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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

#11

Post by lukasb »

photonerd wrote: post #9
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 w…

The way I would rephrase OP is "what is the most useful abstraction for the mechanism of action of these drugs". It might be that limiting yourself to neurological phenomena gives you a much longer, more unwieldy model of what's happening here than an equally predictive model that centers on subjective experience.

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

#12

Post by JohnMakin »

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…

It can also be harmful. I know someone who went through this treatment, they had an out of body/ego death experience, and were convinced that's what death felt like, and they really liked it. They had a suicide attempt just a few days later. It isn't the type of treatment one tries unless they've exhausted all other options. It's saddening to hear a lot of depression treatments seem largely reliant on placebo effect - for someone with decades of dysthmia, it's really disheartening to hear.

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

#13

Post by cooper_ganglia »

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…

>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.

I couldn't agree more, you've made really great points that allowed me to reflect on my own approach to my mental wellbeing. I honestly needed to see this comment right now. Thank you!

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

#14

Post by omginternets »

photonerd wrote: post #9
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 w…

>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.

No, they are definitely not. I don't see anything in these studies to the effect of "hey, it's the feeling that they feel that's making them better". They're looking for some mysterious mechanism, usually on the cellular or molecular level, whereas "numen" and "transcendence" are not even on the biological level of analysis.

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

#16

Post by omginternets »

lukasb wrote: post #11
photonerd wrote: post #9

Earlier quoted context omitted.

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 w…

The way I would rephrase OP is "what is the most useful abstraction for the mechanism of action of these drugs". It might be that limiting yourself to neurological phenomena gives you a much longer, more unwieldy model of what's happening here than an equally predictive model that centers on subjective experience.

Nit: my feelings are closer to "we are ignoring one of possibly many useful abstractions", but otherwise yes.

If I'm being pedantic here, it's that I really don't want to downplay the importance of the pharmacological level of analysis. It's a very useful analysis. It's just not a complete theory of life well-lived.

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

#17

Post by dv_dt »

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…

Another issue is the variability of depression as a diagnosis itself. An admittedly anecdotal set of my encounters with people who take or have taken anti-depressants is most are on changing set of prescriptions because nothing works continuously and a high percentage of them are ones which no anti-depressant drug worked and were fixed by a different diagnoses for something like adhd.

How does one evaluate if a new drug works vs depression when there isn’t a consistent diagnosis or presentation of the symptoms.

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

#18

Post by teaearlgraycold »

JohnMakin wrote: post #12
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…

It can also be harmful. I know someone who went through this treatment, they had an out of body/ego death experience, and were convinced that's what death felt like, and they really liked it. They had a suicide attempt just a few days later. It isn't the type of treatment one tries unless they've exhausted all other options. It's saddening to hear a lot of depression treatments seem largely reliant on placebo effect…

That sounds terrible. It really sounds like they were already pretty far gone. I was able to get help with my depression from magic mushrooms, but it was at most a moderate case.

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

#19

Post by PlunderBunny »

I don't want to downplay depression (which I have no experience of), or come across as being flippant, but could the placebo effect in many of these kinds of trials be as simple as "a caring person (professional and/or stranger) interacting with the depressed subject improves their condition?"

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

#20

Post by omginternets »

JohnMakin wrote: post #12
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…

It can also be harmful. I know someone who went through this treatment, they had an out of body/ego death experience, and were convinced that's what death felt like, and they really liked it. They had a suicide attempt just a few days later. It isn't the type of treatment one tries unless they've exhausted all other options. It's saddening to hear a lot of depression treatments seem largely reliant on placebo effect…

Sorry, what can be harmful exactly? The experience of drugs? I completely agree.

A corollary of my position is that you should be able to fix a fair bit of depression by providing non-pharmacological access to transcendent experience. The drug is then a (very potent and correspondingly sharp) tool among others.

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