what I was doing. I enjoyed the full sobriety of realizing that nothing was different externally, no circumstances had changed. But at the same time, all the habitual codes normally running within me had been suspended. All that was left, underneath those silenced codes, was “me” in the most authentic sense of the word. Stripped of nothing, missing nothing, needing nothing. Just being. It was a state of total acceptance and balance – the kind of acceptance and balance I’d spent years trying to reach through meditation, but couldn’t.

During a journey like this, your suspended codes – habits and patterns that tend to be active inside, ruling your sense of things – are still there, and maybe even attempt to run as usual. MDMA doesn’t obscure them or anything else; it just disables the Enter key for a while. So you can see them exactly for what they are: peripheral scripts, which your mind normally runs 24/7. If A happens, do B. If C or D unfold, feel E intensely. To prevent F from occurring, be sure to G and H. Watch for J. Avoid K at all costs. A never-ending collection of formulas we’ve accumulated and internalized over the years. 

Turns out that all these blueprints are separate from you, which makes them optional. Optional to who you are, to your true Self. Not activating them doesn’t make you less you. You are beyond them, outside them, complete without them. I’d never felt complete before.

There are so many traits that we just assume to be an intrinsic part of us. Say, sensitivity to things and people. If you take away my heightened sensitivity, will I still be a compassionate and caring person? Who knows. So I hold on to it, through suffering, as a defining feature of what I have to offer to the world. Turns out, all these traits are like clothes, except they’re worn internally. Internal outfits. Without them, you are still wholly you. 

At the same time, in what I call “codes” here, I’ve also begun to recognize what’s called “parts” in the Internal Family Systems (IFS) framework, which I started to discover around the same time. Either way: codes or parts, they aren’t the Self. 

This was the stunning part. Again, I knew nothing had changed and all the problems were still there. Yet things were, inexplicably, kinda alright. So I felt okay with everything as it was. I don’t use the word “okay” lightly: it was the central part of my experience. Not happy, not euphoric, not wanting to dance or touch things or any such stuff. Nah, none of that. I was high on relaxation: accepting and letting go.

Later, I wondered if we tend to trip on states of mind that are atypical for us. I’d been happy; I’d been sad. I’d danced; I’d touched. None of it would be new. For me, the most uncommon (and, thus, the most yearned for) state was inner equilibrium. Grounding physically and mentally. “Haha,” I’d write to Oskar later, “I freakin’ tripped on evenness.”

If it was possible that I was so fundamentally okay, then I had one major concept to process. In all that okayness, I know I was still me. Thus, beneath the codes, I’m not really broken.

The 5+1 things I felt 

This is a more detailed account of the qualities that came my way during the journey. These were the first words I jotted down as the experience came to an end that day.

1. Wordlessness

It flooded my overworked writer’s brain and allowed it to stop commenting and assigning descriptions to absolutely everything. The exploited narrator muscle, which had known nothing but flexing until that moment, uncoiled. Suddenly, I no longer had to attach words to things. I could be beyond words. For an articulator like me, this was nothing short of a revelation.

Even now, as I write this story, I watch those primal sensory experiences – originally recorded in succinct bullet points – bloom into these long narrative sentences, and I’m not sure: is it for better or for worse? For you, my reader, but also for me?

Afterwards, I jotted down on a blue sticky note: 

Feeling of change without words

Feeling of everything without words

2. Lightness

“Floaty” was the word I had offered Oskar before all those words finally gave me a break. Except, it wasn’t the body that felt floaty. It was me, inside, who was not weighed down any longer. The same ol’ me, but in a state of temporarily suspended codes. Some of them still tried to run; others just hung around. They were all so recognizable.

Oskar provides an audio recording of the experience afterwards. This was contained in mine:

You okay, Oskar? (my code of ensuring everyone’s fine and fixing everything if not)

I am. What are you experiencing right now?

Lightness. 

Mm.

I don’t usually experience it … You think it’s okay to just feel this lightness without some deep enlightenment?

Yeah, totally. There’s nothing you need to think about or do, just notice and enjoy.

… A whole new way of being.

3. Effortlessness

One of the biggest realizations that struck me during the experience was the constant, relentless state of effort I live in. Everything is a strain, everything must be worked hard at, everything needs to be earned. Try try try. Fix fix fix. All the time, no breaks. 

What if, just for once, I stop? Stop fixing. Stop trying. Stop… efforting.

Afterwards, I jotted down:

That moment of looking up at the blank white wall and feeling effortless and complete. State of full being without needs or wants. Blankness that contains the whole of me in total calm.

4. Acceptance

Receiving. This was the main tonality of the stillness that flooded me as my ill-fitted shoes came off. A touch of nausea? Well, ok. An external event that has always felt torturous? Well, ok. Deciding not to run and repair this situation that I would normally run and repair? Turns out, also ok. Whatever comes is – ok.

Imagine that, for someone who’d been trying to analyze, manage and improve their experience so desperately?

Not fighting, not going against something, not struggling, it’s ok to «just» receive 

• sense of complete openness to whatever comes, without directing it, without striving, just “as is” 
• letting it come or not; no condition – relief and release
• no need to prep with “it’s alright if X doesn’t take place”, because even this effort is unnecessary
• I don’t need to “will it” or make it happen or prepare for it not happening, I’m just okay

5. Painlessness

Another state I didn’t think was possible for me. This one is so vulnerable that, rather than overformulate it, I will let my dialogue with Oskar speak for itself. 

Oskar?

Mm?

What if I don’t want this to end?

Mm, it’s okay.

It’s pretty cool that life can be painless, huh? [with sadness]

It is. This experience you have right now, you can integrate. You can take parts of it into your life, more and more, and in the end, the need to get high will disappear. Your need to get to this state will be softer and softer because you’ve had more and more of it in your own life, every day. Now it feels like a relief, you don’t want it to end, and that is a part of the process.

Ok… ok. … it would be good if it was possible to be pain-free often.

Mm.

Or… [adjusting expectations] sometimes.

[both laugh] Sometimes?

Yeah. Once in a while.

It is. It is possible.

I’ve never been pain-free.

Mm. Maybe it’s time to start, a little bit. Try it out.

And what do I do when it ends?

We’ll see.

5+1. Comfort (the physical body)

Here’s the kicker. All of this was unfolding on the same unbearable mattress I had spent the night tossing around on. Except, now it was just right. On the same pillow I had spent hours battling with; perfect now. I was, physically, unconditionally comfortable.

And I realized: am I ever comfortable? Never. I’m always trying to repair something, not just externally (with regard to other people or situations), but on a bodily level, too. Tossing and turning for hours? Every night. Shifting around on the couch while watching something? By default. Some muscle is always unhappy, some limb’s position always needs tweaking. Something can always be improved. But now, every posture felt natural. No adjustments were necessary. There was nothing to correct.

At the same time, ironically, my body was on a stimulant substance. My heart rate, despite lying down for hours, stuck to around a hundred beats per minute, according to my trusty Fitbit. At some point, my jaw started to tremble uncontrollably. I grind my teeth at night, so I had a nightguard on standby. And as I reached for it, I realized: it wasn’t just the jaw. My hands were shaking, too. Plus, at one point, my eyes did the weird drunky thing called nystagmus (I think?), where they dart slightly back and forth in a rather amusing way.

How can a stimulant be relaxing? I still don’t know. But one thing was interesting to observe. My pulse was racing, or my eyes felt kinky for a bit, but I didn’t interpret it as wrong or a problem. It was fine. Just a given state of things. It didn’t need fixing. As for the shaking? I was struck by the contrast between how uncomfortable it sounds when articulated, and how unproblematic it was in reality. It felt, like everything else, okay. 

Memo: how things might sound in words (ugh) vs how they actually feel (no biggie)

After 

The sheer optionality of things

When evening began to set over Gothenburg, I picked up my phone for the first time that day. As I held it, I registered: I’d turned it on without a “gulp” this time. My dormant codes hadn’t kicked in yet, so I could observe them clearly: this is where I’d normally go “gulp”. Realizing: I live in dread. Hearing the bing of a text message or an email… Needing to do something downtown… Having to get up in the morning, really. Gulp.

Anxiety. Life is permeated with it. My heart is constantly dropping over the tiniest things. But why? Just how mandatory are those countless “oh no” moments? What would happen if I stopped trying to catch and fix them? In most cases, I saw clearly, it would be okay either way. The sheer optionality of things that have always felt unavoidable – this was one of my most mind-blowing takeaways.

This idea of recognizing a wormy code for what it is – a code – has stayed with me, too. There was a moment during the experience, for example, when Oskar turned to face me. And in the clarity of that state of mind, I could see it: the little red light blinking urgently where a habitual script would run. “Reciprocate and reward all gestures of closeness, or you are a bad person. As a bad person, you will be punished, likely by the withdrawal of that closeness. Hurry! Turn to face him, too. Fix this now, before it’s too late.”

Must always stay actively kind. Must reciprocate friendliness or risk it being withdrawn; must reward it or I’m a bad person who will regret it – these formulas were still there, but disengaged now. So I kept still and watched the blinky red light, which would overpower me in any other setting. Oddly, I had just achieved what my meditation teacher had been preaching for years: observe, but don’t engage. I don’t think I even knew what that meant, until now.

Through relaxation, I saw how non-compulsory it was to follow those blueprints. Physically, I was comfortable and content in my position – a rare delight, as mentioned. So I made a choice: I’ll go against my inclinations this time. I’m not going to run this code. 

As I went ahead with this decision, I grew aware of the adjacent light beginning to blink, straining to run its own code. It was the fear rolling in. He’ll turn away, and you will have caused it and earned it as retribution for being unkind. He’ll turn away from you now! 

Wait, and what if he does? Unbelievably, that would be okay, too. Imagine that.

Heightened self-perception

As days turned into weeks, I kept recognizing the preset mental blueprints activating within. Those realizations kept flooding in, and I couldn’t stop observing them. Say, on the bus from Gothenburg back to Oslo, I had chosen to reserve a front seat to avoid getting motion sick – one of my plagues. Alas, the bus was largely empty, meaning that my purchase had been unnecessary. In my situation, the cost was not unnoticeable.

It stirred inside right away: “Paid for a seat on an empty bus? So dumb, making wrong choices as always…” Oh, hello, code. I see you. You’re not compulsory. Off you go.

The fact that you can choose to let go of your crippling mental habits continues to stun me today. It’s different from the pesky idea that one can just decide to be happy and such. The simplicity of that statement has always disturbed me; I don’t think it’s accurate. I do think that one can learn to discern inner codes that are optional. At first, maybe they come into focus after the event. Then, maybe during one. Ideally, you begin to catch them preemptively, and disengage before they take control. I can’t say I’ve been consistently good at this, especially as the experience retreats in time. But now I’m aware that it’s possible.

Those overworked muscles

I reckon now that an MDMA experience releases the muscles in us that are most overworked. Oskar had told me about a client who was uncomfortable with closeness in life; that client was able to achieve emotional closeness with him during their day together. For that person, this is the strained muscle that unfurled as the tight shoes came off. One of my many overtaxed muscles is the repair of wrongs and mending of distances – real or imagined – so I, in turn, achieved the perfect solo space during my time with Oskar. As a guide, he grasped and reflected what was needed as the journey unfolded.

The muscle effect is literal, too. Remember my jaw shaking? I struggle with TMJ issues from clenching my teeth, nightguard and all. I suspect that the overloaded muscles went wild precisely due to that.

What are your most weary muscles, inside and out? What will you achieve when they let go?

Coming back to the fears

Anticipated enemies coming to your aid – this happens, too. Remember that fear about my brain hijacking the experience? Here’s what I shared with Oskar about it afterwards:

“I was so worried that, among other obstacles, my mind would be my enemy. Instead, it turned out to be my helper. It helped me to stay lucid enough to comprehend clearly where I was and what I was doing. It stayed up with me the whole time – but in a new, deeply chill way. Now, this helps to alleviate any retrospective questions (because man, am I a questioner) about whether I was cheating or hallucinating.

I was concerned about creating some artificial illusion temporarily, then realizing it was never real. But I knew all along that nothing was fixed on the outside, so it’s the internal shifts that were enough to make everything feel unbroken. So: my helper is helping me trust my experience, because it stayed with me and kept observing the authenticity all along. Which is exactly what I thought would be an obstacle. Interesting, huh?”

Speaking of cheating

During my journey, Oskar pointed out that there’s no inner peace encoded in the substance I’d just taken. No self-compassion, no acceptance. Chemicals are just chemicals. The things you feel in response to them – those are in you. Why they hide away in daily life is one of the biggest questions I came away with. I don’t have a profound answer to that; at least, not yet. But what I felt came from within me, not from within the pill. It was intrinsic to me. This I know.

I was concerned that psychedelic therapy means merely cheating one’s way out of reality. Now I realize: I wasn’t afraid of just going back to the miserable me after the journey ended. I was afraid of going back to the miserable me who had failed even in trying to cheat.

Instead, I gained the most lucid take on what’s possible when the codes are paused and the burdens lifted.

Here are the notes that came out of this:

I can exist differently yet still be me / be conscious – high with relaxation, not with cheating.

«So, is this cheating?» – no, just the authentic you.

Authentic you is a state of being okay. 

There are bumps, they pass; still okay.

They pass at letting go. Of them and of the fear.

This may sound like transcendental nonsense, but it’s not. There’s a scientific explanation, one of the reasons MDMA is being researched as a therapy substance. It floods one’s brain with good stuff like dopamine, serotonin, norepinephrine, oxytocin. But like I said, I experienced no stereotypical euphoria. Instead, what I got was profound chillness. Those chemicals chip away at the tensions we carry around with us. As we release the tensions, we get access to the “self” beneath them. That’s all. The effect will end and the tensions will return, maybe even with a vengeance. But guess what? Now you’ve seen you without them. 

Now you know.

Clarity in the larger scheme of things

Every day, everything in my life is an effort. Even good stuff, not to mention bad stuff. Meditation is an effort, straining to get it right. Going through a list of positive affirmations is an effort, almost bursting with willpower. Dealing with negative thoughts and keeping them at bay is an effort. Making sure that everyone is fine and fixing everything is, do I even need to say it, an effort. It’s a full-on state of being.

Turns out that it’s possible to move through life differently. Not trying to be happy. Not trying to stay positive. Not trying to be useful, perceptive, loved, fill in the blank. Not trying to be anything at all. And still being okay. Actually, not «still» – for the first time, being okay. 

When a good friend habitually reminded me to think happy thoughts sometime after my experience, I responded: No more mandatory happy thoughts for me, I think. I want something else. I want to exert less effort on the smaller ins and outs of mere existence. Forced happy thoughts included.

We’re taught to strive for things, to imagine good things coming our way. Numerous traditions are built on some kind of exertion. Some kind of wanting. There are whole philosophies that teach us to want right, in a way that would make things come true (such as affirmations and positive thinking and such). Never quite worked for me. In tune with my patterns, I assumed I wasn’t trying hard enough. I also concluded the habitual: I’m probably defective. The mere possibility that I’m not is, well, mind-boggling.

I was so worried that this experience would go so very wrong, and it went so f*cking right. Two possibilities arise from that:

1. I am not as broken as I thought, or
2. It was just a fluke / an accident
   • Implication: it might never return – and there’s a real fear of this

Focus on the first, I tell myself. Recognize, but don’t focus on, the second. It’s a code. You know about those now. And you know deep inside, with clarity that’s pretty unusual for this bedazzled being, that it was anything but a fluke.

Getting a blank slate

The evening after my experience, talking to new friends at a dinner table, I caught myself reciting the same old stories that supposedly define and illuminate who I am. This thing happened at twenty, that thing happened at thirty, and so on. Except, this time, there was a distinct sensation of pouring stale water onto a new clear sheet. 

An MDMA journey can yield a kind of blank slate, so to speak. I had to ask myself: wait, why do I keep telling this unchanged old tale? It’s outdated and kind of irrelevant now. The thing is, it’s never felt outdated or irrelevant before. So, in a way, you get to redefine yourself a bit, while the canvas is still freshly washed. You get to choose the stories you keep.

And, at the same time: it’s okay if an ancient chronicle was accidentally re-told tonight. It doesn’t really matter. The lack of self-punishment here, the shrinking of scales of what’s important to repair, was one of the most riveting effects of my first journey.

What about the comedown?

I didn’t experience the traditional comedown, or crashing – a marked deterioration in mood as all those good chemicals leave one’s body. Instead, I carried the feeling of inner flight into everyday life for a while. No longer medicated, but still impacted. This was so vivid that some things no longer fit. For example, a friend and I had been binging a show with a fair amount of dark and unhappy imagery. After I got back to Oslo and we sat down to continue watching it, I pretty much couldn’t stand it. Life was so out of tune with its ambience that, after a while, I had to ask if we could stop for now. It just felt off.

Weeks later, when we tried it again, the ambience no longer felt disagreeable. I suppose I was back to the old vibrations, so to speak, and we binged the show to the end without obstacles. In a way, on a scale from 0 (below ground) to 10 (above clouds), I went from 1 (before experience) to 10 (experience) to… maybe 2 or 3? So, back to real life, which is a kind of extended comedown, I suppose. Yet that couple of gained points on the “default state” scale? Priceless.

Which is to say: you do end up returning to the crappy habits and old blueprints and the not-so-great inner stuff. At the same time, you return there with fresh, first-hand knowledge of how things could be, and what state of mind might get you there. Not in theory, not in wishful thinking, but in practice. A kind of inner guidance can stem from that knowledge, if you let it.

To sum up the aftereffects: the first days were brilliant, the second week was lovely; the third one started to get a bit shaky; I had defaulted by about a month later. At the same time, things look clearer, somehow. Even back down here, at scale level 2, they continue to look clearer. 

There was this colossal wall in front of me for most of my life, and I just got to the other side of it. I’d like to make choices that lead me forward from there (even if it’s mostly at 2 or 3). I would rather avoid doing things that will set me running back towards it.

Intention-wise, it doesn’t get much clearer than that. In practice? Let’s see how it unfolds. 

The guide’s role 

I keep mentioning Oskar because he was such a vital part of my experience. Preparation, trip-sitting, integration: he provided these three columns, and everything rested upon them. But before I got in touch with him, his role seemed rather unclear.

What makes a good sitter? No, really. Are they always around to fetch a glass of water when you need one? Do they pat you on the hand if you’re having a hard time? The thing is, I’d say this kind of stuff makes a good person. Any one of your friends is, more likely than not, a good person. But you’re hiring someone else. So, what makes a good sitter?

It’s not too different from what makes a good mountain guide, which is why “trip sitter” and “psychedelic guide” are often used interchangeably. These individuals must have been here before, many times and in all sorts of weather. They know the terrain, the pitfalls, the shortcuts. They may not have the proverbial map, because some things cannot quite be mapped. But they’ve got the compass. And despite their immense experience with such journeys, they haven’t lost sight of how you might be feeling as you walk there, wide-eyed, for the very first time. In fact, they’re rooting for you.

Oh, and they’re carrying the first aid kit. If things go south, they’ll know how to reach you in a way even the best of friends might not. 

Like a good mountain guide, a good sitter excels at helping you both stay safe and feel safe. I’d say this happens through three channels:

1. Normalizing the experience at all points in time 
2. Keeping track of the details, whether or not you remember them
3. Continually gauging your needs, whether or not you’re aware of them

Normalizing the experience

One of the most important things Oskar did for me, throughout the experience and beyond, was normalize its nuances. He listened to my observations and concerns with full respect for them, but without offering a judgment in return. He didn’t propose some standard words of comfort about that newly coined “pukiness”, for example. He acknowledged it and then let it be a part of things. And, as an accepted part of things, it calmed down. I didn’t realize until then how often we rely on consolation (“oh no, are you okay, it will get better”) when acceptance can be, as it turns out, more reassuring. 

Whenever I brought a question to him, he offered feedback that was honest, thoughtful, and non-pathologizing. What if I have a bad trip? Could be; we’ll deal with that. Yikes, are my eyes jolting weirdly? Yeah, a bit. D’you think having a heightened sense of hearing, like I do, is a defect of some sort? Mm, who knows, it might be.

No denying, no diminishing, no smoothing over anything that feels odd, no verdicts. Because the point is: all of these things could be true, or not true, and you’re still okay. 

A person projecting a steady and informed recognition of your experience, as it turns out, is the right person to have by your side when you’re facing the unknown.

This brings us back to the first aid kit. Guides can be calm and supportive in a convincing way when they have the tools to recognize and address the things that might actually need intervention. A day later, while reading a book on another floor of the building, I briefly happened to hear some of the sounds of another person’s experience. One could tell that it was unfolding differently from mine. I also knew that Oskar was there with that client, and that the client was safe. This guide has seen and handled a whole lot of different journeys by now.

Keeping track of the details

You’re experiencing existence on so many new levels that it shouldn’t be your job to remember the little things. For example, that nightguard I described earlier. I brought it up with Oskar only in passing, while discussing something else. It was, indeed, a very brief mention. 

Hours later, when the effect of MDMA had reached my jaw, I fumbled around the mattress while muttering: “It might be time to protect my teeth…”. To this, Oskar said: “It’s right here.” – and handed me the nightguard case, which he’d kept by his side from the very start.

He heard me mention a detail that he knew to identify as relevant, took note, and made sure he could provide it without delay when needed. This is quite unlike asking for a glass of water (which, as we’d agreed, any good friend would bring you) because it takes perceptiveness and some orientation skills regarding what may come up along the way.

In another discussion, I shared my reservations about using the eye mask and the headphones – “do I have to?…” – because it didn’t sound right in terms of isolation, somehow. Maybe because I wanted to stay connected to my guide, maybe because I’m claustrophobic. Either way, I was reluctant. And, indeed, I didn’t use the headphones at all during the experience, and only tried the mask for a little while. 

But something else came out of that discussion: from this mention of concern over closed space in the context of headphones, Oskar had gathered enough to leave the room door wide open that day. An open door was exactly what I would have wanted, but I was thinking about other things and didn’t address this particular element. In the end, without any direct requests, the room stayed unlocked all along, though I suspect it’s usually closed during private sessions. Basically, he picked up more than I had said. He picked up the details.

Gauging your needs

On a larger scale, too, a good sitter is proficient in identifying clues as to what their role should be in order to benefit you most. I think this gauging started in our online prep sessions. To me, they were mostly about talking and sharing. To Oskar, I reckon now, those conversations also offered a chance to assess what I might require from him – even when I didn’t quite know it yet.

For example, I needed to have no external expectations as I went about my experience. This was important because I’m so darn preoccupied with (not) disappointing others. In response, Oskar made sure his presence was unintrusive. For the most part, he relaxed nearby with his eyes closed. The moment I moved or stirred, however, one eye was inevitably on me, watchful. It was exactly the kind of companionship I thrived with, but didn’t know I would until the experience began. It appears he knew, thanks to his background in guiding very different people with diverse sets of needs and preferences.

Another sketch can help reflect this attunement to the client’s individuality. As we talked during the experience, I mentioned that I struggle with receiving services like haircuts or massages. I get consumed with entertaining the other person, keeping things warm and human for them, trying to be worth their time, perpetually earning any effort spent on me. In this anxious setting, passive enjoyment is out of the question. This, too, is about other people’s expectations – though, more than likely, projected and imaginary. They do feel remarkably real when you sense that you’re failing them.

To explore this further under the influence of MDMA, Oskar offered a gentle foot touch. And even though the substance was freeing me from so many things, I still couldn’t receive it without heightened self-awareness, immediate guilt about his efforts, and questions about worthiness. In response to this struggle, Oskar did a perceptive thing. Remember those eye masks he keeps for his clients? He found one for himself and put it on.

Now, psychologically, by some odd association, he was no longer expecting anything of me. If I did do something – try to smile, acknowledge him, or signal concerns about his comfort – he simply wouldn’t see it. “Why did the eye mask make such a difference?” I jotted down later, and I still don’t have an answer to this question. But it did. Uneasily, delicately, I was able to enjoy a few minutes of that foot touch.

This kind of intuitive orientation skills take an experienced, thoughtful, and self-reflective guide. I didn’t realize I had lucked out with one, until I had lucked out with one. 

What happens next?

Integration refers to weaving the experience into one’s daily life afterwards. Oskar offers a guidance document on that, where he writes: “There is a grace period of about two weeks following the psychedelic experience when you can form new habits or get rid of old ones.” When I read it at first, I wasn’t sure what this even meant. New habits? Old ones? What?

Now, I’d say I was pretty much on schedule. And, as he predicts, I do feel a calling to repeat the journey. I’m being mindful of that and taking it slow. I definitely want to do it again, but for the right reasons. Not merely for more relief from the cramped old shoes, but for further insight about keeping them off. I know experiences differ, and I know the next one can be very dissimilar. I’d like to be ready for that. I’d like to learn from that, too.

“What do I do when it ends?” I had asked Oskar when I waded through the sadness of my journey’s temporality. He offered an answer to that, and I’d like to conclude by sharing it here.

Maybe you’ll grieve that it ends, and you’ll be scared that you won’t get it back, and that this is the only way you can feel this way. And then, you’ll realize that it’s not. Part of this process is just to learn what is good, to recognize that feeling. Then, even if it’s over and gone, you’ll still recognize it. You’ll recognize it when you meet someone, when you’re by yourself, you start noticing what feels good to you, and then you start using that as a compass. What you should work on, where you should live, who you should hang out with, what you should do for yourself. It’s a very natural process. We’re all drawn to what feels good.

Would you need more trips for that?

Probably. It took me a while. But as long as you start the process, it doesn’t matter if it takes a while. As long as you feel like you have a goal or you’re moving in the right direction, you can start enjoying the journey that you’re on. The hopelessness disappears… you know?

Yeah, I think I know. 

It’s as if I have dropped a location pin onto some inner maps: this is how I’d like to feel every day, someday. This is the freedom I’d like to achieve inside; this is the lack of suffering; these are the unhelpful patterns; this is what unfolds when they are suspended. It’s almost like an orientation device, a kind of GPS. Now I feel around for this state of mind – this state of being – as if poking my way through a dark room, catching tiny moments of light in the simplest of places: brewing a fresh cup of coffee, walking through the woods, watching the fireplace, easing into a warm bath.

Those moments were always there, and I’ve always sought them out instinctively (I love baths, and fireplaces, and forests, and fresh coffee). But now, they’re not just incidental pleasures; they’re a part of something larger. Something that’s invariably there, but obscured most of the time. Something I can work on revealing and grasping more fully. 

If that’s not hope, then what is?

… Trust, let go, be open.

T.B. – Spring 2024

Innlegget Triprapport: Under koden dukket først opp på psyn.no.

Innlegget Filmer og TV-serier jeg har tenkt mye på dukket først opp på psyn.no.

Hvis du føler det er en beskrivelse som er treffende for deg og det kan være av interesse, send meg en melding i kontaktskjemaet mitt og skriv litt om deg selv og din erfaring og bakgrunn.

Innlegget Søker erfarne tripsittere i Norge og Sverige dukket først opp på psyn.no.

Mange av mine klienter går på ulike medisiner og det er et tema som derfor kommer opp ukentlig. Hvilke medisiner kan man fortsette på? Hvilke må man gå av for å ikke dempe effekten? Hvilke kan være farlige i kombinasjon med psykedelisk terapi? Siden det finnes utallige medisiner og kombinasjoner, er ikke svaret helt enkelt. Men det finnes noen retningslinjer som er greit å følge og noen tips til hvordan man kan gjøre research på egenhånd. Hvis man skal slutte med medisiner er det viktig å gjøre dette i samråd med lege/psykiater/psykolog/venner/familie så man gjør dette på en god måte og andre er informert om prosessen. Å trappe ned på stabiliserende medisiner er ofte destabiliserende i seg selv og en psykedelisk opplevelse destabiliserer ytterligere. Det er viktig å få nok søvn i løpet av de første dagene etter en opplevelse.

Antidepressiva og psilocybin/LSD/DMT

Da jeg begynte å jobbe med dette i 2020 ble det alltid sagt ”man må gå av antidepressiva minst to uker før en psykedelisk opplevelse”. Dette gjaldt de kliniske studiene som ble gjort og hos ulike retreatsentre verden over. Dette er ikke fordi det er farlig å kombinere (med unntak av med ayahuasca), men heller basert på antagelsen om at antidepressiva demper effekten av klassiske psykedelika som psilocybin og LSD. En amerikansk farmasøyt som kaller seg Spirit Pharmacist har lagt ut en oversikt over nedtrapping for ulike antidepressiva her. Dette har for det meste vært basert på anekdoter fra folk som har prøvd. I sent 2021 kom det ut et placebo-kontrollert studie fra Compass Pathways som viste at deltakere som gikk på SSRI under psilocybin-behandling allikevel fikk sammenlignbare resultater med de som ikke gikk på SSRI. Dette er et lite studie, men viser i alle fall at mange kan få gode resultater av psilocybin-behandling til tross for at de fortsatt går på antidepressiva.

Min erfaring tilsier at risikoen for å få en dempet opplevelse med psilocybin er litt høyere om man samtidig går på antidepressiva, men at de fleste får forventet effekt. Jeg har en tynn hypotese om at det kan ta lengre tid før psilocybinet gir effekt om man samtidig går på antidepressiva.

Antidepressiva og MDMA

Også her har det gjeldende rådet vært å gå av antidepressiva to uker før en opplevelse. Her har årsaken vært todelt, både at de fleste antidepressiva ser ut til å dempe effekten av MDMA betydelig, men også (lav) risiko for seratoninsyndrom. Når man i et lite studie har sett nærmere på resultatene til de som gikk av en antidepressiva to uker i forkant av en MDMA-terapisession, ble den terapeutiske effekten redusert med over 60 %. Spirit Pharmacist har en hypotese om at man må trappe ned mye lenger i forkant for å få normalt forventet effekt, minst 4 til 6 uker. Denne hypotesen begrunnes med at det ofte tar 4-6 uker før antidepressiva begynner og virke og at det er naturlig at det vil ta like lang tid for at virkningen skal forsvinne igjen.

Angstdempende og antipsykotika

Angstdempende medisiner som benzodiazapiner (f.eks. Vival/Valium/Xanor/Xanex) kan dempe effekten av både MDMA og klassiske psykedelika som psilocybin, LSD og DMT betydelig og bør derfor trappes ned på i forkant av en opplevelse. Disse omtales derfor noen ganger som en «trip killer» fordi de stopper den psykedeliske opplevelsen.

Antipsykotika/neuroleptika som kvetiapin/Seroquel og olanzapin/Zyprexa sies også å dempe den psykedeliske opplevelsen. Antipsykotika kan foreskrives etter ulike indikasjoner/symptomer, men det er viktig å merke seg at man skal være spesielt forsiktig hvis de er skrevet ut for diagnoser som schizofreni, mani eller psykoser, som er en gruppe med høy risiko for forverring av symptomer etter en psykedelisk opplevelse. Dette gjelder i lavere grad for MDMA, og høy grad klassiske psykedelika.

Farlige kombinasjoner

Det finnes også noen medisiner som er svært ubehagelige eller farlige i kombinasjon med psykedeliske substanser. Jeg lister noen av disse her.

• Litium med klassiske psykedelika (psilocybin, LSD, DMT) har vist seg å gi kramper, sjokk og i verste fall død hos omtrent 50 % av registrerte tilfeller.
• MAO-hemmere (en uvanlig antidepressiva, men også en ingrediens i ayahuasca) kan gi serotonergt syndrom/serotoninsyndrom i kombinasjon med MDMA. Dette kan være dødelig. Det er derfor spesielt viktig å ikke innta MDMA for nært en ayahuasca-opplevelse.
• Noen migrenemedisiner (som f.eks. eletriptan og Zomig) frarådes i et tidsrom på 24 timer før og etter en trip med LSD, psilocybin og DMT.
• Jeg tror man bør være forsiktig med andre medisinsopper som reishi og chaga i kombinasjon med psilocybin basert på erfaringer.

Hva med andre medisiner?

Hvordan medisiner interagerer med hverandre er komplekst og siden din fastlege kanskje vet mindre om psykedelika enn deg, er det dessverre sjeldent man får gode svar der. Når jeg skal finne ut om medisiner kan kombineres med psykedelika begynner jeg rett og slett på Reddit for anekdotisk bevis. Det er mange på Reddit som har prøvd nesten alle mulige kombinasjoner av medisiner og rusmidler og det kan i alle fall gi en indikator på hvor farlig det kan være. I tillegg kan jeg også Google virkningen til medisinene det er spørsmål om for å se om krasjer med psykedelika på noen måte. Migrenemedisinen Zomig, for eksempel, skal ikke kombineres med ergotamin i følge Felleskatalogen, et stoff som er nært beslektet med LSD. En annen medisin kan være en sterk belastning på leverfunksjon, for eksempel, og derfor være farlig i kombinasjon med MDMA som også gir belastning på leveren. Og det generelle rusmiddelrådet «Start low. Go slow.» er alltid fint å ha med seg.

Ta gjerne kontakt for en gratis, kort konsultasjon her eller en hel betalt time her for litt råd på veien.

Innlegget Psykedelika og medisininteraksjoner dukket først opp på psyn.no.

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Hva begrenser forskningen?

I USA klassifiserer man narkotika i ulike nivåer. Schedule 1 er det øverste nivået der stoffer «som har høyt avhengighetspotensiale og ingen akseptert medisinsk bruk» plasseres. Disse klassifiseringene ble gjort i en slags panikk rundt hippie-tiden og det er ingen som kan forsvare disse begrunnelsene lenger. Cannabis, MDMA, psilocybin ligger alle i denne gruppen. Dette blir spesielt komisk når cannabis er Schedule 1 på føderalt nivå, men kan fås som medisin på resept i over 35 stater. Det som gjør at forskningen blir vanskelig på disse stoffene er at det er vanskelig å få økonomisk støtte i tillegg til at det er mye papirarbeid og byråkrati man må gjennom for å få tillatelse til å sette i gang. Hvis man vil forske på cannabis må man ha stoffet innlåst i en safe festet til gulvet med to separate dører. I tillegg har man vært redde for at forskningen skulle stoppes hvis det skulle oppstå uønskede situasjoner. Noe som er ganske vanlig når man utfører studier på psykisk lidende. Dette er grunnene til at forskningen har vært strategisk fokusert på lidelser det vil være enklere å få godkjenning for. Nå når de første studiene har kommet så langt, er det lettere å få godkjenning for nye faser og andre studier.

De grunnleggende funksjonene

Generelt har psilocybin og MDMA ulike grunnleggende funksjoner som medisiner og fungerer derfor bedre til ulike lidelser. Psilocybin skaper mer åpenhet og stimulerer nevroplastisitet (mulighet til å tenke nytt), noe som hjelper de som sliter med rigide tankemønstre. De som synes det er vanskelig å se ting på en annen måte, føler seg låst, håpløs, ikke klarer å bryte ut av mønstre eller vaner. Depresjon er et godt eksempel på dette, men tvangsnevroser, angst, avhengighet og midtlivskrise faller også innenfor dette spekteret.

MDMA stimulerer opptak av oksytocin, «kjærlighetshormonet», som gjør at man kan prosessere traumer mer effektivt og se verden, seg selv og sine forhold med medfølelse. Min forståelse basert på det jeg har lært er at traumer (store eller små) ligger til grunn for alle psykiske lidelser. Barn er ekstremt sensitive og tilpasningsdyktige, og lidelsen var sinnets måte å tilpasse seg situasjonen på. Man kan se indikasjonene på dette ved at erfarne forskere ser på MDMA for mye annet enn bare PTSD. Merk at dette er små studier i tidlige faser, så kan ikke regnes som bevis på at det fungerer, men det gir en indikasjon på hva ekspertene tror det vil fungere for. Jeg har ikke linket til alle studiene her, men du kan se listen for alle kliniske forsøk med MDMA her og psilocybin her.

MDMA-studiene

• PTSD
• Anoreksi og bulemi
• Alkoholisme
• Parterapi der den ene har PTSD, men begge får behandling
• Angst knyttet til dødelig sykdom
• Autisme og sosial angst
• For friske, uten psykiske lidelser

Psilocybin-studiene

• Depresjon
• Kroppsdysmorfisk lidelse
• Anoreksi
• Depresjon knyttet til Alzheimers
• Tvangsnevroser (OCD)
• Migrene
• Klasehodepine/cluster-hodepine
• Avhengighet (alkohol, kokain og tobakk)
• Angst knyttet til dødelig sykdom

Innlegget Oversikt over studier på MDMA og psilocybin dukket først opp på psyn.no.