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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

#51

Post by nullindividual »

progmetaldev wrote: post #40

I'm more interested in the effects of Ketamine on anxiety. I know that it's not as effective, but haven't seen any statistics specifically related to anxiety. I have gotten my Ketamine through Mindbloom, and just need to schedule my treatment and follow up dates. My depression effects are due to my suffering through anxiety for over 20 years (started in 1999). My anxiety also seemed to correlate with 2 bad trips from…

They will give Ketamine and benzos together as K can cause anxiety symptoms (or terror with a K-hole).

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

#52

Post by omginternets »

cpncrunch wrote: post #26
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…

Your comment seems to ignore the main point of the article: that the placebo group did actually have life-changing resolution of their depression symptoms.

I'm not sure I see a contradiction. This is compatible with the established idea that you can have transcendent insight without drugs, and with the equally-established idea of suggestion as one of the principal mechanisms behind placebo effects. A cohort was put in a situation that facilitated reflection upon life in a closed setting; that's exactly what I'm suggesting is helpful.

See also: "you're not anxious; you're distracted."

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

#53

Post by thom »

PlunderBunny wrote: post #19

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?"

This is neither downplaying depression nor flippant - the therapeutic relationship is clearly very important and I don't think anybody denies that. But I suspect a lot of this is about your inherent world-view. Some people do well after purely online CBT, some don't. Some do well in talking therapy, some don't. It seems likely that how your brain perceives the world (and itself) affects which interventions help.

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

#54

Post by dv_dt »

NickM wrote: post #37
dv_dt wrote: post #17

Earlier quoted context omitted.

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 d…

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. An alternative explanation for this is that if you keep giving people different drugs and different di…

Well except the changing of drugs is usually because they are not feeling better or are feeling worse.

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

#55

Post by nullindividual »

scythe wrote: post #4

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, al…

Ketamine IV or compound medication without any other drugs is so profoundly different from Ketamine as part of a procedure where you’re otherwise unconscious.

Just no comparison.

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

#56

Post by omginternets »

acchow wrote: post #39
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…

Much of the benefit of psychedelics is the introspection , which you can do sober as well (although the depth of the reflection is magnified and qualitatively different while tripping). This is confirmed by the linked study (which shows that placebo-ketamine is also very effective).

Agreed: https://news.ycombinator.com/item?id=37949537

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

#57

Post by whoisburbansky »

pard68 wrote: post #50
b33j0r wrote: post #21

Earlier quoted context omitted.

Agree. I have heard stories of people who “had one treatment and never smoked/put their elbows on the dinner table ever again.” My experiences seemed to benefit more from watching David Attenborough and feeling a connection to life. I’d interpret the dad of a family of mountain lions as an analogue of my dad, etc. Seeing events as taking place in a dissociated context. All that introspection is what I found useful ab…

That's not silly at all. Like the other guy who posted, connecting back to "life" is pretty important. My family committed to this at a very extreme level in 2020 and we fulfilled it in April 2021. Our lives have been changed for the better in so many ways!

Wait are y'all the folks who moved together cross-country so you could be neighbors with your siblings?

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

#58

Post by omginternets »

alisson_dover wrote: post #49
acchow wrote: post #39

Earlier quoted context omitted.

Much of the benefit of psychedelics is the introspection , which you can do sober as well (although the depth of the reflection is magnified and qualitatively different while tripping). This is confirmed by the linked study (which shows that placebo-ketamine is also very effective).

Many psychedelic-era personas expressed this sentiment as well: you don't need psychedelic drugs to reach that state, you could also spend 10 years practicing meditation daily. This view ignores the major application of these substances. Ketamine-induced self-therapy is accessible instantly and acts as a major reset. When you are experiencing long-term depression and/or anxiety, the advice to "just meditate" or do de…

I just want to endorse this comment. Psychadelic drugs have a miraculous property: they elicit transcendent states reliably. Eat the mushroom and you will experience it.

There are corresponding risks to this, of course, but that's the flip side of their utility as a (sharp) tool.

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

#59

Post by omginternets »

tonnydourado wrote: post #48
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…

> 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 I thought the same thing when reading the article, but then I started to wonder how the fuck would you double blind that?

Well, you wouldn't. It's largely a metaphysical stance rather than a scientific one[0], which I suspect is precisely why modern medicine is struggling to engage with it.

[0] Mostly. Part of it falls under Dennett's notion of an intentional stance, but that requires us to take self-report seriously, and so precludes a number of experimental designs.

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

#60

Post by iwonthecase »

supportengineer wrote: post #28
calibas wrote: post #27

A big part of depression is negative thinking, so it's not too much of a stretch to believe that positive thoughts, like hope, would lessen depression.

In a late-stage capitalism world, where the climate is collapsing, and homes are unaffordable, where does hope come from?

Without wanting to underscore the seriousness of those problems, a day or two in the woods without access to email or a constant stream of news (Discord and SMS seems fine for me in that situation) really dampens a lot of mental health issues I have, even after going back to civilization.
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