Ed. Note: The below piece includes the experiences of people who use drugs and medical interventions without the guidance of medical professionals. You should consult with a doctor before starting or stopping any drug. Ignoring a doctor's advice can be dangerous, and the below article is not intended to condone or endorse doing so.
In 2017, coping with the stress of a near-death experience and the sudden realization that I was trans, I had a mental breakdown.
Life became confusing, dark, nearly unlivable. Immediately, I went to a psychiatrist, hoping to find a drug or combination of drugs that would solve, or at least ameliorate, my pain, not realizing this would be the start of a yearslong journey toward solving my mental health on my own.
First, I was put on the antidepressant Wellbutrin, a norepinephrine and dopamine reuptake inhibitor (NDRI); when that didn’t work, I was prescribed another antidepressant called Lexapro, a selective serotonin reuptake inhibitor (SSRI); when that didn’t work, another antidepressant called Effexor, a serotonin and norepinephrine reuptake inhibitor (SNRI). Effexor worked… kind of.
I felt less anxious, and less of a sense of impending doom while on Effexor. But I also felt unlike myself, like there was a plate of fogged glass between my eyes and the world. Life felt unreal.
On a swamp boat ride through the coasts of Louisiana, one of the most awe-inspiring places I had ever been, I realized I felt little excitement and couldn’t experience much of the surrounding beauty. The je ne sais quoi of life was missing. I mostly felt numb, which terrified me.
I decided to taper off the drug. But with each step down I took, halving the pills, then dissolving them in water and measuring each morning’s dose out, some anxiety would return, until it was even worse than before I went on it. Antidepressants can cause severe discontinuation symptoms, which remain largely unstudied. But I was adamant that I wanted to get off Effexor. I wanted to feel like a human again.
For two years, I lived in that compromised state: more like myself, but also more anxious, depressed, and unmoored from the world, constantly feeling unsafe and detached. I went to another psychiatrist. She recommended more antidepressants. I refused.
I thought this constantly-agitated state of being would last for the rest of my life. Until I found ketamine, mushrooms, and finally — and most critically — acid.
I had tried each drug before recreationally, but it took me a long time to feel comfortable viewing these drugs not just as drugs, but as medicine. The ketamine allowed me to dissociate safely, to view my problems from a bird’s-eye view and resolve them without too much pain. The shrooms allowed me to find forgiveness within myself. And the LSD… well… I don’t know what the LSD did, but it worked.
I would microdose (taking 1/20th to 1/10th of a tab) three days in a row, then stop for four days, and repeat the process for about two months. Without exaggeration, that routine cured my depression. While on LSD, I felt barely anything, but in the days following my dosings, I would feel a sense of freedom, and a sense of security in my body that I hadn’t experienced in years.
And then I felt angry. Angry that I hadn’t been told about these interventions earlier. Angry that my doctors gave me the same, ineffective treatments over and over again.
My anger only intensified when I realized I was not alone. On internet forums, and in real life, people complained over and over again about being given the wrong drugs, and needing to figure out their mental healthcare outside of any system meant to help them. People, but especially trans people, have had to take healthcare into their own hands, using their own research, finding information from their own communities, and experimenting with their own bodies to find what makes them happy. Countless trans friends had done the same with hormones and surgeries — experimenting with what worked, and going against doctors’ recommendations to do so.
It was a struggle to find this level of happiness, but now I know the process to solving any future problems I might face, whether they be related to gender or mental health: I’ll need to find the answers on my own.
There are no statistics on how many trans people self-medicate, but if you know trans people, you know it’s a common experience. The long wait times at doctors’ offices and clinics, the gatekeeping of hormones, the humiliation of having to convince medical authorities of your gender crisis — all of these factors push many trans people to find medical interventions independently of any establishment. Instead, we turn to our communities, to the internet, and to friends.
But it wasn’t until recently that I’d connected my willingness to self-medicate with mental health meds and my experience of transitioning. I realized that once I’d taken my own body into my own hands — pushing for care, meds, surgeries that I had been told over and over again I didn’t need or shouldn’t get — it wasn’t much of a leap to start taking responsibility for my own mental health, and find my own interventions.
About a dozen trans people I interviewed have told me that their transness was integral to figuring out their mental health while spurning psychiatric and therapeutic institutions.
In 2016, Adam, a trans man who now lives in Brooklyn, was living with his mom, trying to figure out his gender, and feeling constantly anxious and depressed. (Adam requested use of a pseudonym for privacy.) He tried cognitive behavioral therapy and a psychiatrist suggested antidepressants. Like me, Adam tried several, none of which worked, and some of which made his mental health problems worse. Eventually he was diagnosed with borderline personality disorder, which he felt he did not have, but was a catch-all category for a trans person figuring out their life. (Trans people are diagnosed with personality disorders at an astronomical rate.)
Adam went off the antidepressants on his own, against the advice of his doctors. Two years later, he sought help again in the midst of a bout of mood swings and was put on the antipsychotic Abilify. It made him sleep throughout the day. He quit cold-turkey.
He was wary of returning to any professionals. Instead, he decided to forge his own medicinal path. He did not want to be pigeonholed into a diagnosis, and instead found that self-medicating with weed and mushrooms helped him cope with the process of transition and life in general. It was on a mushroom trip that Adam came out as a trans man.
“I’m eccentric, and sensitive, and I’d rather view myself through that lens than over-pathologize my life,” Adam tells me. “It's like the psychiatrists were trying to throw several darts at a board and hoping it hits a bullseye, and I don’t have a bullseye.”
Adam views his transition and his mental healthcare as inextricably linked.
“It’s like, if I’m going to be miserable in life, I have to do this — I have to transition,” he said. “And that’s how I started to view everything: I should maybe eat better, and exercise more, and do the drugs that make me feel better about life and help me heal.”
Noelia, who did not want her last name used for privacy reasons, is a 20-something trans woman who had a bad experience being prescribed SSRIs. She found that she could figure out her meds more easily on her own, both for transition and mental health. She ordered progesterone from the web after her doctor wouldn’t prescribe it to her. And she found microdosing LSD helpful for her depression.
“Part of the nature of being trans is having to figure things out through non-traditional routes and through community,” she says. “You build up this communal, collective knowledge, which can be really helpful. Without that, I probably would not have been comfortable seeking out medications on my own without the help of a doctor.”
Beyond finding prescribed medications to be limited in their efficacy, many of the trans people I interviewed said they simply preferred self-medding because it did not involve the bureaucracy of traditional routes, and it did not involve being defined by disorders that can feel constraining. One trans man told me that he would rather buy Adderall through friends than go to a clinic because he hated the process of being diagnosed with ADHD.
“If I want to be more in control of myself and be sharper and more attentive at work, Adderall works,” he said. “I don't think that's a sickness as much as it is a fucking job requirement.”
More and more people are seeking mental health interventions outside of traditional psychiatry, sometimes by themselves, and sometimes with mental health professionals who help people with psychedelic experiences.
Dr. Erica Zelfand, a naturopathic doctor who sometimes prescribes traditional mental health medications and also guides patients through experiences with psychedelics, says that the profession has to accept the latest science, which suggests that the drugs can be tremendously helpful for depression and myriad other mental health issues. If the profession and its politics remain staid, we can expect people to seek out alternative treatments on their own.
“My hope is that we can catch up,” Zelfand said. “It doesn't have to be one or the other option — traditional or psychedelic. There should be support for both.”
Zelfand said part of the reason people, especially from marginalized communities, take medicine into their own hands is because diving deep into the brain with the support of medical professionals is often inaccessible and expensive. Psychiatric practitioners often don’t take insurance. The two options are often going to a primary care doctor and getting an antidepressant that may or may not help, or figuring it out on your own.
“It’s a luxury a lot of Americans can't afford,” Zelfand said. Finding a therapist willing to work beyond traditional psychiatry, and paying monthly for that service, is a lot harder of a task for many than “spending some money on a big bag of mushrooms that's gonna last a few months for microdosing.”
When it comes time to calculate “the cost-benefit analysis,” Zelfand added, “you don't have to pull up a calculator.”
Eddie Jacobs, a psychedelic ethicist at the University of Oxford, agreed that it made sense that people, especially those from marginalized communities, would end up seeking out psychedelic treatment on their own.
“I find it very hard to condemn people who are [seeking out these drugs], because no one comes to these drugs to support their mental health on a whim,” Jacobs said. “It's because other things haven’t worked. People take drugs for two reasons, either to feel good, or to stop feeling bad. It seems ludicrous to criminalize either of those motivations.”
Though Jacobs and Zelfand said there are material reasons people do psychedelics to help their mental health without professional guidance, they both agreed that having professional support of some kind would be ideal — drugs are still drugs, and human brains are sensitive. In cultures where psychedelic use was prominent, there were rituals and experts that helped guide communities through their psychedelic experiences. But because of gatekeeping and cost, we’re often left on our own to figure out what works best for us.
“There's always been a specific cultural container where there are elders in the community that know when it's time to do this,” Jacobs said. “And I think finding what that looks like in the West is going to be a challenge, because at the moment doctors in mainstream psychiatry are jostling to be the only holders of this medicine.”
Though most of the people I interviewed were not against the practice of psychiatry in theory, all of them said their experience of taking drugs on their own had a more powerful impact on their lives than traditional interventions had.
“I’ve been depressed, and I’m sure I’ll be depressed again,” Alessandra, a 30-something trans woman in New York told me. (Alessandra also requested use of a pseudonym.) “But when that happens, I’m absolutely going to microdose, I’m absolutely going to seek interventions myself first. I definitely have that as a tool in my chest now. And it’s invaluable.”
That’s the attitude I approach medicine with now too: whenever I think about getting back on a psychiatric medication, whenever I think about changing my hormone regimen, I ask friends, especially trans friends, first. Then I search the internet. Then I’ll go to a doctor. The medical establishment is useful to me only inasmuch as it holds the keys to the medicine cabinet I need to access.
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