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

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

#81

Post by oaktrout »

mtlmtlmtlmtl wrote: post #24
tokai wrote: 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…

Small correction, the active ingredient in Salvia is a kappa opioid agonist.

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

#82

Post by PragmaticPulp »

cypherpunks01 wrote: post #59

This is rubbish. Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting. It is not magic and does not work in every case, but the effects are proven across countless studies. S-ketamine has even gone fully through FDA approval. Personally I have used it at home, and at a treatment center. There is no difference in the antidepressant properties, whether someone was…

> Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting.

It’s really not uncommon for some trials to fail to differentiate from placebo when it comes to depression studies. That doesn’t make this study “rubbish”, it just shows that you need to examine the body of evidence rather than cherry-picking studies that appear to match the outcome you want while dismissing those that say the opposite.

Ketamine is a temporary boost for some people, but it has also been overhyped in recent years. The single biggest downside is that it’s not a long-term solution. The duration of the antidepressant effect is relatively short (days to weeks) and the antidepressant effect appears to diminish with repeated dosing.

It can be a great help for suicidal patients or for getting traditional treatment started, but it’s not a singular solution to depression for most people.

Ketamine prescribing also got out of control fast. I traveled to a city where Ketamine clinics were advertising on the radio and billboards and competing with coupons and discounts and exaggerated promises of efficacy. Reddit and other forums are also filling up with stories of people who think their ketamine “stopped working” because they weren’t properly informed that it was a temporary effect for most people that needed to be combined with traditional therapy. Way too many clinics and influencers looking to ride the hype train without honestly assessing the situation.

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

#83

Post by cubefox »

> But it’s a problem for researchers running double-blinded clinical trials, as participants can usually tell whether they have received ketamine or a placebo. [...] The scientists gave the volunteers ketamine or saline as placebo right after they were put under anesthesia, but before their surgery, essentially blinding them to any psychedelic or dissociative effects.

That's a genius way to avoid unblinding. All psychoactive treatment trials have this problem: placebo controlled studies rely on patients not being able to distinguish whether they are in the test group or the control group. I hope future studies (say, for psilocybin) can also use this study design.

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

#84

Post by tasty_freeze »

ModernMech wrote: post #26
aftoprokrustes wrote: post #17

Earlier quoted context omitted.

As a relatively seasoned meditator, I am absolutely sure that this is the trip that helps, not the chemistry. One way to look at meditation (and, I hear, psychedelics) that fits my experience is that it has the potential effect of opening the range of "ways of looking", to change the way one builds the perceived world. What propulsed my meditation to a totally different level was to see it as a practice of actively e…

Indeed, I remember a while back there was a TikTok filter going around where it made old people look younger. One of the people using it said it basically had cured her self-perception issues; she had been bullied for her looks as a child and internalized that she was ugly. But as an adult when she saw her younger face in the app, she realized immediately how the characterization of that face as ugly was just the per…

There is a similar thing going on with one type of treatment for amputees that suffer from phantom pain in the missing limb. It uses a box and a mirror positioned such that the subject can see a reflection of their existing arm/hand but the mirror spatially locates it to where their missing arm/hand would be.

It isn't a sure-fire cure, but apparently it offers enough relief to enough sufferers.

https://mirrortherapy.com/how-does-mirror-therapy-relieve-ph...

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

#85

Post by throwawaylinux »

cypherpunks01 wrote: post #59

This is rubbish. Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting. It is not magic and does not work in every case, but the effects are proven across countless studies. S-ketamine has even gone fully through FDA approval. Personally I have used it at home, and at a treatment center. There is no difference in the antidepressant properties, whether someone was…

Did you read the article? It explains the study is attempting to narrow down the mechanism for ketamine's effects, not disprove them.

The title is misleading though, unfortunately. What the study found is that Ketamine-while-unconscious is no better.

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

#86

Post by FollowingTheDao »

tasty_freeze wrote: post #78
FollowingTheDao wrote: post #72

Earlier quoted context omitted.

> It is not magic and does not work in every case, That is exactly what they are saying in the study. No better than placebo means Ketamine does not cure depression. If ketamine cured depression it would work in every case. Increasing serotonin receptor density trough Ketamine use may relieve depression, but so can being cared for. Your beliefs do not matter, biology matters. And it may in fact be that your "strong b…

I don't have a position on the paper (I haven't even read it), but this statement you just made seems unjustified: > If ketamine cured depression it would work in every case. Depression can have many different causes, and people have many different biological variables, so it should not be surprising that a given treatment isn't 100% effective. There are many example of this in the real world. With your logic, one mi…

> Depression can have many different causes,

Then why this singular focus on ketamine and psychedelics all the sudden? If it has many different causes why focus on activating a single serotonin receptor?

> and people have many different biological variables, so it should not be surprising that a given treatment isn't 100% effective.

Yes, and that is why we need to stop recommending mediation to people without knowing/researching the cause of each individuals depression. Why is there such limited nutritional and genetic testing on people with severe depression?

> With your logic, one might say: the sars covid-19 virus doesn't cause illness because some exposed people showed no symptoms. The families of the dead people would disagree.

If SARS2 does not cause illness in me that is all I care about. And if it does not cause illness in me you should all be interested in me.

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

#87

Post by PragmaticPulp »

arthur2e5 wrote: post #70
cypherpunks01 wrote: post #59

This is rubbish. Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting. It is not magic and does not work in every case, but the effects are proven across countless studies. S-ketamine has even gone fully through FDA approval. Personally I have used it at home, and at a treatment center. There is no difference in the antidepressant properties, whether someone was…

The study actually shows ketamine works as well with anesthetia (45%) as without (40%), if you read the non-anesthetia study linked in https://news.ycombinator.com/item?id=36030251 . (Of course you can argue they are not using enough K at the 0.5 mg/kg mark, because disccociation starts at 1 to 3 mg/kg per StatPearls.)

> Of course you can argue they are not using enough K at the 0.5 mg/kg mark, because disccociation starts at 1 to 3 mg/kg

Dissociation isn’t necessary for the antidepressant effect, according to studies. In fact, many of the more responsible clinics target longer duration, lower peak dose infusions for this reason.

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

#88

Post by SiempreViernes »

mtlmtlmtlmtl wrote: post #40
SiempreViernes wrote: post #27

Earlier quoted context omitted.

Actually, what it shows is both that getting ketamine while under general anaesthesia is roughly as effective as when taken without anaesthesia (40% here vs 45% in [1]), and as effective as just taking anaesthesia (their placebo treatment). [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992936/

I see. But this seems to cast even more doubt onto the use of general anaesthesia as an active placebo. I mean, usually people waking from it don't feel great because they're very ill or had major surgery. Maybe in the abscence of things like that it could have some antidepressant effect. Things similar to this have been used as treatment in the distant past of psychiatry as well, when ethics was nowhere to be found.…

To be precise, the anaesthesia is part of the masking procedure, the placebo is a saline injection that was administered the same way as the ketamine (in practice the ketamine was simply diluted in a saline dose that is then given to the patient).

Of course, getting all those anaesthesia drugs into you could mess up the body chemistry in all sorts of ways that make the ketamine not work, but it is still very surprising that the net effect of this big cocktail of substances is that you get basically the same outcome regardless of treatment method.

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

#90

Post by automatic6131 »

cypherpunks01 wrote: post #59

This is rubbish. Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting. It is not magic and does not work in every case, but the effects are proven across countless studies. S-ketamine has even gone fully through FDA approval. Personally I have used it at home, and at a treatment center. There is no difference in the antidepressant properties, whether someone was…

>Ketamine is a life-saver

Anyone who talks in such terms shouldn't have their opinions on medicine listened to. There's a reason that medicine typically sticks to such terms as QALY (quality adjusted life year) and other such terms to produce the best outcomes in a resource constrained environment.

By your reasoning, many things are "life savers", but not every intervention is equal, is it?

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