Live data from Hacker News

Ketamine no better than placebo at alleviating depression, unusual trial finds

science.org

161–170 of 196 posts

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#161
post #158

Earlier quoted context omitted.

You must not be familiar with the bath salt scenarios in Florida :)

Bath salts are similar to amphetamines. They have nothing to do with ketamine or other psychedelics. You're committing the same error people did when they declared cannabis and LSD as scheduled 1 drugs in the same category as heroin. By this line of thinking might as well avoid taking aspirine, because sounds like ketamine and is also a drug.

I was responding to the "altering state of mind" comment, which is quite broad :)

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#162
post #14

Earlier quoted context omitted.

yes ofc, but if the treatment is the trip it will never work blinding it like this. If anything they should be looking for drugs that give comparable trips, with no potential for depression treatment.

I agree in principle, though having tried most of the various types of trippy substances, I've yet to encounter one that hasn't showed potential for a short term antidepressant effect. I guess I haven't tried those weird delta opioid ligands(salvia divonorum). I guess deliriants(like diphenhydramine) would have about zero antidepressant effect too, but that would have possible negative effects, even being liable to c…

Diphenhydramine as a first generation antihistamine acts on a large number of receptors and can even be used as a mild anxiolytic, so I'd guess it could very well have antidepressant effect.

No idea about deliriants like atropine/scopolamine, but in low doses, they were traditionally used to spice up beer (hence Pilsen named for Bilsenkraut, black henbane), so I could imagine short antidepressant effect there too.

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#163

Earlier quoted context omitted.

Or general anesthesia prevents ketamine from having it's usual effect on the brain. This is such a stupid study, I hope they didn't anesthetize people just to study this

> I hope they didn't anesthetize people just to study this Why not? Apart from potential side effects of anesthesia, this sounds like a great study to find the mechanism of ketamine helping depression.

Is it still a widespread theory that depression is a purely physical condition that can be treated with just a chemical intervention? I thought the medical community moved past this notion.

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#164

> They gave volunteers ketamine while they were under general anesthesia, theoretically preventing the participants from going on a trip. Maybe it's the trip that helps.

Ketamine depression treatment doesn’t have to induce a “trip” to elicit the effect, according to studies and the protocol. It can produce some sensory distortions, but anyone who is going into a full “k hole” is almost certainly taking too much. It’s not a case of more is better.

Is there a clear definition of a trip that these studies subscribe to? I would guess they attribute any change in perception to "tripping". K-hole is not the expected experience in most Ketamine-based treatments afaik.

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#165
post #162

Earlier quoted context omitted.

I agree in principle, though having tried most of the various types of trippy substances, I've yet to encounter one that hasn't showed potential for a short term antidepressant effect. I guess I haven't tried those weird delta opioid ligands(salvia divonorum). I guess deliriants(like diphenhydramine) would have about zero antidepressant effect too, but that would have possible negative effects, even being liable to c…

Diphenhydramine as a first generation antihistamine acts on a large number of receptors and can even be used as a mild anxiolytic, so I'd guess it could very well have antidepressant effect. No idea about deliriants like atropine/scopolamine, but in low doses, they were traditionally used to spice up beer (hence Pilsen named for Bilsenkraut, black henbane), so I could imagine short antidepressant effect there too.

> Diphenhydramine as a first generation antihistamine acts on a large number of receptors and can even be used as a mild anxiolytic, so I'd guess it could very well have antidepressant effect.

It does, and this observation led to the development of dedicated antidepressant drugs. There are several such cases where interesting side effects turned out to open a world of possibilities, including an anti-TB drug that also led to antidepressants, and of course Viagra.

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#166
n=1 and all but ketamine is the only med out of 30+ that I've tried for my TRD over the last 40+ years that actually helped me long term. Every other med either had side effects that were worse than being depressed or they just didn't work beyond the first few weeks which I attribute to the initial placebo effect.

What I try to stress to people who ask is that ketamine is a powerful agent of neuroplasticity. So, so many people expect to take a pill and just feel better. With ketamine, you have to stay as positive as you can before, during and for days afterwards to reprogram your brain to be more positive. The people that I know that have had success with ketamine are those that either had therapists working with them during or right after the experience, or those who followed the "must work hard at being positive for 2-3 days after taking ketamine" advice.

This is a med that I suspect you could actually damage yourself permanently if you just take the med and then go right back to doomscrolling social media or something similarly negative. The initial experience can make you feel better for a day or two, which is huge because no other antidepressant has that kind of quick impact. But if you work at it during that 2-3 days after, you can become a more positive person permanently.

I'm hoping that it gets more accepted over time and can be prescribed by psychiatrists because compared to most other "here's some pills, hopefully you'll feel better in 6 weeks and if not, we'll give you more pills that will hopefully work in 6 weeks" depression meds, it works really fast. For someone on the verge of suicide, it can be a truly miracle med.

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#167

Earlier quoted context omitted.

Does drug being approved by FDA prove its effectiveness? If you can demonstrate without reasonable doubt that it does, i.e. that it's virtually impossible for a drug to be both approved by the FDA and as effective as placebo, then that would make a good argument. In any case, any argument is better than just a "Stop spreading FUD and misinformation, you antivaxxer"-style comment.

The standard for drug approval by the FDA is that the drug has proven to be more efficient than the controls in a phase 3 clinical trial, to the satisfaction of the FDA's experts. The ESA has similar requirements, as do the NHS and other national bodies. Given this, I consider that the right prior is to believe that a drug that has been FDA, ESA, NHS and many other national bodies is actually more effective than plac…

> "Stop spreading FUD and misinformation" is the exact right response.

I strongly disagree. Everyone should have the right to "spread FUD and misinformation" as much as they like, and those who care should learn how to argue for the truth. Otherwise our society is pretty much guaranteed to devolve into a bunch of gullible morons.

The fact that nobody is willing to dig up any proof of effectiveness of SSRIs beyond "well, they're in use, so they must be good", but are perfectly okay with silencing people who disagree with them is both funny and scary to me. And annoying. Who the fuck are they to silence others?

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#168
post #162

Earlier quoted context omitted.

Diphenhydramine as a first generation antihistamine acts on a large number of receptors and can even be used as a mild anxiolytic, so I'd guess it could very well have antidepressant effect. No idea about deliriants like atropine/scopolamine, but in low doses, they were traditionally used to spice up beer (hence Pilsen named for Bilsenkraut, black henbane), so I could imagine short antidepressant effect there too.

> Diphenhydramine as a first generation antihistamine acts on a large number of receptors and can even be used as a mild anxiolytic, so I'd guess it could very well have antidepressant effect. It does, and this observation led to the development of dedicated antidepressant drugs. There are several such cases where interesting side effects turned out to open a world of possibilities, including an anti-TB drug that als…

Yeah, I vaguely remembered something like that. The anti-TB drug is isoniazid/iproniazid which is also a MAO inhibitor.

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#169
post #120

Earlier quoted context omitted.

In which case, the headline would be correct. If ketamine can only treat depression by inducing a trip, then it's the trip that treats the depression, not the ketamine, which suggests future avenues of research into trips themselves, possibly excluding ketamine altogether.

Isn't this true of most drugs? It's not the NSAID that treated the pain, it's the reduction in inflammation...

Not really. If it is the _experience_ that is the main cause for reduction of depressive symptoms, it means that other ways to generate similar experiences (such as meditation, talk therapy, prayer, sensory deprivation...) could have a similar effect. If it is the physical effect of the medicine on the brain which is responsible for the effect, it would mean that it might be possible to design drugs that have the same effectiveness without being psychoactive.

Re: Ketamine no better than placebo at alleviating depression, unusual trial finds

#170
post #129

Earlier quoted context omitted.

If you're gonna accuse someone of posting lies and FUD, at least have some sort of reference [0] to point to, please. Otherwise you're just participating in a "uh-huh!", "nuh-uh!" pissing contest. [0] https://www.nature.com/articles/s41380-022-01661-0

The burden of proof is on the person making the initial claim, ie that SSRIs are no better than placebo.

If I say there's no teacup flying in orbit of Saturn, is the burden of proof on me? Or on the person telling me to stop spreading FUD and misinformation, because everyone knows there's a teacup orbiting Saturn?
Post reply on HN