Ketamine’s effect bolsters a new theory of mental illness • Hacker News Board

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

#81

Post by tachyonbeam » Sat, Dec 19, 2015, 1:08 AM UTC

slapshot wrote: post #71

astazangasta wrote: post #34

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 kn…

I fully agree.

I dated for 5 years a woman in the same situation as what you describe. She has money, friends, family, a roof over her head. She hasn't suffered childhood trauma or anything abnormal, but she's consistently depressed and lethargic.

I'm bipolar myself. I've been through some difficult things, but my condition makes me acutely aware of how subjective human emotions are. How much of our thinking is influenced my neurochemistry rather than rational thoughts or memories. I'm pretty stable these days, but I've had times where I would just wake up in the morning and feel happy to be alive. Energized, stress-free, and confident in my abilities. The next day, I wake up depressed and I feel like my life is shit, not worth living. A few days later I feel fine again. No major life events, no major causes of stress, just my neurochemistry being unpredictable.

I think that the overinsistence in some circles on past trauma causing mental illness is harmful. There is definitely such a thing as genetic predispositions. Some depression and mental illness just does not have a cause you can point to. It's not all about overcoming negative experiences and willing yourself out of it. Genetic defects can cause all sorts of physical problems, just think of psoriasis, asthma, acne and peanut allergies. I'm not sure why people think that the brain can't have such issues. Believe me, people with peanut allergies won't overcome that through psychotherapy and confronting their mommy issues.

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

#82

Post by _ywdj » Sat, Dec 19, 2015, 1:10 AM UTC

slapshot wrote: post #71

astazangasta wrote: post #34

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 kn…

I empathise with your friend's plight, and her exasperating struggle to get well. I've been similar in terms of having a life that others would consider pretty darn good but where you find yourself depressed to the point of being largely unable to function, no matter what treatment you try. I get it, it's profoundly awful, and the world needs to to better at dealing with it, and that has become somewhat of a calling for me now that my own mental health is improving.

But all my research and experiences support the notion that both one's experiences and one's emotional reactions to those experiences are crucial. This is why you can have some people living seemingly perfect lives and winding up depressed, and others living through war and oppression and coming out fine.

In your friend's case, the environmental factors could be: (1) pressure from outsiders to "keep up appearances", (2) the negative messages and images that proliferate through the media of war, poverty, murder, terrorism, climate change etc, (3) a world that offers so many options of how to live but little consistent guidance about what is best, (4) living in a society that can still be very difficult for women, due to career challenges, threat of abuse, paternalistic attitudes etc.

These are just hypothetical of course, given that I don't know her.

And for her to be crippled by depression in response to these or other stimuli would be as much to do with a difference in the way she responds to such things vs the "average" person.

But it may not even be unhealthy. Maybe her true calling is to work as a humanitarian helping the needy rather than doing what she's been trying to do, and her depression is her mind's way of making her realise she needs to make that kind of change.

Having gone through this process in myself and with others, when you dig deep enough, something like this always turns out to be there.

But my main point is that the mind does not and cannot function independently of a person's environment, and paths to mental wellness that really work (and they do exist), involve addressing both one's inner reactions to things and one'e outer environment.

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

#83

Post by kruhft » Sat, Dec 19, 2015, 1:10 AM UTC

bigbugbag wrote: post #78

DanBC wrote: 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, s…

Most (illegal) drugs are a wonder-drug for depression.

At least until they wear off.

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

#84

Post by bigbugbag » Sat, Dec 19, 2015, 1:13 AM UTC

DanBC wrote: post #8

spotman wrote: post #4

This makes me nervous. Ketamine has major issues with bladder damage when taken repetitively. Possibly with a low enough dosage this would be manageable, but speaking from experience from watching people that have been on the wrong end of the stick with this one. it can do some really serious long term damage in that department.

They use a much smaller dose than is used recreationally. Here's someone who was using 15 g per day: http://www.bbc.co.uk/newsbeat/article/29811499/k-bladder-the... A therapeutic dose is 5 mg per kg. An average adult would be 80 kg, which gives a dose of 400 mg once every maybe 30 or 60 days.

15g per day is a ridiculous amount. Though not the most common ketamine induced bladder damage has been observed to occur in a few months of weekly recreative use of insuflated doses of 1-2g over the weekend. On the other hand some heavy chronic users in the several grams daily range had little to no damage after years of abuse so YMMV.

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

#85

Post by drharvey » Sat, Dec 19, 2015, 1:14 AM UTC

drharvey wrote: post #79

escape_goat wrote: post #44

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 fai…

-- As an aside, it's a textbook example of multiple discovery/simultaneous invention: https://en.wikipedia.org/wiki/Multiple_discovery --

I also completely agree that the sedative-level dose given to soldiers after stress might have worked by blocking traumatic memory formation. It has already been established that blocking or "erasing" stress memories may prevent PTSD (here's just one example: http://www.medscape.com/viewarticle/819452).

In the studies in mice, ketamine was no longer in the animals' systems by the time they were stressed. So they were not sedated. And the researchers tested memory formation to confirm it was not affected. Thus, it seems that ketamine's protective effect in mice isn't just because memory is disrupted. That said, it is always possible they missed something.

From what I can find, it doesn't seem like anyone has even looked yet to see how this ketamine-vaccine strategy effects neuroplasticity. At this stage, it's probably best to consider the post-stress effect of ketamine in soldiers (1), the pre-stress protection in mice (2), and the neuroplastic effects of ketamine (3) as three separate things.

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

#86

Post by mrbill » Sat, Dec 19, 2015, 1:20 AM UTC

kaybe wrote: post #58

Igglyboo wrote: post #30

Earlier quoted context omitted.

It is very common in my experience. Google, Microsoft, Apple, and every tech company I've ever applied to (even small midwestern shops) do not drug test. The FBI has a problem hiring good security experts because of their strict drug testing policies. http://www.wsj.com/articles/SB100014240527023044227045795743...

Are employer drugtests common in the US, even for non-critical work?

I heard through the grapevine that one of my employers (who drug tested at time of hire, but not after that) said "I can't do random testing, I'd lose half my staff."

Another one joked that "We used to drug test at hire, and if you didn't come up positive for ANYTHING, we'd fire you." That was based in a state where medical MJ is legal, and their drug policy was the most reasonable I'd ever seen. "What you do on your own time is your business, and we only start caring if it affects your work performance or interactions with coworkers during work hours."

Meanwhile, the place where I spent 12 years not only tested at hire, you were under the constant "threat" of "random" testing, and the same policies applied to everyone - from rig workers and truck drivers, to programmers. The only time I got "randomly" tested was after a coworker on my team had blown his "random" test... A couple of weeks later I was "randomly" selected; at least HR had a sense of humor about it. "You won the piss test lottery! Go down to XYZ as soon as you get in this morning and pee in a jar..."

This meant that my first and only time I've ever tried MJ was at the age of 40.

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

#87

Post by cpncrunch » Sat, Dec 19, 2015, 1:24 AM UTC

rl3 wrote: post #77

_ywdj wrote: post #72

Earlier quoted context omitted.

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 cl…

There certainly does seem to be a difference between depression vs bipolar/schizophrenia. Major depression is a lot more prevalent than the others, and stress seems to be a much greater part of the etiology. Having seen various family members with clinical depression and schizophrenia, life events were always associated with the depression, but not for the schizophrenia.

My own view is that depression is an evolved response to negative stresses and situations, and that clinical depression is the far end of this scale. Depression is therefore your brain's way of telling you that you need get out of a bad situation. Schizophrenia seems to be akin to a flaw resulting from some evolutionary aspect of the brain's operation, perhaps due to creativity/intelligence.

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

#88

Post by bigbugbag » Sat, Dec 19, 2015, 1:26 AM UTC

user_0001 wrote: post #39

Igglyboo wrote: post #32

Earlier quoted context omitted.

> Ketamine has major issues with bladder damage when taken repetitively. At recreational doses, doctors aren't going to be prescribing anywhere near that.

Not recreational dosages. At serious addiction levels yes. It would be like saying having a couple of recreational beers on a Friday causes liver failure. It doesn't. Drinking a bottle of whiskey every day for an extended period of time, perhaps. Same with Ketamine

This is in direct contradiction of the usual consensus among harm reduction practitioners, as explained on erowid:

Ketamine and Bladder Health

In some cases, chronic ketamine use has been associated with urinary tract symptoms that can include increased frequency of urination, urinary incontinence, pain during urination, passing blood in the urine, and reduced bladder size. In several reported severe cases, surgical intervention to remove the bladder was deemed necessary by clinicians. The wide dose-response range leading to documented cases suggests that individual responses to ketamine may be idiosyncratic and unpredictable, making it unclear what level and frequency of use may lead to urinary problems.

https://www.erowid.org/chemicals/ketamine/ketamine_health.sh...

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

#89

Post by ninjakeyboard » Sat, Dec 19, 2015, 1:35 AM UTC

astazangasta wrote: post #34

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…

Clinical medical illness is often fabricated. Most of the research and analysis and awareness is also funded by the companies that sell the drugs. Calling ADD or Depression "mental illness" is asserting that it's not normal and is a treatable illness randomly encountered - it's almost often a factor of your environment and psychology.

It's interesting that the Ketamine research comes to the conclusion that depression is not a mental imbalance but is a product of the environment causing structural changes in the brain - this seems more in line with what eg ADD and Depression ACTUALLY are - it's not that I can't focus because I caught something from my neighbour - I can't focus because I'm berated with stimuli and I can't pick just one thing to focus on. I'm not depressed because my brain isn't producing enough seratonin, it's because I've been wore down supressing my wants and needs and extended myself trying to make other people happy or overstimulated myself or whatever.

We don't know but the picture is getting clearer - depression isn't a common cold that you need drugs for - it's more like liver disease caused from chronic drinking. Stop drinking, and let your liver recover only science just barely understands the processes of the psyche and environment that cause those physical changes in the brain yet.

Addiction itself is very much an obvious facet - it's not a degenrate behavior but a degenerative structural change to the brain that cause inner behavioral and perceptual changes that need a physical restructuring of the brain to overcome.

It will take time but science will get clearer. The problem is that there are many motives - the whole "sitting is the new smoking" awareness is evidence that we focus on the wrong things - why is this just coming out now? because there is no profit motive to fund that research.

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

#90

Post by rl3 » Sat, Dec 19, 2015, 1:36 AM UTC

cpncrunch wrote: post #87

rl3 wrote: post #77

Earlier quoted context omitted.

> 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 cl…

There certainly does seem to be a difference between depression vs bipolar/schizophrenia. Major depression is a lot more prevalent than the others, and stress seems to be a much greater part of the etiology. Having seen various family members with clinical depression and schizophrenia, life events were always associated with the depression, but not for the schizophrenia. My own view is that depression is an evolved r…

>My own view is that depression is an evolved response to negative stresses and situations, and that clinical depression is the far end of this scale.

How do you reconcile this with cases of clinical depression where the person's life is otherwise fantastic, and yet they suffer from crippling depression anyways—absent any negative stresses or situations?