Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Ketamine's effect on depression may hinge on hope

med.stanford.edu

Post reply on HN
Print view View original

211–220 of 276 posts

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

#211

Post by scotty79 »

CodeCounselor wrote: post #158
scotty79 wrote: post #142

Earlier quoted context omitted.

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…

I apologize if I misunderstand you, which is very possible. I interpret you as saying that unless there is a "trip" there is only a placebo effect left on the table so to speak. I think this is somewhat refuted by the fact that the standard ketamine infusion protocol (that does not normaly induce "trips") has an effect size that dwarfs the effect size of placebo (say 0.2 - 0.4). Some studies have shown ketamine appro…

But in the light of the study we are commenting on it might be that the effect of ketamine in previous non-doubleblinded studies was due to placebo effect heightened by the positive expectations towards ketamine of both patients and doctors.

At least it is what authors of this study consider.

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

#212

Post by dv_dt »

NickM wrote: post #68
dv_dt wrote: post #54

Earlier quoted context omitted.

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

Well sure, but I don't see how that contradicts anything I said.

True, (sorry friends sometimes tell me I sound like I’m aggressively agreeing with them - it’s something I’m trying to improve on) the long period to take effect and evaluate if combos are “working” make it really difficult to understand if a drug or something else is fixing anything.

The main interesting thing about ketamine was that there were some anecdotes that the effects were very rapid - and that should be at least something to make it easier to assess a change. But maybe harder to separate placebo.

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

#213

Post by nullindividual »

Spivak wrote: post #90
nullindividual wrote: post #70

Earlier quoted context omitted.

I find this... frustrating to read, at the least. This post assumes that all depression is a _lack_ of something external to the body. Or that depression is simply a chemical imbalance. It takes no accounting of physical deficiencies that can _never_ be cured and require a lifetime of maintenance, of which Ketamine can be (literally) lifesaving. The post is irresponsible. No one should be thinking that some sort of "…

I feel like depression as a term is overloaded because it's a description of a symptom rather than a particular cause. If you're depressed because you have a chemical imbalance then you're a great candidate for SSRIs and the like. Serotonin? In this economy? If you're depressed because your life is miserable in some fashion then there's a lot of potential options but this sounds like what you're talking about with K…

Depression comes in many forms, you're correct, including depression due to physical deformities in the brain. This would fall under the last category where some forms of depression can be made worse by SSRIs and SNRIs, though those classes of drugs are most commonly ineffective for any patient.

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

#214

Post by nullindividual »

p1esk wrote: post #80
nullindividual wrote: post #55

Earlier quoted context omitted.

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.

Could you explain? What is the difference? I only had Ketamine once during surgery and I vividly remember the few hours after.

It of course depends on your IV dosage.

You can see and hear things that aren't there. Even have a conversation with mythical, religious, or spiritual entities.

You can experience 'past lives' (whether factual or not, which I don't believe so, experiencing something you THINK is a past life is interesting).

And it can go south with disturbing or dark imagery.

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

#215

Post by marssaxman »

jiveturkey42 wrote: post #193
cnity wrote: 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…

Because for every functional self-dosing career professional, there's 10 self-dosing tent dwellers living in squalor in every major US city

You have that ratio backwards, and it's still an exaggeration.

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

#216

Post by NickM »

dv_dt wrote: post #212
NickM wrote: post #68

Earlier quoted context omitted.

Well sure, but I don't see how that contradicts anything I said.

True, (sorry friends sometimes tell me I sound like I’m aggressively agreeing with them - it’s something I’m trying to improve on) the long period to take effect and evaluate if combos are “working” make it really difficult to understand if a drug or something else is fixing anything. The main interesting thing about ketamine was that there were some anecdotes that the effects were very rapid - and that should be at…

Yeah, fair, maybe we are in violent agreement :)

I agree it is interesting that ketamine seems to work very quickly for some people. Re: your placebo comment, I also agree it's hard to separate it out.

One of the tricky things with the placebo effect is that there are really multiple distinct types of placebo effect; on the one hand, you have objective measurable biological changes that placebos can trigger, but on the other hand placebos can also affect peoples' subjective perceptions of the symptoms they're experiencing.

In the case of depression though, the subjective perception of misery is the core problem we're trying to fix. Hence why treatments that have no biological effect (like, e.g., therapy) are still considered valid approaches. So, then the question is, does it matter whether ketamine is just a placebo? Maybe all antidepressants are placebos, in which case the important thing is to find the safest, most effective, fastest-acting placebo we can.

Really though I do kind of think peoples' subjective experiences matters in a more concrete way than folks give credit for. Even though it's not directly modifying your brain chemistry, I wouldn't call therapy a placebo, for example. Maybe sometimes medications help people because beliefs like "someone is trying to help me" or "I've found an explanation for why I feel bad and there's a treatment for it" actually help people break out of their self-destructive patterns, regardless of the actual efficacy of the meds. It's more questionable though whether those beliefs actually help with long-term root-cause fixes though, or if they just trap people in a local maxima.

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

#217

Post by NickM »

jpadkins wrote: post #209
NickM wrote: post #43

Earlier quoted context omitted.

Not to downplay the current world problems, but you could make similar arguments at any point in history about any number of big problems humanity has faced. Yet, people still find hope and keep solving problems.

in the past we had religion, which gives some people hope. we have yet to find the replacement for religion.

Religion gives you a set of things to believe in, a community, and maybe some transcendent experiences. You can still choose to believe whatever you want though even without religion, and there are many other sources of community and transcendent experiences out there.

Religion wraps it all up in a nice package, and plenty of folks do still choose religion and reap plenty of benefits from it, but there are other options out there.

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

#218

Post by mistermann »

HKH2 wrote: post #121
KptMarchewa wrote: post #79

Earlier quoted context omitted.

I am a materialist. I agree delusions are powerful mechanism against depression, but most of them, like religion, have awful side effects.

Materialism has plenty of awful side effects like hubris, nihilism, and anti-natalism.

...perceptions of omniscience.

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

#220

Post by jiveturkey42 »

marssaxman wrote: post #215
jiveturkey42 wrote: post #193

Earlier quoted context omitted.

Because for every functional self-dosing career professional, there's 10 self-dosing tent dwellers living in squalor in every major US city

You have that ratio backwards, and it's still an exaggeration.

I didn’t realize the ratio was so high but I guess it would explain why the white collar sector doesn’t accomplish anything anymore
Post reply on HN