My experience with ketamine treatment for TRD is that it was lots of awesome shapes and colors and sense of melting into the floor, but definitely no communion with "god" or "mystics", no special reexamination of the self or amazing new perspective. Despite that, I still experienced some improvement in symptoms.
I would hope that pharmaceutical research can reduce the time and expense related to this treatment and the side effects like nausea, and less on the moral panic that some people use these drugs for fun somehow.
This claim has been the prevailing view of almost every psychedelic researcher from the 60s until ~10 years ago. It was also a big contributor to there being almost zero human research into psychedelics over that time period.
It's still the prevailing view today, but not talked about because researchers can actually get funding if they lie about it.
The common theme is that all these things change perspective, and none of them are entirely safe.
I've heard people also make similar comments to the LSD or psylocibin experiences as well. In my personal experience, that's purely a matter of dosage. Sounds like an obvious thing, but not everyone knows how a particular dosage will affect them. Any particular dose that is just a fun time for one person might be 1:1 meeting with a higher power for someone else.
This is where I hope honest legal regulation would help. Rather than having to think about how many stems/caps you can eat from SourceA vs SourceB, you can just take a capsule that is accurately measured at X mg. Maybe you need to take half or take 2, but at least it would be the same each time.
Instead of selling xxx tonnes of xanax&co per day worldwide and make absolutely outrageous profit doing so ? Doubt
Ketamine is well known to have great anti-depressant effects, but since it's long out of patent, no one has the incentive to spend $1B to get the FDA approval for it.
So J&J invented the chiral twin molecule (the mirrored version), got it approved, and it's now sold as Spravato.
To me this is 100% a regulation bug rather than some misfeature of capitalism or corporate greed.
The bug is that we don't incentivize funding expensive studies to discover unpatentable (i.e. cheap) treatments.
The minimum "patch" would be that the governments of the major drug markets decide that effort and discovery of applications count as a basis for patents. Then a drug maker could fund their studies based on which drug candidate is the most promising, not which is the most promising but also novel and thus patentable.
Much better, would be to have the governments presiding over the major drug markets get together and create a proportional fund to cover studies for the public's benefit. The economics of that would be similar to private companies, but at least the profits would go towards further research.
That's actually not how it works.
When a drug is FDA approved for a certain use, doctors are free to prescribe it for anything the think it's useful for. This is called "off label" use, and is ~20% of prescriptions in the US. This "loophole" cures a lot of people!
And there are some clinics who do use regular Ketamine for depression. The main problem for them is that insurance will not cover this usage.
> The bug is that we don't incentivize funding expensive studies to discover unpatentable (i.e. cheap) treatments.
This I agree with. Though I'd expect some philanthropic billionaire to get to that long before any governments would.
Also, while some see the trip as the point of this, I woke up at knife point due to psychosis caused by that. Yet it also really does basically cure depression, if not accompanying anxiety, and it is known to cause new psychosis.
So I hope this works out and can be used on people who really need to avoid the psychosis caused by ketamine.
So that number was probably 10x off. That doesn't change the conclusion though.
I learned all this from Scott Alexander. All details here: https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...
Are you saying that SSRIs trigger changes in the brain? What changes? Why do they trigger these changes?
Genuinely curious.
If you're interested enough to watch a whole talk about this (you can jump to around 26 minutes): https://www.youtube.com/watch?v=k2AdebIbx5Y
Edit to add: Downvotes even though in 2015 the FDA required "black box" suicide warnings on SSRIs because what I'm saying is true?
The problem is, everybody's brain chemistry is unique and different, because our genetics are different. Some antidepressants work for some people and not others. I've personally tried 5 of them. Only one of them worked on me, and it had some unfortunate side-effects (messed with my sleep). My ex-girlfriend used a different antidepressant (Zoloft). Personally, I've tried Zoloft and all it did was make me sleepy all the time, but I've found Lexapro was quite effective and useful for getting my life back on track.
The way efficacy studies are done right now is, we measure the average effect on a group of people. That's doesn't really make sense when you think that everyone's genetics are unique and the antidepressant could be making some people better and some people worse, right? Maybe half the group feels better, but a quarter of the group becomes suicidal. Then on average, you see scores going up, you see the drug is beneficial on average... It would be kind of like giving everyone in a group a prescription for eyeglasses, all with the same prescription, and measuring that on average, participants can read better with the eyeglasses than not.
In some ways, modern medicine is still very primitive. Flooding the whole brain with a chemical and hoping that it interacts with the right receptors and has a beneficial effect without too many side effects if you have the right genetics is very primitive. It's the best we have right now though, and antidepressants in general are probably more helpful than not, but yes, people SHOULD be aware that they might very well not work on them.
MDMA, for example, seems far superior than anything else on the market - and what it does is simply causes the brain to release more serotonin than it normally would; SSRIs (etc) don't do that, they change how the brain actually functions.
Your argument that "in general are probably more helpful than not" also then means you are okay that MORE PEOPLE kill themselves taking the SSRIs than would have otherwise - so you're okay with people dying, when rather there are alternatives - they just aren't mainstream because they haven't been promoted and marketed to doctors, nor advertised to manipulate people via ads by the pharmaceutical industry; I don't think that's acceptable or reasonable.
The "tradeoff" is MORE PEOPLE die of suicide with SSRIs (et al) being prescribed than if they weren't allowed to be prescribed.
"MDMA is know to commonly cause depressive crashes" is another shallow-narrow scope counter argument you put forward. A "depressive crash" - and arguably, in the right container with the right guidance can be avoided, and in fact is underlying depressed state that a person is connecting to - is not akin to people literally killing themselves from SSRIs.
'"Suicide Tuesday" is the nickname given to the trend for people who use xtc all weekend committing suicide when they fully come down from the high on Tuesday.'
You're bringing in abuse, an excess of something, as a supportive argument point? People also accidentally or purposefully recklessly drink too much or take too many opiates - perhaps in hopes they die.
You also put forward a straw man argument - I never said MDMA was a panacea.
Are you aware of the MAPS.org FDA approved clinical trials for MDMA-assisted psychotherapy for veterans with an average of 17.5 treatment resistant PTSD, where after just 2-3 sessions, in 1 year time 80% no longer qualified for a PTSD diagnosis vs. the placebo group where 80% had no improvement? Using therapeutic doses of 100-120mg.
Do you know what the efficacy of SSRIs are, what the tradeoff your arguing and in support of? 3-7% better than placebo depending on the research you look at - and you kill people (through suicide and homicide) that otherwise wouldn't have died; and this happens at prescribed doses, not abusing the medications.
5HT2C activation can be very, very uncomfortable, and can exacerbate depression, anxiety and suicidal thoughts. Downregulation results in an equilibrium where those feelings and symptoms are relieved over time, however.
[1] https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
And there are other options - far better, far less harmful options do indeed exist - but the medical-pharmaceutical industrial complex hasn't made them widely known or available because getting people dependant on (due to severe withdrawal in most cases, another thing they lied about; like how it was lied about the new opiates weren't addictive to get them mass prescribed) medications that are patented allows pharma to make an increasingly large recurring revenue stream; and who cares if X% of MORE people kill themselves than otherwise would have if you're now making many $ billions per month - and as a doctor all you need to do to "help" someone, and the only competency and knowledge you need, the most shallow complexity you need to understand, is to write a prescription for someone?
And then the other side of the coin is the increased homicide, and the responsibility that people they should take on if they want these medications available - on top of being in part responsible for the increased suicides - are all of the mass shooting deaths; let alone the increased ideology and antisocial behaviour we have in society could arguably be heavily influenced by these medications as well, and the widespread harm that causes to society.
If you're meeting god on your trips, I'm willing to bet you believed in god to begin with, and possibly believed you would meet him before your trip started. You see what you were expecting to see. To say that there is a religious-mystical component of the psychedelic experience, well, if its real it for sure isn't universally felt.
I love the headspace that you get into during the trip. It is great for finally addressing issues that you have set aside. After the trip however, you think that all your ideas are good, then it wears off, so either way it is not useful just by itself.
I would even classify this realization as an exception to your "is not useful" rule.
If the supposed anti-depressant effect of whatever specific molecule they claim doesn't induce relatively rapid nerve generation, opening up previously closed or blocked off pathways - that pruned off arguably due to trauma and lack of use - then they likely aren't as powerful as where the mystic effects come from; it's the temporary turning off, removing the ego mind from the algorithm of the mind/the mind's eye - allowing you to see reality very differently then you've been formed rigidly in beforehand; some tribes give Ayahuasca to their babies to keep them open as they develop, rather than letting trauma and/or natural processes lock them into more narrow behaviour and thinking patterns.
About the god thing, my 2 cents. "god" doesn't always mean Christian White Old Guy on a Cloud Looking Angrily Downwards. There's a less narrow interpretation.
If psychedelics strip away your day-to-day preoccupations, and show you life with a vastly different set of mental filters in place, many people experience a transcendent feeling of belonging to something bigger than their sober selves. A connectedness to other humans and nature that goes beyond ordinary experience. The idea that death isn't so bad, only suffering is; and suffering is the price we must pay for the ability to see its opposite, beauty.
Which people then conversationally condense to "yeah you meet god"
Imagine a chronic obsessive cellphone gazer. One day he lifts his nose from the screen. Sun! Clouds! Birds and squirrels!
Except moreso.
So no deities but spiritual like what you said.
I don’t think anyone would earnestly claim that there is zero risk to any hallucinogenic experience. One of my hopes is that through study we can better understand the ingredients that lead to profoundly positive experiences vs. profoundly traumatizing experiences. And anyone who claims we know that today is acting in bad faith.
Terminal cancer patients, those expecting to die and “meet God” soon, are a very, very niche audience compared to a general population with non-specific major depressive disorders.
But at the same time, I love this. The more study, the better!
Griffiths' research is all high quality. He is the pioneer in making this field of scientific research palatable to the mainstream medical establishment.
It's anything but simple if you're depressed. You seem to think that insight drives motivation, but in depressed people these are often decoupled. You can have all the insights you want but the motivation to do anything just does not manifest.
it's a little tongue-in-cheek. of course changing your life is hard. but, if you are dissatisfied with your life, it is also the only solution.
My friend was suicidal, and psilocybin was the only thing that made him go back to wanting to be alive (though the effect only lasted ~2 weeks each time).
As someone with somewhat first hand experience with this, it's not exactly "gives them the energy".
The anti-depresents I started taking worked exactly as advertised. The "problem" was I wasn't just depressed, I was also just not happy with life. Anti-depresents can get you out of a depression but they won't make you happy.
It was a bit enlightening to understand the difference between the sadness I felt and the depression but it can also make you feel more helpless when the depression lifts and you still don't really want to wake up tomorrow.
As a result of this experience, I think it's irresponsible to prescribe anti-depresents without accompanying therapy.
Take "it just showed me that I want to die" and unpack every single word into an absurdly and "pedantically" complex, comprehensively and perfectly correct articulation of the(?) precise meaning in this context. In doing so, use various forms of articulation, not only paragraph/narrative form.
If you are doing it right, ideally you will find yourself having to fight against your own mind at several points during the analysis.
Work on the problem for a month or six, even just two or three minutes at a time now and then. I propose that at the end of this process, you will possess more knowledge than you did before.
There are various techniques to accelerate this process, but I will let you figure those out on your own along the way. As a hint: consider various topics of discussion that arise on the website you are on.
I should probably also note: this is not necessarily a risk-free undertaking, so maybe build some safeguards into your methodology.
"unpack the meaning of a word"...this makes sense?
but obviously nobody can make a fortune with these simple advices.
Funny but I have come to regard the "effort and commitment" as part of the recovery mechanism. Causal or concomitant, I have no idea, let's just say 'linked'.
By the same token I have come to regard "convenience" as, if not a great evil, some kind of joker/trickster that lures us down a dark path.
Insurance likes low variance outcomes because they’re easier to model accurately
And I don’t know what the statistics are, but a significant percentage of people with gym memberships rarely go to the gym. I suspect the percentage of people with free (i.e. payed for by insurance) insurance who rarely go would be much higher.
Maybe your doctor should even get a small reward each time you pass the basic health check, so that in aggregate they are better aligned with keeping people in shape for those checks.
Because neither of those things are necessary to exercise.
I bet if you asked your GP for some body weight exercises you could do at home he'd happily provide some for you and insurance would cover the visit.
Giving pills to these people is a crime
It's our place as a society to ask questions and be very concerned about the fact that more and more people need medication to operate as normal human beings, especially when these medications are dangerous and/or addictive
These things are prescribed way too easily to people who have tons of others ways to get out of their issues without relying on these potentially dangerous drugs.
Medication definitely has a place, but the current trend of over prescription is very alarming.
It's so much more complex than "take that pill and you'll be happy", in lots of countries these things are prescribed by general practitioners without any kind of mental or lifestyle evaluation. You just show up there: "hey I feel down and anxious" and boom you go home with 6 months of xanax. In my country (France), 25% of people consume antidepressant in any given year, 12% are regular users, several studies concluded that out of these 25%, only 1/3rd have signs of depression [0], I know it's the same thing in other EU countries, and apparently also in the US [1]
[0] https://www.slate.fr/monde/76468/depression-medecins-prescri...
[1] https://archive.nytimes.com/well.blogs.nytimes.com/2013/08/1...
Obviously people do that and it works for a handful, but rather ineffective in general.
> willing to suffer a little bit.
Yeah, no. That's definitely not something a seriously depressed person can do, I say as someone doing that now. People who suggest these things are completely out of touch with what depression means. You'd be lucky if they were taking shows at all.
Study with 22 people with major depression: "Treatment with both omega-3s was associated with a significant improvement in depression, with an average 64% drop in symptoms for the EPA group and 71% in the DHA group."
https://www.webmd.com/depression/news/20210618/fish-oil-supp....
i.e. worthless. DHA is being studied and has massive effects on inflammation but the science is definitely not there for depression. You need to adjust your epistemology if you are making decisions based on tiny studies like that.
1. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Certainly not and considering the almost non-existent side effects, it is at least worth a try since it looks very promising. You are right that it is a tiny study but it doesn't mean that it has no value.
I have to say that I know people like you very well, I almost can hear the "go see a therapist and take your meds" or better "don't try and certainly don't think you can solve this on your own". A positive force first and foremost acknowledge people's potential and doesn't put roadblocks everywhere.
If you take the wrong zinc brand it gives you the worst nausea of your life. Although I haven’t heard of even good ones helping with depression - it is a pretty strong aphrodisiac and testosterone booster, but that’d just be an additional distraction on top of being sad.
"According to existing literature there is an inverse relation between magnesium and depression. " https://johs.com.sa/admin/public/uploads/187/46_pdf.pdf
While you N=1000-reddit-teletubbises try to hold back humanity the N=1 change the world.
Intellectually you can agree that all those things are worth doing.
But some deep calculating part of your mind will see that between hard work that will not help, and doing nothing which will also not help, the latter is the rational choice.
2. Tons of depressed people are still depressed even though they exercise, eat well and sleep.
3. Tons of people are making fortunes peddling these and similar 'cures' to everything :)