Making sense of desperation for treatment in decisions to use psychedelics for depression and anxiety: A qualitative Subreddit study anticipating clinical challenges.

Résumé

INTRODUCTION: Some individuals interpret persistent depression and anxiety, alongside the exhaustion of standard treatment options, as leading to a desperate need for relief. While desperation may shape how people assess treatment options, its role in psychedelic self-treatment and its relevance for emerging clinical models of psychedelic treatment remain underexplored.METHODS: We collected discussion threads from two online substance use communities on Reddit.com and investigated how members interpreted desperation in relation to their decisions to self-treat depression and anxiety with psychedelics (including microdosing and macrodosing). Using constructivist grounded theory, we compared posts across 108 threads (173,229 words) from members who expressed desperation (n = 50) and those who did not (n = 68).RESULTS: Members described mounting frustration with standard treatments and worsening mental health that culminated in a tipping point interpreted as desperation for relief. They redefined their need to relieve depression and anxiety as urgent, which contributed to how they made sense of rapid, unplanned self-treatment with available psychedelics, without researching these options or implementing harm reduction and despite acknowledged risks. While some interpreted outcomes as relieving distress, others constructed worsening mental health as linked to multiple desperation-driven decisions to relieve distress.CONCLUSION: Our findings show how desperation shaped meaning-making around psychedelic self-treatment for depression and anxiety in online communities. These interpretations may be relevant to clinical models, where access is often granted after other treatments fail, and where similar urgency and expectations may shape engagement, decision-making, and outcome interpretations.