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Ketamine’s effect bolsters a new theory of mental illness

nautil.us

71–80 of 156 posts

Re: Ketamine’s effect bolsters a new theory of mental illness

#71

I have been depressed a significant fraction of my adult life. I am also a biologist who abhors the medical description of this problem. I don't even like the word 'mental illness'. This shit is not an illness, its a normal response to a fucked up life! Can I get at least some acknowledgment of this fact? The sine qua non for me was an issue of Nature a few years back that focused on depression, talked about how prev…

I am close to somebody who has been strongly affected by depression. She has, in any material respect, a perfect life. She has food, clothes, a supportive family, a great job, plenty of money, etc. There is nothing "wrong" with her life.

But she suffers off-and-on depression. Not just "I feel bad" depression. Crippling, "can't get out of bed" depression. Periodic suicidal ideation. Occasional suicide attempts.

She knows she has depression. She talks about it. And she wants to be done with it. She knows how she feels when her brain is "in balance" and how it feels when she's depressed. One of these states is much more preferable to the other.

She's tried drugs, ECT, talk therapy, etc. And, yes, she's tried ketamine. Anything that will put her back to a state where she is able to get out of bed and function, and reduce the odds of her killing herself when she's depressed.

I'm sure there are a lot of people who are depressed due to outside factors -- poverty, oppression, war, etc. But I can tell you quite certainly that there are people who have "perfect" lives who find themselves clinically depressed. And at least some of those people want to get back to a non-depressed state. This research helps them.

TL;DR: Not all people are depressed because their life sucks, nor is depression something that all people can "cure" by thinking harder or trying harder. Some people have a brain imbalance and would like to fix it so they can have a life. Literally.

Re: Ketamine’s effect bolsters a new theory of mental illness

#72
post #51

Earlier quoted context omitted.

Yeah I used to believe that but having but having lived through a lengthy episode of being in a somewhat depressed and fatigued state, and having researched and observed it in myself and others, I no longer buy that depression can "happen completely independent of your life circumstances". The main reason for this is that it's fallacious to think that your emotions are "completely independent of your life circumstanc…

What you're describing is "exogenous depression", which occurs due to environmental causes. Its existence doesn't change the fact that a lot of people suffer from endogenous depression, which requires no external circumstances or stimuli. A lot of mental illness can be summarised as people reacting to things with the wrong emotions or the wrong intensity of emotion, and some forms of depression fall under this catego…

I understand your position, as it's one I held very strongly for a long time.

I also agree with your point about "people reacting to things with the wrong emotions or the wrong intensity of emotion"; understanding and addressing this has been fundamental to my own recovery.

What I'm disputing is the notion that there is a clear-cut distinction between "exogenous" and "endogenous" depression, and that one is "totally unrelated" to the other. Nothing in biology - or in and truly complex system - works like that.

That said, I'm not presuming to be able to change your mind, but more pointing out that the premise your position relies on - that one's environment and one's emotional response to their environment are completely independent - is neither an undisputed scientific fact nor true in my own experience or anyone else I've observed.

Re: Ketamine’s effect bolsters a new theory of mental illness

#73

I have been depressed a significant fraction of my adult life. I am also a biologist who abhors the medical description of this problem. I don't even like the word 'mental illness'. This shit is not an illness, its a normal response to a fucked up life! Can I get at least some acknowledgment of this fact? The sine qua non for me was an issue of Nature a few years back that focused on depression, talked about how prev…

Or how about fuck off because you obviously don't know what actual depression is.

sorry, but this your comment is extremely condescending.

The day after I graduated from college with a 4.0 and a 6 figure job in the city of my dreams lined up... I had an existential crisis and started going through a depressive/suicidal stage that lasted 4 months.

It had absolutely not a god damn thing to do with my social or financial situation. It had nothing to do with global politics. It had to do with being depressed. And no, it wasn't stress because I'd lived in the city before and was dying to get there.

THE IRONY is how insulting it is for people like you to use the word "depressed", when you actually mean sad.

Re: Ketamine’s effect bolsters a new theory of mental illness

#74
post #28

What with the pro-drug posts here all the time. I'm guessing that most of the HN audience is American. Is it common among techies in the U.S. to experiment with psychoactive drugs, hence the interest and knowledge? Please, do not mention Steve Jobs acid experiences.

are you anti-drug? if so, why?

I think the OP just found it curious. Turning the question around: do you think it's a good idea to screw around with your brain using something like ketamine (other than in a controlled way, such as a clinical trial or under guidance from a doctor)?

Re: Ketamine’s effect bolsters a new theory of mental illness

#75
post #2

I'm excited for there to be alternatives to SSRIs. I've never been diagnosed with depression, but my partner has and takes an SSRI. It certainly seemed to have a generally positive affect (totally subjectively), and relatively few negative side affects. That being said, having to take it every day sucks, and when she runs out, having forgotten to get it refilled, the mood affects are pretty terrible for us both. Hope…

Hey hey! You mean you're not happy about potentially life-long sexual side effects?!

Talk about getting over depression only to find out that removing the SSRI did nothing to fix your gimped sex drive. Wooohoo.

Re: Ketamine’s effect bolsters a new theory of mental illness

#76
I see several people in this thread welcoming the fact that there is "finally an alternative to SSRIs". I don't want to discuss whether Ketamine is or is not a good alternative to SSRIs -- instead, I'd like to point out that there are already a great number of alternatives to SSRIs.

For one, there are tricyclics (TCAs), which were the first antidepressants on the market, and generally are not prescribed nowadays. Another category of older antidepressants includes MAOIs, which were the first mass-market antidepressants. These are also not generally prescribed nowadays due to interactions with common types of food, although modern MAOIs such as moclobemide [1] require far less diatary restrictions than the older MAOIs did. The final major category I'll mention are SNRIs, which along with SSRIs are the most commonly prescribed first-line antidepressants.

Apart from these major categories, there are a bunch of atypical antidepressants on the market. There's bupropion, which I personally take, and which has far less side effects than SSRIs and SNRIs but may not be as effective for all patients. There's St. John's wort, which is available off prescription in many countries. There's lithium, which has recently gained popularity. In total, I would guess there are about a hundred different types of antidepressants in production around the world (including old Soviet concoctions that are not available in the West due to the huge price of getting just one of them to market).

If you're unhappy with the side effects of SSRIs, I would encourage you to look up other types of antidepressants, as they have very widely varying side effects, and most atypicals have far fewer common side effects than SSRIs and SNRIs do. In particular, I would like to point out that bupropion usually increases sex drive instead of lowering it like SNRIs and SSRIs tend to do.

[1]: https://en.wikipedia.org/wiki/Moclobemide

Re: Ketamine’s effect bolsters a new theory of mental illness

#77
post #72

Earlier quoted context omitted.

What you're describing is "exogenous depression", which occurs due to environmental causes. Its existence doesn't change the fact that a lot of people suffer from endogenous depression, which requires no external circumstances or stimuli. A lot of mental illness can be summarised as people reacting to things with the wrong emotions or the wrong intensity of emotion, and some forms of depression fall under this catego…

I understand your position, as it's one I held very strongly for a long time. I also agree with your point about "people reacting to things with the wrong emotions or the wrong intensity of emotion"; understanding and addressing this has been fundamental to my own recovery. What I'm disputing is the notion that there is a clear-cut distinction between "exogenous" and "endogenous" depression, and that one is "totally…

>What I'm disputing is the notion that there is a clear-cut distinction between "exogenous" and "endogenous" depression, and that one is "totally unrelated" to the other.

While I agree that neither exist in complete isolation, it still doesn't preclude one from being the dominant cause.

Moreover, not many people would advance the same argument in regards to conditions such as schizophrenia or bipolar disorder—how clinical depression is somehow special and not deserving of the same [endogenous] understanding is beyond me.

Re: Ketamine’s effect bolsters a new theory of mental illness

#78
post #3

Ketamine is an exciting experimental approach for depression (especially with suicidal thinking) and anhedonia. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-03... Researchers seem to be using an infusion of 5 mg per kg of body weight. That means you don't give a bunch of pills to a patient, which in itself helps a bit to reduce risk. There's a bit of a web-based discussion here: https://www.youtube.com/w…

Is ketamine some sort of wonder-drug for depression?

Probably not, at least not according to most of the research conducted on it so far. Like many treatments for depression — including psychotherapy — it appears to change the way the brain processes certain information and effects the connections between neurons. But it’s not clear how long these changes last, or whether chronic ketamine treatment would be needed, similar to a diabetic taking insulin.

http://psychcentral.com/blog/archives/2012/12/01/should-you-...

Ketamine has been tested in treatment-resistant bipolar disorder, major depressive disorder, and people in a suicidal crisis in emergency rooms.[26] Benefit is often of a short duration.[27] The quality of the evidence supporting benefit is generally low.[27]

The drug is given by a single intravenous infusion at doses less than those used in anesthesia, and preliminary data indicate it produces a rapid (within 2 hours) and relatively sustained (about 1–2 weeks long) reduction in symptoms in some people.

https://en.wikipedia.org/wiki/Ketamine#Depression

Ketamine may have its use for treatment resistant depression and dealing with emergencies caused by suicidal bouts because it can make depression symptoms disappear for few days, but this is only temporary as better ketamine based drugs are developed.

Re: Ketamine’s effect bolsters a new theory of mental illness

#79

The full article title is "A Vaccine for Depression?: Ketamine's effect holsters a new theory of mental illness." I have mixed feelings about posts being required to suffer from the title, as this is often an editorial rather than an authorial decision, but the submerged gist of the article, the novel content, is indeed the suggestion that Ketamine could be used as a "vaccine" for post-traumatic stress disorder. A fe…

"The central suggestion regarding the 'vaccine' effect seemed to be buried a bit in the article (unless I missed something in skimming), but it is the actual new information, which is interesting and heartening."

You are correct, this is a new finding. It does not, however, come from the study looking at soldiers. In that study, ketamine was actually given after stress (not as a 'vaccine'). Those researchers also failed to replicate that effect when they looked a larger group of soldiers. The first study was done in 2008 and the second one was done in 2014. Believe me, if they had found a protective effect in humans 7 years ago, you would have heard about it by now.

The research that actually shows the ketamine might be a 'vaccine' has all come out this year (2015). And, so far, it's all only in mice. The scientific publication referred to in the Nautilus article is "Ketamine as a Prophylactic Against Stress-Induced Depressive-Like Behavior": http://www.biologicalpsychiatryjournal.com/article/S0006-322.... At least two other research teams at other universities (FSU & UC-Boulder) have independently also found similar effects, but none of that is published yet (though it was presented this year at the national Society for Neuroscience conference). In other words: yes, it's new.

Additionally, neuroscientists at Mt. Sinai, the NIMH, and UC-Boulder (among others) have found that bacteria and immune cells might also be used to 'vaccinate' against stress. Again, most of that research--though not all of it--is still not published yet, and has only been presented at conferences so far.

Re: Ketamine’s effect bolsters a new theory of mental illness

#80
post #2

I'm excited for there to be alternatives to SSRIs. I've never been diagnosed with depression, but my partner has and takes an SSRI. It certainly seemed to have a generally positive affect (totally subjectively), and relatively few negative side affects. That being said, having to take it every day sucks, and when she runs out, having forgotten to get it refilled, the mood affects are pretty terrible for us both. Hope…

I recently read that the theory behind serotonin reuptake inhibitors might actually be wrong and possibly cause more harm than good. The actual neurotransmitter mechanism behind depression would be dopamine.

I'm sorry that I can't recall the source, but you should look into this.

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