You wake up abruptly. You reach to wipe your sweat-strewn brow with your sheet, but realise you’re too late. “Uh oh,” you think. “I’ve actually gone and pissed myself”. After some tentative sniffing you surmise that the substance drenching your sheets isn’t your own effluence, but your sweat. It’s the Tuesday after a festival and your post-comedown systems are kicking in. You’re a limp schnitzel wrapped in a giant sweat-sodden wrap – and you’ve awoken from a horrific nightmare. Something about a 20-stone woman giving you a hand job and forcing you to listen to Nickelback’s obscure debut album. No amount of sunshine can save you today.
Comedowns are all good and fun when you’re 18 and no amount of cider or MCAT can stop you getting to college on Tuesday morning. But once you rattle on through the years, post-festival symptoms get worse, more violent and scarily debilitating. After a decade of wondering why I can be found cowering in a ball of tears watching Diagnosis: Murder seven days after the Glastonbury site shuts, I thought I’d find out. So I interviewed Tim Williams.
Tim is a Consultant Addiction Psychiatrist. In his day job, he treats people with substance abuse problems: largely with alcohol, or heroin and crack addictions. He’s an expert in what he calls novel psychoactive substances: legal highs to you and me. He's worked as an onsite psychiatrist at Glastonbury for years and is also, it turns out, an absolute legend. Probably not surprising when you consider his day job. Here's what he had to say.
Noisey: Hi Tim! First things first… I heard 'Suicide Tuesday' - the most depressive midweek period of a comedown - is a myth. Is that true?
Tim: I don’t think it’s completely a myth, but I think it’s a myth that it’s entirety down to the drug. We did a Channel 4 program, The Ecstasy Trial, and as part of that questionnaires were filled out by those taking part about the after-effects. Afterwards, there wasn’t the significant deficit we expected. These were people, not regular users, taking a one off dose without other substances involved. Some people had ratings of feeling low. Overall, though, it’s not a significant effect if you take MDMA in a strictly medical context. Obviously using MDMA with lots of other substances, you don't get a very clean effect so you can’t attribute [Suicide Tuesday] to just the MDMA use.
Okay, so what if you take it three days in a row, like you would at a festival? I always thought of taking MDMA/pills as opening a serotonin gate, and after a while there’s nothing left behind the gate.
I think that’s fair comment. There’s lots of studies for people that are MDMA users who have described their feelings, but to image the brain after three days of MDMA use is a hard study to do; we’d have to get people into brain scanners and someone would have to pay for the research. There’s not many people out there who fund this kind of research! We do know there is an effect on the serotonin system when you look at the drug in scientific experiments. So you can surmise that there will be a serotonergic system depletion effect as you are describing. But we have to be careful to stick to what we know and what we don’t.
Are there ways of boosting your serotonin during and after? Loads of people reckon bananas help.
There is a chemical called tryptophan, which you need to make your body replenish the serotonin field behind the gate. But most people have good levels of tryptophan: if you eat a normal diet you’ve got good level of tryptophan in your body. If you're a normal person with a normal balanced diet there’s no reason to eat a lot of bananas, or drink amino acid heavy drinks, because your body will be replacing it all the time with the stores that it’s got. Tryptophan is present in dairy products. Saying that, bananas are part of a healthy balanced diet so I’d never dissuade people from eating them!
Does 'Suicide Tuesday' vary drug to drug? What about with ketamine?
Ketamine is a different class of drug - it’s a dissociative anesthetic originally. It doesn’t have the same effect. It works through the NMDA receptor system so it’s a very different chemical area it is targeting. You wouldn't automatically expect any comedown from ketamine. In fact, it’s a widely used drug in trauma situations, still used in accident emergency departments and used a lot in the developing world because it’s quite safe to give as an anesthetic without (generally) significant after effects.
Presumably you would sleep more with ketamine.
It’s a downer rather than upper. Sleep is a very important part of the festival experience. A lot of the drugs that people take have an effect on sleep. Like cannabis, it helps people get off to sleep but it disrupts healthy sleep, so you sleep with much less quality. Alcohol is also terrible for sleep. Every day you have poor sleep, you have a physiological effect: in particular that can be responsible for mood. It’s extremely powerful.
So, even if you only only drank alcohol, could you expect to encounter these symptoms?
Absolutely. The breakdown product of alcohol is called acetaldehyde. Most people will have the experience of waking up in the middle of the night, feeling hot and sweaty and needing a wee. That hot and sweatiness is the acetaldehyde. So just drinking alcohol will disrupt sleep hugely. If you are at a festival with sleep disrupted because you’re in a tent which isn’t comfy like your own bed, then you add alcohol into the mix for several days… you’re likely to have severe performance deficit in those days afterwards.
What about if you drink or eat something to counteract the booze? There’s been a lot of talk about coconut water lately.
No. Alcohol has been around a long time, and there are so many things that have been reported to cure hangovers. But if someone had invented something that reliably cured a hangover they would be millionaires – it’s a symptom suffered by many, many people. The fact that nothing is universally accepted shows that nothing really works. If you believe something works it will be more likely to make you feel better about yourself, but the bottom line is nothing works to cure a hangover.
Why do you such get horrendous dreams and night terrors after a festival?
The first thing to say is that most chemicals people take disrupt sleep. Secondly, we should all dream, because it’s really important having REM sleep. REM is the phase in which you dream, but you don't remember the vast majority of dreams if you have a normal sleep pattern.
You go through four phases of sleep, and then REM. If you are woken during REM you can often remember dreams. If you are flipping in and out of REM sleep in an irregular pattern and having periods of wakefulness or unsettled sleep - as you would expect at a festival - then you will have much more memories of your sleep.
But why do the horrible dreams come in the nights after the festival?
Your body will be trying to recover from a period of sleep deprivation. You have a certain amount of REM you have to have in every sleep [about 20% for adults, which apparently we are] and if you are deprived of REM sleep for various reasons then your brain remembers how much REM sleep you’ve got to catch up on. It’s an incredible ability, really. So on the nights when you can have more normal sleep, back in your normal environment you will have much more intense REM sleep.
What are the drugs that really inhibit REM sleep then?
Cannabis is a very potent disrupter of REM sleep. Particularly if you aren’t a regular cannabis user and smoke it over the festival weekend, it stops you having the REM sleep. Then in the few days or weeks after your brain will be trying to catch up and a bigger proportion of your sleep over the next few days will be more intense and vivid.
It’s also characteristic of people that are regular cannabis users that suddenly stop. Basically, once their brain is allowed to be in a situation where it can dream again, it does it so intensely to catch up on the lost REM sleep. Alcohol, because it disrupts the way you sleep, will affect your REM sleep too.
Often people go to a festival, and then have a day or two off work after and smoke lots of weed to battle through the comedown. What do you make of that?
In those two days, the best thing would be to get back into normal sleep routine. Cannabis is a bad idea. Promote healthy sleep, get in a routine, do some physical exercise early in the day, don’t drink drinks that stimulate you like caffeine and certainly no other drugs. Take TV and computers out of your bedroom.
Exercise would be the one drug I would prescribe in those two days. Don’t do a hard physical exercise closer than two hours before sleep because it increases your basic metabolic rate and your level of alertness. I’d also get up during daylight hours, preferably in the sunshine because that would trigger your melatonin in terms of promoting your sleep wake cycle.
What about foods to help?
Any healthy, balanced foods. Nothing too rich in fats or carbs, because bloatedness will affect sleep.
No X Large Papa Johns?
No, maybe not. A nice salad with some oily fish that would be good for your omega 3 fatty acids, something like that.
What’s the deal with the head twitch - it’s kind of like a tic inside your brain. I’ve spoken to loads of people about it and it freaks everyone out.
It’s not something I’ve come across before. But overall levels of anxieties and sleeplessness would be responsible for those sort of tics. If I’m run down I get these little fasciculations in muscle, where small muscle groups twitch and that’s supposedly due to electrolyte imbalance. Being unhealthy for a whole weekend, would make you prone to these unhealthy side effects.
Have you had any experience of these drugs or symptoms yourself?
I have been involved in psychedelic studies, where I’ve taken a substance. We’ve done several studies using psilocybin, the active ingredient in magic mushrooms, as a therapeutic agent. When we started off we had to prove it was safe in a medical context, so me and a few other psychiatrist volunteered to take some in a medical context and have our brain scanned. I can be certainly better understand some of the experiences people talk about after that!
Awesome! You’re definitely an expert. Thanks Tim!
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