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Psychedelics and mental illness

stuartritchie.substack.com

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Re: Psychedelics and mental illness

#31

Post by monktastic1 »

kmod wrote: post #28
monktastic1 wrote: post #20

This argument seems disingenuous: > Just as you’d feel extra-sceptical if all the research showing that pork is unhealthy was written by Muslims who’d already decided for religious reasons not to eat pork, you should be worried about the sheer number of studies by psychedelic researchers who are themselves aficionados of the drugs. Perhaps a better analogy would be: just as you'd feel extra-skeptical if all the resea…

Personally I think it's valid to consider selection-bias effects in authorship -- in general, things are written by the people who are the most excited about the topic, which leads to there being a bias towards excitement. I don't think it invalidates the research but it feels like a valid point. I think an interesting observation is that this anti-psychedelics post is written by someone who doesn't even want to try…

My qualm isn't about whether it introduces bias, but why it does. The example he gave implies that the only possible reason is a _religious_ one, and that's not fair.

Re: Psychedelics and mental illness

#32

Post by slibhb »

kayodelycaon wrote: post #26
slibhb wrote: post #16

I like the article. With psychedelics, it's clear that much of the excitement comes from people (including scientists) who have used them and found their experiences helpful. That's not science but that doesn't mean it's wrong. Not everything is amenable to clinical study and this doesn't mean we should disregard it. And the issue isn't just psychedelics being hard to study. Mental health is hard to study. An overwei…

> Mental health depends on subjective feelings. This isn’t correct in a lot of places. There is a number of diagnostic criteria. The most important being how much it affects your quality of life. This can be directly measured by looking at how the individual functions day to day. An example is “Was the person able to shower regularly?” (This assumes the person wishes to shower if they have the ability and opportunity…

It's worth it to study these things from a behavoral or functional perspective but that is also very hard. If only because, ultimately, people seek treatment or don't based on subjective feelings.

I think there's unavoidably an element of subjectivity here. You can attempt to minimize it but it's always there.

Re: Psychedelics and mental illness

#33

Post by PragmaticPulp »

h2odragon wrote: post #2

I know a lot of cannabis fans (and count myself as one). Very, very few of them acknowledge that cannabis affects people inconsistently; one person's reaction to it can be very different than others. This is inconvenient for calling it a "medicine" so let's just ignore it. Psychedelics are even worse. The same dose of the same drug can produce wildly vary effects in the same person depending on factors we have troubl…

Psychedelic enthusiasts can be even worse in this regard. When someone does have a bad trip, they tend to reach for every possible excuse to avoid blaming the drug. This ranges from criticizing their "set and setting" to blaming "triggering an underlying mental health issue". The latter is particularly concerning in the context of treating mental health issues, because by definition everyone in that category has some level of underlying mental health issues.

Research is particularly difficult in this area because the study volunteers are self-selecting for psychedelic research. Basically, anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out. This creates a huge risk of placebo effect when your patients are arriving with huge enthusiasm and preconceived notions of efficacy. Combine that with the weirdness of a psychedelic trip and it's a recipe for a sort of super-placebo.

However, that's doubly interesting in that maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo. Put someone through a weird, confusing psychedelic experience and tell them that it their life will be radically different afterward and maybe they'll believe it so much that it becomes their new reality. Weirdly enough, we have the opposite problem with SSRIs right now because so many patients will start googling side effects and become convinced that they're not going to work before they even take the first dose.

It's an interesting area of research, but I think right now there's too much crossover between the research and the pop-culture phenomenon of "psychedelics cure everything". It's also strange that so few people are questioning why all of the previous psychedelic users didn't notice that the drugs were treating depression. In fact, the common wisdom among psychedelic enthusiasts years ago was that psychedelics were to be avoided if someone was not in a good mental state, largely due to all of the negative reactions they noticed. It seems that telling someone "this will cure your depression" provides a different set and setting than just giving them the psychedelics without context.

Re: Psychedelics and mental illness

#34

Post by kayodelycaon »

seanwilson wrote: post #30

> A few years ago, John Ioannidis (RIP) published an article on conflicts of interest in nutrition research. The conflicts you get in this field, he said, are different from those in, say, Big Pharma-funded trials of new drugs. Not only are there those usual kinds of financial conflicts—some research is paid for by the food industry; nutrition scientists have diet books to sell—but there are “nonfinancial” conflicts,…

> If you become known for producing highly biased research that can't be replicated this is surely going to impact your career so there's a strong incentive to keep this in check?

I would strongly say no.

If the vast majority of studies in the “soft” sciences are already not reproducible, the risk to a person’s career is minimal.

This is before accounting for the pattern of prioritizing short term gains over mitigating long-term risk, especially if that risk is considered to be low.

Re: Psychedelics and mental illness

#35

Post by standardUser »

slibhb wrote: post #16

I like the article. With psychedelics, it's clear that much of the excitement comes from people (including scientists) who have used them and found their experiences helpful. That's not science but that doesn't mean it's wrong. Not everything is amenable to clinical study and this doesn't mean we should disregard it. And the issue isn't just psychedelics being hard to study. Mental health is hard to study. An overwei…

"Lots of people used LSD in the 60s and 70s"

That's an overblown stereotype. The vast, vast majority of people did not use any drugs in that era.

Re: Psychedelics and mental illness

#36

Post by endorphine »

jamal-kumar wrote: post #22
h2odragon wrote: post #2

I know a lot of cannabis fans (and count myself as one). Very, very few of them acknowledge that cannabis affects people inconsistently; one person's reaction to it can be very different than others. This is inconvenient for calling it a "medicine" so let's just ignore it. Psychedelics are even worse. The same dose of the same drug can produce wildly vary effects in the same person depending on factors we have troubl…

It's fun to send this "MAYBE YOU JUST HAVENT TRIED THE RIGHT STRAIN" [1] image to friends who don't like weed because it's a pretty hilarious embodiment of the downright anxiety the stuff engenders in a lot of people. I'm pretty sure it's like a genetic thing. I think I remember hearing something about the COMT gene being potentially affected if you smoke too much too early in life as a teenage stoner or whatever, an…

Cannabis triggered my first panic attack, which then triggered my depression for a few months.

It wasn't the first time I was doing Cannabis, but I haven't done any more ever since then.

Re: Psychedelics and mental illness

#37

Post by zafka »

I would be very interested to know where Stuart Ritchie's funding is coming from these days also. I am rather surprised that he did not list all his sources of income in a show of transparency.

Re: Psychedelics and mental illness

#38

Post by standardUser »

jamal-kumar wrote: post #22
h2odragon wrote: post #2

I know a lot of cannabis fans (and count myself as one). Very, very few of them acknowledge that cannabis affects people inconsistently; one person's reaction to it can be very different than others. This is inconvenient for calling it a "medicine" so let's just ignore it. Psychedelics are even worse. The same dose of the same drug can produce wildly vary effects in the same person depending on factors we have troubl…

It's fun to send this "MAYBE YOU JUST HAVENT TRIED THE RIGHT STRAIN" [1] image to friends who don't like weed because it's a pretty hilarious embodiment of the downright anxiety the stuff engenders in a lot of people. I'm pretty sure it's like a genetic thing. I think I remember hearing something about the COMT gene being potentially affected if you smoke too much too early in life as a teenage stoner or whatever, an…

I'm convinced that the "normal" way Americans consume weed is basically an overdose for most people. Heavy users drive the market and the 30% THC and higher strains are targeted at those high-spending, high-tolerance users. I started to enjoy weed again when recreational stores opened up and I could find 10-15% THC weed that gets me pleasantly high, not paranoid and incapacitated.

Re: Psychedelics and mental illness

#39

Post by banannaise »

kayodelycaon wrote: post #26
slibhb wrote: post #16

I like the article. With psychedelics, it's clear that much of the excitement comes from people (including scientists) who have used them and found their experiences helpful. That's not science but that doesn't mean it's wrong. Not everything is amenable to clinical study and this doesn't mean we should disregard it. And the issue isn't just psychedelics being hard to study. Mental health is hard to study. An overwei…

> Mental health depends on subjective feelings. This isn’t correct in a lot of places. There is a number of diagnostic criteria. The most important being how much it affects your quality of life. This can be directly measured by looking at how the individual functions day to day. An example is “Was the person able to shower regularly?” (This assumes the person wishes to shower if they have the ability and opportunity…

> The most important being how much it affects your quality of life.

This is unique among illnesses. Whether or not I have a cold does not depend on how much it affects my quality of life. Why is mental illness different?

Re: Psychedelics and mental illness

#40

Post by newbamboo »

It’s easier to market “psychedelics” than meditation, prayer or something like DBT. We should learn from that and try to make more things as popular as psychedelics. “Put this little square of paper on your tongue” is much less of an ask than “sit in chair for 30 minutes everyday and be mindful of your breathing.” It’s like the McDonald’s approach to mental health, and who doesn’t love McDonald’s! Over a billion served. Psychedelics scale similarly.
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