How King’s College Hospital Cured My Depression

Introduction:

In 2020, I participated in a medical trial which cured my depression. The treatment was simple and effective, but I need to work up to describing what it actually was. Also, this story can get a little dry and technical at points, and with stories about mental health I think it’s important to maintain focus on the feelings of those involved, so during this post I’ll be using Robin Higgins to represent me and my mood:

Patient history:

Somewhere between the ages of five and twelve I developed ADHD. This went untreated until I was thirty-seven. Being unaware of my condition meant I couldn’t take steps to live with it. Slowly, starting in my mid-twenties, my brain started to shut down. The ADHD meant I had serious trouble focussing, which led to depression and anxiety. My symptoms eventually got so bad that I had no choice but to consult the NHS. The NHS then attempted to treat my depression for around six years. I was given eight different anti-depressants along with two years of therapy. A psychiatrist noted that I displayed autistic symptoms, but no-one considered the possibility of an underlying cause for the depression. These problems together caused me to develop chronic fatigue symptoms.

Depression

Depression manifests in different people in different ways. I felt a persistent, overwhelming sadness that wasn’t lifted by positive events. When I got news that my first book was going to be published, for example, I felt nothing. I knew objectively that it was good news, but I didn’t have a positive emotional reaction at all. Physically, I felt like there was a stone in my chest constantly dragging me down. As the depression really took hold of me in my late 20s, I gradually lost interest in activities that had interested me previously. I found it hard to see the bright side of anything and was generally miserable. Motivating myself to engage with my career or life in general was very difficult. For long, long periods I didn’t see the point in being alive - there didn’t seem to be anything in it for me.

Tracking mood on a scale of 0-10, where 0 is the most miserable a person could possibly feel and 10 is the happiest a person could possibly feel, I spent nearly seven years with my mood hovering around the 1-3 zone. Occasionally it would dip down to 0. Very occasionally, it would raise up to 4. It very rarely hit 5 - what I would consider normal or neutral. The occasions when my mood broke through 5 and into the ‘happy’ zone were so rare across seven years that I can count them on the fingers of one hand.

Prior to 2013, my episodes of depression were frequent but less persistent. After leaving school, I seemed to go through a cycle of three months where I was depressed and three months where I was fine. That being said, I only started being actually aware of what my mood was doing around 2014 so this ‘three months on, three months off’ thing may not be completely accurate.

What I have learned since indicates that these early periods of depression acted as a counterbalance for my ADHD symptoms. My ADHD meant I would get gradually overwhelmed by life, which caused me to slip into depression. The depression would cause me to retreat from social activity, along with work. Retreating caused me to become less overwhelmed, which caused the depression to fade. This cycle grew in severity until the depression was constant.

Anxiety

My anxiety symptoms were limited to occasional panic attacks. 

Chronic Fatigue

My fatigue manifested in overwhelming tiredness that only lifted very occasionally. On some days I couldn’t get out of bed at all. Physical exercise drained me and could incapacitate me for days afterwards.

ADHD

When untreated, my mind is foggy. I can find it hard to concentrate on a question more complex than ‘what colour is that bus?’ I couldn’t work because I could only force myself to concentrate on tasks for so long before my brain responded with worsening every symptom on this list. I got overwhelmed easily - being in a crowd or in a room with too many people talking would mean I’d have to go somewhere quiet and hide. When things were really bad I couldn’t engage with any of the hobbies I loved. I’d just sit staring at walls (preferably blank walls) because it was the only way to stop myself feeling overwhelmed.

Treatment History

I reacted badly to antidepressants – it took four years and seven different drugs to settle on one which didn’t make my symptoms worse. I have since learned that this is common in patients where depression is masking ADHD. The only anti-depressant which had a net positive effect (lofepramine) didn’t actually alleviate my depressive symptoms that much, it just took the edge off a little.  

I’ve had two years of therapy. One year of psychodynamic psychotherapy, six months of CBT and six months of a blended approach with a private psychotherapist. I found therapy interesting and useful – it gave me a much better understanding of my condition and the reasons behind it. It gave me a set of tools with which to combat certain aspects of my depression and anxiety, but it was ineffective when combating the debilitating misery. 

In 2018 I took part in a medical trial at King’s College Hospital which supplemented my antidepressant with a second drug to see if that would make the treatment more effective. The trial lasted a year and made very little difference.

Conclusion

I had spent around seven years trying every treatment for depression I could get my hands on, from therapy to antidepressants. Therapy was useful but didn’t solve the problem, because my problem was ADHD. By 2019 I had concluded that depression was a fact of life and I was never going to be free of it. Still, some part of me still desperately wanted to get better, so when I saw that King’s College Hospital was running a trial for treatment resistant depression, I applied.

The Medical Trial 

The best thing I can do here is quote directly from the study information sheet, although I’ll cut it down a bit to make it less dry: 

From the study information sheet - what is the purpose of the study?

The main purpose of this study is to test how well psilocybin works to lessen depressive symptoms. Psilocybin is a controlled drug and a chemical compound found in some species of  mushrooms. Psilocybin works on the serotonin  system in the brain which is linked to the regulation of mood. Current regulations do not allow psilocybin to be prescribed in the UK for treating depression, although it has been approved for use in this research study.  

From the study information sheet - what are the effects of Psilocybin?

The psilocybin experience varies greatly between individuals. Psilocybin may  temporarily change the way objects and people appear to you. For example, the size  and shape of things can appear distorted, walls may appear to move as if they are  made of fabric or as if they are ‘breathing’, shapes and colours may be seen on  surfaces and the room may appear to get bigger or brighter. You can close your eyes  during the experience, and wear an eye mask which we will provide. With your eyes closed, you may see shapes and colours and unusual images as if you are dreaming.  Time may appear to pass more slowly and it may be hard to judge how much time has passed.   

Some people have reported visions of their pasts; for example, they might feel as if  they are remembering or even reliving events from their childhood. It is sometimes  difficult to know if these visions are real memories or fantasies, and the study team will  not be able to pass judgement on such matters.  

Many people find the effects of psilocybin quite pleasant but others can get anxious  because the experience is unfamiliar. The study team and your therapist are specially  trained to prepare and support you through this experience. Your therapist will be with you at all times and will be able to help you if you do get anxious. 

The therapeutic effects that the study information sheet didn’t tell me about

The reason psilocybin is such an effective treatment for depression, in my experience, is due to something one of the doctors told me about: Apparently psilocybin breaks down certain pathways in the brain, thus ripping up ways of thinking that have been there since childhood.

Before Reading Further

One important thing about psilocybin is the effects are extremely personal. I was told to not do my own independent research into psilocybin prior to the dosing, although I suspect the reason behind this advice was so I didn’t freak myself out. So, if you are on a similar trial to mine, maybe don’t read any futher? Or maybe do. Who can say.

Applying to the trial & endless screening

I’ve applied to about five medical trials in my time, and they all start the same way – you send an email and the trial co-ordinators take your details and arrange a screening phone call. There, they chat to you about your medical history (at great length), your reasons for wanting to join the trial, and they get you to do endless questionnaires.  

They did three screening calls with me, then a screening conversation over video link. The purpose of this was to ensure, as much as possible, that I met the study criteria and I wasn’t just someone who really wanted to take psilocybin.  

The study had a big time corporate sponsor, so it was very important that they only let the right sort of people onto the study. They were worried that I had some mild suicidal ideation during one of the screening calls and had to run it past some higher ups (who I never met). The drug company sponsoring the trial wanted to make sure that they only got the results they wanted, and this involved only getting very specific types of people onto the trial. 

Finally, they brought me into King’s Hospital, did yet more screening questionnaires, took my blood and urine (not all of it, thankfully), did a ECG and a bunch of blood pressure checks. Then I was finally accepted onto the study.

The lead up

I had to come off my antidepressants before the dosing, which involved a 12 week tapering off period. This wasn’t a problem for me because, previously, I’d decided to stop taking my antidepressants for a few months to see if anything bad happened. I had a headache for about a week and some minor GI trouble, but otherwise didn’t suffer any ill effects. They brought me into the hospital every week to check on how I was doing. This was, thankfully, in between waves 1 and 2 of Covid.  

I met Wendy.  

Wendy was a therapist whose purpose was (and still is) honestly a little unclear to me. The doctor told me she was there for me to get the most out of the session therapeutically, so I should think of some things to say to her. So I thought of some things, and started saying them, but she told me it wasn’t that sort of patient-therapist relationship. She was there to facilitate my journey, nothing else. 

Everyone was very keen to make sure I felt safe, which to my depressed brain made me a little suspicious. They had a very expensive looking video on the study website explaining the sort of things that might happen – I might have a wonderful, amazing experience, and I might go to some extremely dark places. I was told the people who got the most out of psilocybin were the people who went in with a spirit of experimentation. I was told not to shy away from the dark stuff but instead to go in and through. 

I filled in more questionnaires - I don’t know how many I filled in over the course of the study but it’s easily more than 50. The clinicians talked to my wife to explain what was likely to happen, and that she’d need to come pick me up after the dosing. They always referred to psilocybin as ‘medication’. Never, ever a ‘drug’.

The day before the dosing 

Wendy and another clinician called Leanne, who was there to make sure I didn’t wander away after I’d taken the psilocybin and walk into traffic, took me to see the room I was going to be dosed in. It was a standard hospital room, about two meters by four. White walls, Styrofoam ceiling tiles and a wash hand basin on one wall. There was also a hospital bed in the middle of the room for me to lie on during the dosing. The team had tried to make the place look homely – they’d set up a floral print screen along two of the walls, an aromatherapy device of some sort and some flowers in a pot. Essentially, they’d taken a hospital room and turned it into a weird hotel bedroom.  

They asked me to make myself at home in the room, to make sure I felt comfortable in the space. I immediately checked behind the screens for assassins, because I’ve seen films. They showed me the blindfold and the headphones. I was going to need to wear those on the day. The blindfold was to make sure I didn’t get distracted by the environment – my journey was supposed to be entirely internal and not influenced by the outside world. The headphones were going to play a soundtrack specifically designed for the study. The music was going to match what the drug was doing in my system. I later learned that this meant going from really nice piano music to make me feel comfortable, to really dark, depressing music to induce a therapeutic effect and back to lovely piano music to bring me out the other side.

 The Dosing 

The day of the dosing, a taxi took me to the hospital. I went through yet more questionnaires, just to check I wasn’t about to explode or something. I left my phone and my bag in an adjacent room. The only thing I took into the dosing chamber was my memory foam pillow, my slippers and a few knickknacks.  

One of the things about taking psychedelic drugs in general and psilocybin in particular is your experience can, apparently, be influenced a lot by your surroundings, so bringing some things from home would apparently help make me feel like it was my space.  

Here’s a picture of the things I brought, which I balanced on the wash hand basin next to the medical bed thing: 

The book is an RPG corebook I was trying to re-familiarise myself with at the time. The picture is a shot of my wife on our honeymoon at Nara. The models are from an RPG I ran with my friends, played by four of my friends and one representing a particularly fun NPC. It was a small way of having my friends with me in the room.

A nurse came in with five small, white pills in a little bowl. One by one, I swallowed them.  

I lay on my back for an hour, listening to some very pleasant piano music. Nothing happened. 

It was completely dark with the eye mask on. Thanks to the music, things didn’t get boring.

Occasionally, I’d get a flash of something or other. Because I’ve lived with depression and fatigue for as long as I can remember, whenever I think there’s a chance of improving my condition, I get very excited. So, whenever I got a flash of something, I remembered the advice of going towards whatever it was and exploring. The problem was the drugs hadn’t kicked in, and my visual imagination isn’t particularly strong, so the image would disappear as soon as it arrived.  

After an hour I asked to go to the toilet. Wendy had to accompany me. She didn’t follow me in, but she waited outside and asked that I didn’t lock the door. This is because people on psilocybin can get distracted by how fascinating their surroundings are, and the point was to be on my inner journey, not getting distracted by running water from the bathroom tap. 

I told Wendy about getting excited and losing the images I was seeing. She recommended I concentrated on my breathing, as we’d practiced. When I got back into the room, that’s what I tried.  

Soon, I started to see things. Silver and grey ferns.

Then slightly more complex shapes, such as dolphins. Then, I found myself in a room with two characters from horror manga that had previously terrified me. I had a chat to them, and moved on, rounding off the moment with a line from John Finnemore’s Souvenir Programme.  

Then, I felt more tired than I ever had before in my life, but also about as tired as I felt on a daily basis. I was feeling quite euphoric because of the psilocybin at that point, so the tiredness didn’t feel like a bad thing. I lay there and let myself feel it. I let it wash over me. Lines from Aunty Donna’s ‘Don’t Get In The Kiln’ kept popping into my head.  

Then, I felt nothing but sadness. Then, I felt like I was being waterboarded by reality. Then, time stopped existing. I didn’t have a body. I separated into threads. I started to wonder, if you took all the bad feelings away, would there be anything left of me? Yes, was the conclusion I came to. 

My years of therapy were very useful. One of the things which I spent a lot of time with was the idea that a negative state, such as unwanted panic, is a response that comes from somewhere. Sometime in your past, my body responded to a stimulus with panic, and I found it useful at the time. The reaction stuck, and as an adult it’s not malignant. I shouldn’t try to push the instinct away or suppress it. I should thank it for doing its job, but gently tell it that it’s not needed now. It can stand down. 

Three main things happened during the peak of the dosing: 

Sensation

I was endlessly sad, endlessly tired and endlessly angry at various points. None of these felt entirely like bad states. If Wendy had pulled me out of the trip, I would have told her I was having a great time.  

Feeling out new ways of looking at things

When I didn’t have a body, one of the things that happened was I found myself broken down into strings. Some strings were memories, some were feelings. I got in amongst the strings and had a poke about. I looked at a memory and teased apart the strings that were attached to it.  

Since the dosing, I’ve had a few occasions where I’ve felt panicky or scared or ashamed, and I’ve done this same thing of trying to tease apart what strings of memory or emotion are attached to what I was feeling. Had a therapist tried to get me to do this prior to the dosing, I would have found the exercise too abstract and not useful in the least. I still feel this way about things like personality roles (the inner critic, the inner child and so on). I find that way of thinking reductive and abstract. The reason I connect with this string theory (ha) is, having had it actually happen to me, I’m able to connect with the idea properly and use it therapeutically.  

Internalising difficult concepts

There’s a line Abby Thorn used when discussing Jordan Peterson – it goes something like ‘don’t confuse the idea Existence Is Suffering with Existence Inevitably Features Some Suffering’. I dove deep into this idea, among others. These ideas were all things I’d intellectually understood before the dosing, but that intellectual understanding hadn’t helped. I suspect what happened was that thing I mentioned earlier – old pathways were breaking down and I was forming new ones.

Coming home 

After more time than has existed, or will exist in the universe, I started to have a body again. My muscles ached and I’d cried a lot. I got up and did some stretches. The team gave me some fruit, which tasted absolutely amazing.  

Wendy got me to go back under for a little bit, to see if there was anything else left to explore, but I was pretty much done by that point. I got back up after a few songs and they gave me a sandwich.  

The doctor had a chat with me and I explained some of what had happened. I felt very strange. I felt like I’d been traumatised. I felt like I might have died and come back. I felt very satisfied with the experience. I remember saying to the doctor that it’s something that everyone should do, and absolutely no-one should do. 

My consort came to pick me up. They met the team and I told them about Aunty Donna wanting me to get out of Broden’s kiln, which they found very funny. They were carsick on the way back. I was just tired.

After the dosing

The next day, went back to King’s Hospital. I was honestly starting to feel sick of the place at that point. Emotionally, I was very confused. I was feeling a jumble of almost every emotion at once. I couldn’t tease things apart. Wendy and I went over what had happened during the dosing.  

Over the next few days, things started to settle down a bit for me and when they did… I wasn’t depressed. It felt very strange. I’ve been depressed pretty consistently for years at this point. Since 2014 at least. I’ve had a few weeks off here and there, such as when I went to Japan on my honeymoon, but other than that, it was all depression, all the time. Not having that constant weight in my chest, that constant feeling of misery was, and still is, very strange. 

My depression eventually started to return after about eighteen months. What interested me was it seemed to come in waves, like it had in my early 20s. The trial had effectively reset my depressive symptoms, but hadn’t cured me completely.

Thankfully, my consort had also applied to the psilocybin trial. They weren’t as lucky as I was. They were given one of the smaller doses. They remember lying on the bed, feeling the psilocybin kick in, but not experiencing the same extreme effects I had. There is a certain threshold that I crossed on my dose of psilocybin. It’s called ego-death. When you experience this, you lose your sense of self and begin to completely disassociate. I consider myself unbelievably fortunate to have experienced this. My consort wanted to experience it too. They lay, waiting for ego-death, but their mind wouldn’t shut up. They couldn’t let go. The next morning, a thought popped into my consort’s head: “do I have ADHD?”

Six months later, both my consort and I were diagnosed with ADHD, and have now both started treatment. After nearly a decade of my life being effectively ruined by ADHD and depression, I’m finally pulling myself back together.

The future

Assuming treatment for ADHD is the final piece of the puzzle which is my health, I might be able to return to living a normal life. 2022 is going very well for me, so far. I’ve returned to work, part time, which would have been completely impossible even two months ago. There have been times in the past when I’ve thought I’d finally found the answer, the solution, the thing I could do to return to life. I might have finally found it.

None of this would have happened without the psilocybin trial. My consort might never had considered ADHD as a possibility. I would still be living with life threateningly serious conditions. I am so, so, so forking happy with the results of the trial.

There is one more thing to say:  

Psilocybin was made illegal in 1968 in the United States as part of the war on drugs, a policy which was immoral, devastating to communities and extremely racist. The UK followed suit, classifying it as Schedule 1, meaning that it ‘it's thought to have no medicinal value’ and therefore cannot be legally possessed or prescribed. 

I am not a doctor, I am not a scientist. I cannot give anyone advice on what they should do with their lives so please do not take psilocybin because I made it sound good, because I’ll get in trouble if anything goes wrong. All I can say is, in my case, psilocybin had a profound medical impact. It makes me very angry that the drug is so heavily restricted for such flimsy reasons, when it provided me such relief.  

I am no longer depressed after decades of suffering under that weight. Other people should have the opportunity to have that weight lifted too.