What if You Don't 'Come Down'?

Aldoux Huxley said it best, "Embraced, the lovers desperately try to fuse their insulated ecstasies into a single self-transcendence; in vain," aka, that there seems to be a universal interest in self-transcendence.

And as is the case with psychedelics, self-transcendence holds a certain allure for those curious about expanding consciousness. But for many, a trip isn't just an experience, it's a gamble with stability in sanity and there remains the lingering fear of "what happens when the trip doesn’t end"?

This article will delve into just that.

The Brain on Psychedelics

Psychedelics such as LSD, psilocybin (magic mushrooms), and DMT work primarily by activating serotonin receptors, especially the 5-HT2A receptor. These receptors are abundant in areas of the brain responsible for perception, mood, and cognition, such as the prefrontal cortex and the visual cortex (the area that processes visual stimuli).

Under the influence of a psychedelic, normal brain activity is disrupted, and the boundaries between different neural networks start to blur. For example:

• Default Mode Network (DMN): This is the part of the brain responsible for your sense of self, autobiographical memory, and ego. Psychedelics temporarily "quiet" the DMN, leading to experiences of ego dissolution, a sense of being one with the universe, or even feeling disconnected from the self.

• Increased Neural Connectivity: Psychedelics also create hyperconnectivity between brain regions that don’t normally communicate. This can lead to new, intense sensory experiences and thought patterns, which is why people often describe their trips as "seeing sounds" or "feeling colors."

  
  

Most people return to their normal neural networks once the drug wears off. However, for a small group, the brain’s return to baseline doesn’t happen smoothly, resulting in lasting changes or disruptions in perception, mood, and cognition.

When a person feels like they haven’t fully “come down” from a trip, it’s often because their brain’s balance between different networks has not fully returned to its pre-trip state. This can result in a variety of mental health symptoms, each tied to specific neurological changes.

Some of these include:

1. Hallucinogen Persisting Perception Disorder (HPPD)

What’s Happening in the Brain: Psychedelics profoundly alter how the brain processes visual information, and for some individuals, the brain struggles to recalibrate back to normal visual processing after the trip. The visual cortex may remain in a hyperactive state, leading to persistent visual disturbances like trails, halos, or seeing patterns where none exist.

Serotonin and Visual Processing: The overactivation of the 5-HT2A receptors in the visual cortex during the trip can cause the brain to “over-learn” certain visual distortions, making them more difficult to unlearn after the trip. This can result in long-term disturbances where visual information continues to be misinterpreted.

2. Psychosis or Schizophrenia-like Symptoms

What’s Happening in the Brain: Psychedelics stimulate serotonin receptors in areas of the brain involved in perception and cognition, but they also disrupt dopamine signaling, which is crucial for reality-testing. For some individuals with a genetic predisposition to psychosis, this disruption can trigger or unmask underlying conditions such as schizophrenia or bipolar disorder.

Hyperactivity in the Prefrontal Cortex: When the prefrontal cortex, responsible for organizing thoughts and making sense of reality, remains overstimulated or disorganized after the trip, it can lead to paranoia, delusions, and hallucinations. Psychedelics essentially “open the floodgates” of perception, and if those gates don’t close properly, the individual can remain stuck in a state of distorted reality.

3. Depersonalization/Derealization Disorder

What’s Happening in the Brain: The Default Mode Network (DMN), the network that houses our sense of self and identity, is significantly downregulated during a trip. This is often the source of feelings of oneness with the universe or ego dissolution. In some cases, though, the DMN may not return to its normal functioning after the trip, leaving the person feeling detached from themselves or their surroundings.

Disrupted Sense of Self: This disruption can manifest as depersonalization, where individuals feel like they’re watching their life unfold from outside their body, or derealization, where the world around them feels unreal or dreamlike. The ongoing suppression of the DMN can lead to difficulty reintegrating a stable sense of self post-trip.

4. Persistent Anxiety or Panic Disorder

What’s Happening in the Brain: Psychedelics amplify emotions and sensory experiences by increasing activity in the limbic system, the part of the brain that regulates emotions. During a trip, this can lead to intense, often overwhelming emotional states. If the limbic system remains hypersensitive after the trip, it can result in chronic anxiety or panic attacks.

Hypervigilance: After a challenging or fear-inducing trip, the brain’s stress response systems (including the amygdala) can remain overactivated, leaving the person in a heightened state of arousal, as if they’re still in the terrifying moments of the trip. This makes them prone to panic attacks or feelings of impending doom that mimic the intensity of their psychedelic experience.

5. Mood Disorders: Depression or Bipolar Disorder

What’s Happening in the Brain: Psychedelics can lead to temporary changes in neurotransmitter levels, especially serotonin and dopamine, which regulate mood. While this often results in positive effects during or shortly after the trip, such as feelings of euphoria or peace, some individuals may experience serotonin depletion after the drug wears off, which can lead to a "crash" in mood or even trigger a depressive episode.

Bipolar Disorder Risk: For those with bipolar tendencies, psychedelics can destabilize mood regulation, triggering mania or hypomania, followed by depressive episodes. The brain’s mood regulation circuits may struggle to regain equilibrium, leading to prolonged periods of mood instability.

6. Post-Traumatic Stress Disorder (PTSD)-like Symptoms

• What’s Happening in the Brain: Intense or traumatic trips can leave lasting imprints on the brain’s hippocampus and amygdala, regions that are crucial for processing fear and memory. During a traumatic trip, these areas may record and store the experience in a way that makes it difficult to process, leading to flashbacks or intrusive thoughts similar to PTSD.

  
  

• Unprocessed Fear Responses: The amygdala, which is responsible for the fight-or-flight response, may remain in an overactive state, triggering hypervigilance or emotional flashbacks to the trip. This can make individuals feel as though they are still trapped in the intense emotional loops experienced during the trip, long after it’s over.

With all these potential repercussions it’s crucial to understand that the impact of persistent effects from psychedelics varies significantly among individuals due to a combination of genetic and mental factors.

These factors can heavily influence how the brain reacts to psychedelic substances, potentially leading to prolonged consequences. For instance:

• Individuals who have a family history of psychosis or mood disorders are more susceptible to enduring disruptions in mood or perception following psychedelic use. The genetic predisposition towards these conditions can heighten the risk of experiencing prolonged adverse effects.

• People with existing anxiety disorders or a history of trauma may find themselves more vulnerable to developing panic attacks, anxiety disorders, or symptoms resembling post-traumatic stress disorder (PTSD) after a challenging psychedelic experience. The pre-existing mental health conditions can amplify the intensity and duration of negative outcomes.

  
  

The good news in most cases is that a never ending high may only feel that way because of lingering effects or reawakened patterns/trains of thought, not because you're still high or in another reality. The bad news is that these sensations can be extremely overwhelming and trauamatizing if you're unprepared for the occurance and/or have a predisposition to chronic anxiety.

If you or someone you know is considering a psychedelic journey, it’s vital to approach the experience with care, preparation, and an awareness of potential risks. Psychedelics can offer extraordinary insights, but they demand respect and a thoughtful approach to ensure that when the trip is over, you are able to safely come down.

Thank you and safe travels

Resources:

• Carhart-Harris, Robin L., and Guy M. Goodwin. "The Therapeutic Potential of Psychedelic Drugs: Past, Present, and Future." Neuropsychopharmacology, vol. 42, no. 11, 2017, pp. 2105–2113. DOI:10.1038/npp.2017.84.

• "Johns Hopkins Center for Psychedelic and Consciousness Research." Johns Hopkins Medicine, www.hopkinsmedicine.org/psychiatry/research/psychedelics-research.html. Accessed 7 Sept. 2024.

• "Multidisciplinary Association for Psychedelic Studies (MAPS)." MAPS, www.maps.org. Accessed 7 Sept. 2024.

• Nichols, David E. "Psychedelics." Pharmacological Reviews, vol. 68, no. 2, 2016, pp. 264-355. DOI:10.1124/pr.115.011478.

• Pollan, Michael. How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. Penguin Press, 2018.