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Ketamine's effect on depression may hinge on hope

med.stanford.edu

171–180 of 276 posts

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

#171

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…

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

#172

It's shocking how much of medicine is just based on trust and word of mouth. Studies made decades ago that turn out completely wrong and not reproducible. We flatter ourselves that we're enlightened and based on science, but the more you dig the more you realize it's all a game of trial and error and fighting cultural wars to get your "remedy" out there and profit. It's rather shocking to someone who's not familiar w…

It is kind of ironic that study hints about hope/placebo. What I experienced were always side effects, no relief and then different drug, rinse and repeat. Left with original problem, worried what the next drug gonna bring as side effect with more and more diminishing hope it will ever help - despair.

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

#173
post #139

Earlier quoted context omitted.

> 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. Ketamine dosed at levels used in a lot of the original depression studies won’t result in anything resembling a “trip”. Many of the more res…

This system of scientific gatekeeping and law enforcement is a direct projection of the barriers put in place between individuals and god by the catholic church. For millennia authorities have attempted to prevent people from having meaningful spiritual experiences directly, of their own accord, via access to substances that grow e.g. in their nearest cow fields. In this way, your psychiatrist friend is simply the ne…

Correct! My schizoaffective disorder bipolar type is actually a spiritual issue at its core.

When people tell me about their psychedelic trips, I am like, so? I’ve been doing it my whole life without drugs!

However, my tendency to go on these trips are highly affected by environmental variables. So the only thing I would add is, it’s a mix between the spiritual and the material And we cannot negate either.

So all these therapist and psychiatrist trying to cure me are taking the wrong tact. What I learned is I needed to understand it, and understanding it alone is the cure.

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

#174

Earlier quoted context omitted.

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.

The prejudice against it is huge to be honest. I am a Jodo Shinshu Buddhist and a majority of other Buddhists online mock me for using religion in the way you describe, that is, to connect with the Absolute and to understand my life. Not even just the secular ones, who call me pathetic for believing in Amida Buddha or Pure Lands, but even the very religious ones, who say that I am arrogant for thinking that I can give myself up to Amida fully. Thankfully, Jodo Shinshu is popular in Japan, and also in the US, so it is not difficult to find English resources that understand.

Everywhere there is huge gatekeeping from these experiences, or from life in general. I definitely agree with people who say that our society is spiritually bankrupt. It isn't that they are missing some essential doctrine or belief or they will be damned, it is that they can't give themselves up to life fully if they have no recognition of the Absolute.

> Reverently contemplating Amida’s directing of virtue for our going forth, I find there is great shinjin [faith]. Great shinjin is the superlative means for attaining longevity and deathlessness. It is the wondrous way to awaken aspiration for the pure and rejection of the defiled. It is the straightforward mind directed to us through the selected Vow. It is shinjin* that actualizes Amida’s profound and vast benefiting of others. It is true mind that is diamondlike and indestructible. It is pure shinjin by which a person easily reaches the Pure Land where no one goes. It is the mind that is single, realized by the person who is grasped and protected by the compassionate light. It is great shinjin, rare and unsurpassed. It is the quick path difficult for people to accept. It is the true cause of attaining great nirvana. It is the white path by which all virtues are fulfilled instantly. It is the ocean of shinjin that is itself suchness or true reality.

Shinran Shonin

> Shin Buddhist practice is not based on belief in an uncertain better future but instead places emphasis on the present moment—a moment made possible by the causes and conditions of the past. Many take for granted the efforts that generations of humans have made, along with the interdependence of all life forms, that contribute to our being here now.

> Reciting Amida’s name is like an alarm clock that says “Wake up!” to the joy of being alive each and every day. Awakening to this rare gift of life, we can accept and endure the wide spectrum of human grief and bliss and become a source of happiness for others.

Buddhist Churches of America

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

#175

Earlier quoted context omitted.

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.

LSD was negative for me. It basically made me realise that suicide was an option, and I struggled to stop thinking about it, even now

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

#176
post #118

>The take-away should not be that ketamine “is just a placebo,” Heifets emphasized. This is the very definition of placebo and why double blind studies are done. The control group and the actual group both improved thinking they got the drug. > In fact, there may be physiological resonance between the placebo effect — in other words, hope — and how ketamine works. This is just mumbo jumbo. There's no 'resonance effec…

This is insane, people are really unwilling to let go the idea that illegal psychoactive drugs may have any beneficial effects for depression.

I don't understand why they are so desperate for it. I suppose it's because they have a purely mechanistic view of the brain, and that if there isn't some chemical you can change to help, you're fucked

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

#177

Earlier quoted context omitted.

I am happy to be sorted into the "responsible" category, since I prescribe IV ketamine with the mentioned 40 minute slow IV infusion at 0,5mg per kg of body weight. I would like to chime in a thought about the choice of words... I think that we might be doing us a disservice when reducing the whole discussion down to "trip" or "no trip". Some patients have mild sensory experiences from the treatment, some have unplea…

Isn't the "trip" just a side effect of it having some impact on the brain and if you adjust dosage and protocol so that the trip doesn't happen you are basically left with placebo effect proportional to hope of improvement which is positively correlated with opinions on ketamine? I'm not sure if I remember correctly but I think I've read ketamine makes neurons groe new dendrites in petri dish. I have no idea how this…

There are all sorts of effects that drugs can have on the brain/body that aren't a "trip". Consider the effects of caffeine and alcohol for example.

Also consider the difference between high and low doses of alcohol: just because having 1 beer won't make you blind drunk doesn't mean that the effect is a placebo.

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

#178

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 generally agree with you, but I would like to comment on the expression you used: "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.". I think you would agree that if evaluations such as life-meaningfulness are secondary-properties or qualia like you said then arranging it as a debate between rationality vs irrationality is out of the picture. It is customary to consider various forms of mysticisms as opposed to rationality but it doesn't have to be the case as long as we properly define what is entailed by such experience.

I suppose that the reason people might object to such idea is that they are implicitly committed to a form of positivism and they sense that if people can experience evaluations then the fact/value distinction is undermined. Therefore I think that while it is understandable what you mean when you use the term "rationality" as equated with positivism it would be good for the long term debate to separate those two, since I take it that people like us would like to have it both: science and a form of atheistic mysticism [0].

Ultimately the grand-father of rationality, Plato, was anything but a positivist.

[0] I use the term mysticism mostly because I lack any better term. Evaluative intuitionism is probably the most correct technical term but it has historical roots which I dislike because it was constructed around the single intuition of what is Good, and I believe that we need a wider range of evaluative terms to adequately describe our experiences.

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

#179
post #168
post #139

Earlier quoted context omitted.

This system of scientific gatekeeping and law enforcement is a direct projection of the barriers put in place between individuals and god by the catholic church. For millennia authorities have attempted to prevent people from having meaningful spiritual experiences directly, of their own accord, via access to substances that grow e.g. in their nearest cow fields. In this way, your psychiatrist friend is simply the ne…

The customer is not always right. Just because the customer wants something or believes something doesn’t make it factually true. This really isn’t about being a lawful authority trying to buzz-kill society as much as it is about having principles as a doctor. The patient wants a cure to an ailment while their doctor has no evidence of its efficacy. If I had someone coming into my auto repair shop telling me they did…

My original post left too much to the imagination and I realise re-reading it that it appears as an attack on professionalism within science, and possibly even an attack specifically on the parent commenter's friend, and I regret that angle.

What I broadly mean is that modern society has done a relatively poor job at helping to produce integrated humans that have the capacity, tools, and know-how to navigate their inner journey. I know this sounds woo to a lot of people here. That the new wave of psychedelic interest is reified as purely medical treatment is a continuation of this trend. That is what I'm trying to articulate.

I have a deep suspicion that you can't simply sterilise the transformation at the heart of these experiences.

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

#180

Related to the psychological vs. physiological discussion: I can say with confidence that the first time I did ecstasy changed how I look at the world. We went for a walk barefoot on warm pavement and it was the most wonderful thing I ever felt. I realized on a visceral level that so much of our personal happiness is based on how we look at things, not what happens to us. I don't know if I got any chemical benefit fr…

Same thing happened to me the first time I tried using molly. I am convinced it was actually a fake of some amphetamines and caffeine or something. But it still had an effect on me: for the first time in my life I was able to have fun while being surrounded by a crowd of people (it was a music festival). It didn't make me feel dumbed down like alcohol used to. I just felt happy, just wanted to have fun and enjoy the moment. After that I realized I had the sparkle in me. I even knew I could do it without drugs. That was the beginning of my healing process. I've remembered that experience many times later and still come back to it sometimes.
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