Psilocybin, the active ingredient in ‘magic mushrooms’ and PMMD, or premenstrual dysphoric disorder have more in common than you might think.
Both date back to ancient times and have endured a great deal of stigma throughout the years. They are equally misunderstood and under researched despite their rich history, natural occurrence, and global reach. However, there is a growing evidence supporting the idea that they just might belong together.
PMDD affects around 5% of women worldwide, and although it’s not well understood, researchers believe it is caused by an altered gene complex that leads to a sensitivity in the normal hormone fluctuations in a woman’s menstrual cycle. This sensitivity is believed to disrupt serotonin processes, causing severe depression and anxiety that affects quality of life. Estimates suggest that around 30% of women with PMDD will attempt suicide. Feelings of hopelessness and suicidal thoughts are common during the luteal (premenstrual) phase of the cycle for sufferers of PMDD.
Marked changes in the luteal phase were observed as far back as 400 BCE when Hippocrates theorized that anxious blood caused headaches and heaviness. While PMS, or premenstrual syndrome is a common term, PMDD is not well known. PMDD is not PMS, it’s more like the debilitating, disastrous relative of PMS. Midol and chocolate simply don’t fit the bill for treatment of PMDD and many sufferers require help from a professional and medication to cope with symptoms. Up to 80% of women suffer from some form of PMS, while a much smaller fraction suffers from PMDD. The prevalence and cyclical nature of PMS has undoubtedly led to confusion between the two vastly different conditions.
It wasn’t until 1987 when ‘Late Luteal Phase Dysphoric Disorder’ made an appearance in the Appendix of the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. The appendix described a list of ‘proposed diagnostic categories in need of further research’. It took 26 years for PMDD to be added to a list of depressive disorders, complete with diagnostic criteria. To say that the medical community missed the mark on this is an understatement. By the time it was officially recognized in the DSM, I was 26 and had suffered from PMDD for 13 years. A lack of awareness in the medical community would perpetuate my suffering, sentencing me to a full 20 years of enduring PMDD symptoms without knowledgeable medical help.
In 2017, the National Institutes of Health found a link between PMDD and a sex hormone sensitive gene complex. For years, women have been ridiculed and demoralized, left to believe that their symptoms are dramatic and exaggerated, when in reality, this condition can be linked to a biological abnormality and deserves more attention from doctors and researchers. If nothing else, women deserve the right to know it exists. Awareness alone can be lifesaving.
De-stigmatizing menstrual related symptoms can help women express their feelings more openly with doctors and loved ones. The harsh reality, however, is that not many people have heard of the disorder, including many healthcare professionals. PMDD is oftentimes misdiagnosed as bipolar, major depressive disorder or generalized anxiety. While the symptoms may be similar, PMDD is relieved by the onset of menstruation leading to a feeling of normalcy. The cyclical nature of the disorder may be one of the reasons so many fail to seek proper treatment, because once they realize how bad their symptoms are it may only be a few days before they are alleviated, not knowing that they would return in a few short weeks.
Given that women have on average 459 menstrual cycles in their lifetime and PMDD sufferers experience symptoms an average of 6.4 days per month, untreated PMDD can equate to roughly 2,937 days enduring symptoms over a sufferer’s lifetime - that’s more than eight years of needless suffering. Quality of life is significantly impacted, not only for sufferers but also for their loved ones; PMDD can have devastating impacts on personal and professional relationships. Alcohol use during the luteal phase tends to be higher among sufferers and personal accounts of drug abuse and addiction are common.
The sensitivity in normal hormone fluctuations in PMDD sufferers is believed to disrupt serotonin processes; a major function of serotonin is regulating mood and the feeling of well-being. It’s no surprise that sufferers of PMDD may be at an increased risk for drug and alcohol abuse to compensate for biologically induced mood swings and strong feelings of hopelessness. Suicidal thoughts might be common in PMDD, but human nature typically forces us to consider other options before making that final call. The relationship between addiction and mental health isn’t new, but it takes on a whole new meaning when you consider that the mental health issue may precede drug abuse and not the other way around.
The controversial history of the War on Drugs
Throughout history, drugs have been thought to create or exacerbate mental illnesses; from marijuana madness to the war on drugs, they have been direct targets of political agendas under the assumption of decreased violence and making communities safer. Since 1971 when the war on drugs was signed into law by President Nixon, the United States has spent roughly one trillion dollars on the effort. An effort that was never focused on rehabilitation, but rather incarceration and steep penalties, further disrupting the lives of people who may have benefited from mental health awareness and proper treatment.
Poor communities, and in particular, communities of color, have been targeted heavily leading to higher conviction rates and increased jail time. The Anti-drug Abuse Act, passed in 1986 further perpetuated the divide when sentences for crack cocaine far exceeded sentences for powder cocaine. Although they are both derived from the same plant and have similar effects and impact, crack was more widely used in African American communities and powder cocaine was more prevalent in white communities. It would take five hundred grams of powder cocaine to land the same sentence as just five grams of crack cocaine. In response to a great deal of scrutiny it was rewritten in 2010, although the sentencing is still an 18:1 ratio.
Drugs are classified, or ‘scheduled’ depending on abuse potential and medicinal use in the United States. Schedule one drugs represent substances that have a high risk for abuse, no current accepted medicinal use in the United States, and a lack of accepted safety for use of the drug. Drugs in this category include heroin, LSD, psilocybin mushrooms and of course, marijuana. You read that right - marijuana is still considered a drug with no accepted medicinal use in the United States, at least at the federal level, despite decriminalization in Colorado and California and approved medicinal use in several states.
While there is little to no evidence for marijuana to be classified with heroin, there is growing evidence to the contrary. Studies show that access to medicinal marijuana decreased opioid prescriptions by 5.88%. A 2014 study published in JAMA Internal Medicine, found that “states with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws.” It is impossible to overdose on marijuana and it is prescribed for the same chronic pain that opioids are typically used for. So, essentially in the same category, or schedule, you have heroin - a drug proven to be highly addictive with a potential for deadly overdoses, and marijuana, a drug that is currently being prescribed for medicinal use in several states.
Knowing what we know about the classification of marijuana, let’s take a leap of faith and look at another drug in the schedule one category - psilocybin mushrooms. On the federal level, psilocybin mushrooms carry the same stigma as marijuana and of course, heroin. There is no scientific basis for addiction to psilocybin and the substance has shown promising results for use in treatment for various mental health conditions including obsessive compulsive disorder, late stage cancer related anxiety disorders, and last but not least, nicotine addiction.
A study on the use of psychological support assisted psilocybin treatment for treatment resistant depression published in the Lancet Psychiatry Journal states: “This study provides preliminary support for the safety and efficacy of psilocybin for treatment-resistant depression and motivates further trials, with more rigorous designs, to better examine the therapeutic potential of this approach.” The psychiatric application of psilocybin is profound; not only is the research promising, the natural pharmacological makeup of psilocybin is not available in any other current antidepressant. Unlike prescription antidepressants (selective serotonin uptake inhibitors, or SSRIs), psilocybin is a direct agonist of serotonin without the numerous side effects of SSRIs.
If you woke up tomorrow and read the headline “New mushroom species discovered, profound implications for mental health treatment”, you’d likely be open to learning more about this mysterious discovery. Psilocybin mushrooms do in fact grow naturally in the wild and have been used for centuries by natural healers and shamans for a variety of issues, including mental health. So what’s holding us back from embracing the idea of psilocybin? Likely the same factors that contributed to the 26-year delay in PMDD being added appropriately to the DSM - misinformation, lack of research, and of course, stigma.
Psilocybin mushrooms are not the same as other street drugs, just like PMDD is not PMS or depression, or bipolar, or generalized anxiety. Classifying things too broadly and falling into the trap of misinformation is harmful to our society in countless ways. Thankfully, just like marijuana, there is a growing community of researchers and institutions like the Johns Hopkins Center for Psychedelics and Consciousness Research that are making waves and reeducating us with actual science. Denver Colorado, one of the same cities that paved the way for marijuana legalization has effectively decriminalized psilocybin mushrooms, although it’s still categorized as a schedule one drug at the federal level. Oregon is pushing similar legislation, and if history tells us anything, we will one day be able to access the psilocybin mushroom for medicinal purposes.
Microdosing, taking small amounts of the drug, is growing in popularity because of the associated benefits without hallucinations or the typical psychedelic ‘trip’. After 20 years of unknowingly battling PMDD, I turned to microdosing psilocybin for symptom relief. The difficulty in effectively treating PMDD is the cyclical nature of the disorder. Typical treatments include antidepressants, but they take time to build up in your system for full effect. They are also meant to be taken on a regular basis, not just for one week of the month. Some doctors may prescribe the drug in this manner, recommending it be taken only during the luteal phase of the menstrual cycle, but this method relies on precise predictability for the cycle, which is not always the case. This presents a problem for PMDD sufferers because they have to choose between taking an ongoing antidepressant medication that may not be effective and may have side effects for the entire month, further decreasing quality of life. Psilocybin works within the first hour of ingestion and can be used as symptoms arise - this is an important distinction from typical treatment options. I’m hopeful that psilocybin will soon be available for sufferers of a wide range of mental health problems, including PMDD.
My personal journey through life with PMDD opened my eyes to the stigma attached to premenstrual disorders in America. The lack of research and awareness is appalling for a disorder that affects millions worldwide. Even for the lucky ones that find the proper diagnosis, treatment options are limited and some will inevitably give their life to the disorder. My experience with psilocybin has changed my life for the better and I no longer live in constant fear of my own thoughts for one week out of the month. To read more about my experience with PMDD and Psilocybin, check out my book - The Woman in the Basement, available exclusively on Amazon.