Similar psychedelic therapy claims—for LSD/psilocybin alleviating cancer-related anxiety/depression—have echoed since the 1950s-1970s, yet they've never panned out into practical, scalable clinical therapies. This alone should raise a MASSIVE Bayesian statistics red flag, due to prior discount: with decades of unfulfilled hype. At this point new evidence requires extraordinary proof to update our view.
If such massive effectiveness were true, it would blow what we already have out of the water, and I would be the first to promote it to my patients. But you know what they say when something sounds too good to be true.
https://www.prnewswire.com/news-releases/compass-pathways-re...
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Breakthrough Therapy designation means they can continue to study it with support.
It does not mean it’s approved for depression.
When I was a teen a friend gave me an analogy that stuck with me. In much older computers (e.g. C64, Vic-20, etc), they'd behave "interestingly" when you mucked around with the physical circuit board or there was a fault. E.g. if something short circuited because a screw was loose in the board, or a cartridge was halfway in or a chip partially desocketed, etc. Characters would appear in random places, or the machine go through odd loops and so on. And to someone who didn't know how the machine worked, there could be a certain "magic" and a "pattern" to this. But clearly you'd be missing the point if you thought you had "enhanced" the machine this way.
LSD and psilocybin are kind of like that, but for your brain. They short circuit and alter pathways. In ways that can be entertaining but you're entirely missing the point if you try to assign a higher meaning to them.
Our brains are expert pattern-finding machines, and produce causes and reasons even when there are none. For some there may be value in the experience of altering the operation of your brain to get yourself out of a stuck pattern, I guess. But I am not sure the very random stochastic nature of the whole thing is ... medicinal.
Legalization has never been a question of “is this good for people?”
Then again, I think it's important that my views are never imposed on anybody. So it's perfectly fine to be a pure hedonist and use everything under the sun.
The dose makes the poison, though. So I think that limited use of alcohol, cannabis, shrooms, and LSD might be useful to gain new perspectives, serve as a social lubricant, or even provide some form of temporary relief.
The drug isn't really the problem; it's the pattern of use. So maybe I should have said that "most drugs are mostly used in a terrible way, to such an extent that they become terrible by default."
If I were to try anything, psilocybin would be high up the list of stuff I would like to try. Just to see what effect it would have on me. I suspect little (every life-changing, perspective-changing experience people yab on about never changed anything for me once they actually happened to me, and I am 100% immune to hypnosis and personality change when drunk), but it would be interesting to see.
That is true, but it misses some important nuance: the war on drugs has effectively eliminated the ability for legitimate researchers to do significant research on these criminalized drugs.
For example, for me personally, a mild dose of marijuana is as effective as Zolpidem (Ambien) as a sleep aid, but without the lethargy and mental fog the next morning.
That's not true any more. We have a substantial body of data already from clinical trials and a huge number of trials currently in the pipeline. The results from completed trials are quite equivocal - while psilocybin does appear to work as a treatment for depression, anxiety and other common psychological disorders, we have no evidence yet to suggest that it is meaningfully more effective than current treatments.
We have good reason to believe that psychedelics may be useful for some patients in some circumstances, but the widespread talk of a revolution in psychiatry is pure hype.
https://pubmed.ncbi.nlm.nih.gov/?term=psilocybin&filter=pubt...
https://clinicaltrials.gov/search?intr=psilocybin&aggFilters...
For many people (myself included) taking psychedelics was an immediately life altering experience. I don't need any more scientific validation that psychedelics helped me than I would need to prove that touching a hot stove burned me. It's an immediate and unmistakable effect that is wholly different from any other experience I've had.
Now, proving that these drugs would be beneficial at a population level may be an unanswered scientific question. But, to quote you: "trying to prove psilocybin works for psychiatric illness" - well, that's been done. The people who have been helped have all the proof they need. I think the issues you've raised are more properly targeted at the question "should we recommend psilocybin treatment to depression patients more broadly" which is in fact a much higher bar than "do they work?"
I would only add that it's extremely hard to know if something actually works. There are seriously some medications that people claim don't work, but objectively they are healthier, happier, more social, more active, and "better" on almost every objective measure. An example of this is when you really have a good match with venlafaxine for co-morbid panic disorder and depression.
Then there are drugs everybody claims are good for them, but they almost never are, especially in the long run. Basically, all of the benzo sleeping aids (in the context of chronic use).
So I can't and won't say you are not right. But I hope you permit me my goal of finding "objective" markers for saying "something works." Because, to quote Murderbot, "Humans are idiots!" (me included). And self-report is a notoriously unreliable measure.
Even taking the data at face value, the trial cannot disentangle the drug effect from expectancy, psychotherapy, and statistical noise. The enormous effect sizes are almost certainly inflated, multiple-comparison error is uncontrolled, and the participant pool is highly self-selected. Until a preregistered, parallel-group, active-placebo, adequately powered study with blinded independent raters replicates these findings, their practical value for routine cancer care remains minimal.
It’s so interesting to see how strong the drive to prove something works is, overriding everything. As a clinical psychologist, I would welcome this kind of therapy if it worked. But this is just sad. It’s just like listening to people claim that ivermectin can cure everything.
Show me one place where this therapy is conducted by people who haven’t "drunk the Kool-Aid," and I’ll be impressed. It’s so frustrating to work with actual patients and see how much these therapies really don’t work in reality. These kinds of biased studies pop up all the time without actually panning out. I’m starting to think that people promoting therapy, giving false hope, and spending money on research like this should be viewed as corrupt and evil.