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Ketamine's effect on depression may hinge on hope

med.stanford.edu

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Re: Ketamine's effect on depression may hinge on hope

#3

Post by greenpresident »

ClassyJacket wrote: post #2

This isn't specific to ketamine tho is it? The placebo effect is well studied.

Notably, the placebo effect usually only effects suffer reported symptoms as in this case. It’s a folk wisdom that it has physiological effects, which is often not true.

Re: Ketamine's effect on depression may hinge on hope

#4

Post by scythe »

This is not the first trial of ketamine used under clinical anaesthesia to disguise its effects. A previous study using similar methods in 2018 found the usual effects of surgery: a transient increase in depressive symptoms. I'm no expert but my inclination is to blame this on postoperative pain.

https://www.sciencedirect.com/science/article/pii/S000709121...

The confidence interval in the new study includes zero, although the average beneficial effect is still surprising when considering the usual expected negative effects. I suspect that the real effect may simply be that general anaesthesia causes a susceptibility to suggestion.

It's not clear if ketamine — or anything else — should be expected to work normally when it is administered to patients under general anesthesia. General anesthesia has profound effects on the functioning of the nervous system.

Re: Ketamine's effect on depression may hinge on hope

#7

Post by omginternets »

Beyond the importance of controlling the placebo effect, I am worried that a lot of the drug-depression research is overlooking an important possibility: that the thing about ketamine/psilocybin/etc that is helping with depression is not some latent property of the molecule, but rather the actual transcendent experience of the trip. In other words, the trip is the point, not the mechanistic neuro-tinkering [0].

Importantly, this tracks with what we know about the protective effects of things like religiosity against depression. As such, the qualitative experience of the drug might not be something we can (or should) do away with. I would even go as far as suggesting that an absence of transcendence in one's life is precisely what causes a large segment of people to become depressed in the first place, and that perhaps drugs are helpful only insofar as they produce a transcendent experience.

This isn't to say we can't take a scientific approach to treating depression, but that has to be balanced with something profoundly metaphysical: the actual qualia of life experience. Wellness isn't the absence of disease; it's the presence of thriving, and that includes within it a component of things like hope, inspiration, and elevation above the ordinary. We used to have various ceremonies designed to turn us towards the numinous, but we've pretty systematically dismantled those in favor of a grounded hyper-rationality [1]. As a scientist, I can't really object to rationality on its own, but it may be worth considering non-rational, transcendent experience as a fundamental psychological need.

[0] If you're a materialist, you might object that neurological machinery is not differentiable from qualia. Fair enough! I even agree! My point is simply that medicine needs to consider qualia as a major parameter in the treatment of depression. Fixing depression is not like fixing a car.

[1] I suspect most people here are familiar with Nietzsche's "God is dead quote". Many people in my entourage are floored to discover that he correctly predicted the dramatic increase in anxiety, depression, neuroticism and nihilism that is present in modern life.

Re: Ketamine's effect on depression may hinge on hope

#8

Post by standardly »

ClassyJacket wrote: post #2

This isn't specific to ketamine tho is it? The placebo effect is well studied.

Correct. It's important to remember the existence of a placebo effect isn't correlated with the efficacy of the drug being tested. I suppose that is obvious, but placebo studies tend to have a negative connotation.

Re: Ketamine's effect on depression may hinge on hope

#9

Post by photonerd »

omginternets wrote: post #7

Beyond the importance of controlling the placebo effect, I am worried that a lot of the drug-depression research is overlooking an important possibility: that the thing about ketamine/psilocybin/etc that is helping with depression is not some latent property of the molecule, but rather the actual transcendent experience of the trip. In other words, the trip is the point, not the mechanistic neuro-tinkering [0]. Impor…

If qualia are not different that our “neurological machinery” (and all available evidence shows this so far, not least the incoherence of definitions of qualia that try to exclude such) then medicine is already considering such as a major parameter.

If they are different (and exist at all) then such needs to be demonstrated before they can be reliably considered.

Given even proponents of qualia can’t reliably agree with each on what they even are defined as (other than using vague circular reasoning)… frankly, I’m not holding my breath.

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