6 ms·

The recent emergence of studies suggesting psychedelics as a novel means of treating depression and other mental illnesses is a double-edged blade: the sheer ca

The recent emergence of studies suggesting psychedelics as a novel means of treating depression and other mental illnesses is a double-edged blade: the sheer capability of drugs like LSD and psilocybin and ketamine to hard-reset the brain's pathways is a huge leap from the accepted style of treatment that often boils down to "Take these pills, check in each week, maybe you'll feel better in a month or two." However, it also gives people the false impression that all they need to do is chew on some shrooms and listen to the Grateful Dead for a couple of hours and suddenly they will be free of all addiction and depression forever. Every time a study like this comes out there is a predictable pattern in patients' depression scores: immediately after psychedelic treatment, depression signs plunge, wade around the low end for a while, then steadily creep back up. With the exception of people whose brains simply do not work as they should (I have a friend who is chronically depressed because his body can't produce enough serotonin even with antidepressants), depression is often as influenced by external factors as internal ones. A spectacular drug trip won't change the reality of having a death in the family, not being able to find a job after being laid off at 45, or simply the stress of the modern, always-on world. Discoveries like these are always helpful towards understanding the brain and how to formulate effective treatment, but in the end, mental health will always be vastly more complex and harder to cure than any physical ailment. There will never be anything close to an ibuprofen for the brain.

RankingMember 10y ago
> A spectacular drug trip won't change the reality of having a death in the family, not being able to find a job after being laid off at 45, or simply the stress of the modern, always-on world. It's true that drugs won't change reality, but our interpretation and reaction to reality is what's important, and therapy/drugs can certainly change that.
- rincebrain 10y ago
  One of the more interesting properties of ketamine that underscores your statement is its effectiveness in treating PTSD...[1] ...as well as lowering the incidence of PTSD among people who had been treated with ketamine as an anesthetic prior to a traumatic experience. [2] [3] [1] - https://www.ncbi.nlm.nih.gov/pubmed/24740528 https://www.ncbi.nlm.nih.gov/pubmed/24740528 [2] - http://www.biologicalpsychiatryjournal.com/article/S0006-3223(15)00360-1/abstract http://www.biologicalpsychiatryjournal.com/article/S0006-322... [3] - http://www.dtic.mil/get-tr-doc/pdf?AD=ADA480518 http://www.dtic.mil/get-tr-doc/pdf?AD=ADA480518
llamataboot 10y ago
#1) The serotonin theory of depression has seen way better days. There's simply no way you (or anyone) can say with such reductive certainty that your friend is "not producing enough serotonin" http://bigthink.com/devil-in-the-data/the-chemical-imbalance-myth http://bigthink.com/devil-in-the-data/the-chemical-imbalance... #2) The novel method of ketamine doesn't really appear to be related to the psychedelic trip itself -- indeed many people are using regular sub-threshold doses of ketamine in their self-designed regimens and seem to be getting good results. LSD and psilocybin treatment seems to be mostly about insights gained during the experience -- much like a supercharged therapy session. Ketamine on the other hand, appears to have some sort of mode of action that isn't about insight and is more about a "brain reset" of sorts. #3) I do agree with you that mental health issues defy reductivity simply because they encompass biological, psychological, and sociological systems that all interact.
- rm_-rf_slash 10y ago
  All good points, although I would supplement that "microdosing" tiny amounts of powerful hallucinogens (with doses so low that psychoactive effects can barely be registered) has also gained traction in recent years. Proponents of microdosing argue that taking 1/20th of a tab of acid every few days allows them to remain productive while under the influence, and that the effects are more positive and profound than they have experienced with traditional antidepressants. It's no silver bullet but it is an option that merits further study. http://motherboard.vice.com/read/a-brief-history-of-microdosing http://motherboard.vice.com/read/a-brief-history-of-microdos...
drumdance 10y ago
> With the exception of people whose brains simply do not work as they should Exactly the people these treatments target. I'm on of those people and I have never thought I could "chew on some shrooms and listen to the Grateful Dead for a couple of hours." Quite the opposite. Depression makes you think nothing will work. When I'm in a depressed state it takes a tremendous amount of will to do anything, including taking medication of any sort or even getting out of bed for that matter. Fortunately SSRIs work for me, as well as tight control of my diet and exercise. Exercise alone has never made a difference for me, though. One of the worst episodes I ever had came at a time when I was in the best shape of my life, working out everyday.
- martin1975 10y ago
  that mirrors my experience w/depression prior to having it diagnosed. I knew something was up, and tried to self medicate in a number of ways, among which dieting, exercising and long term fasting was present. Everything seemed to help a bit, kind of mask the turmoil of the anxiety and panic that was going on, but eventually my 'nature' took over and I'd go back to feeling like doomsday's around the corner... SSRI seems to have done the trick. Apparently we all produce "normal amounts" of serotonin, but with depressed folk like myself, the serotonin doesn't hang on the synapse long enough ...i.e. our specific biology depletes it faster. Looking at my wider family, this condition is so pervasive ... and inherited, it's not even funny in all the ways it wreaked havoc on people's lives in many ways. Glad I caught a break.
  - stuxnet79 10y ago
    Based on your description it seems like we suffer (or in your case 'suffered') from the same condition. I've been suffering from panic-disorder since my mid-teens and it is only recently when I tried an MAOI that my doctor recommended that I've seen the condition lift a bit. There is some co-morbid depression but I believe that is a result of the anxiety and not the reverse. The MAOI is effective but my anxiety still flares up from time to time, and I've been thinking of other ways I can try to improve my state of mind. I'm not even sure how I would broach the subject of ECT, as I haven't experimented with enough drugs to know if they are all ineffective. However, these trials give me hope that in the future we will have better ways of dealing with anxiety / panic disorders. > Looking at my wider family, this condition is so pervasive ... and inherited, it's not even funny in all the ways it wreaked havoc on people's lives in many ways. Glad I caught a break. I agree, it is quite sad. Like right now I'm certain that my father is depressed although the reasons for this are somewhat interconnected with real life events like unemployment, loss of loved ones, etc ...
PragmaticPulp 10y ago
Ketamine is quite different than psychedelics, so the two can't be compared. It's also important to note that the recent study of psilocybin in treatment-resistant depression was extremely preliminary and not of good quality. The sample size was very small (n=12), there was no placebo control group (huge red flag in any depression study), and nearly half of the patients indicated previous psilocybin use. Placebo control groups are absolutely critical in depression studies because the placebo response rate for depression is incredibly high. Moreover, placebo response rates are actually rising in recent years for unknown reasons. It's not uncommon for the placebo control group in a depression study to have response rates upwards of 60%, at least in the short-term timeframes of clinical studies. When you read sensational news articles about how SSRIs are barely better than placebo, remember that placebo is pretty damn good (again, in the short-term) at producing a response in depression studies. The story changes in clinical practice over the long-term, of course, but the point is that separating placebo response from actual treatment effects is critical for assessing anti-depressant efficacy, and psychedelic (not ketamine) studies lately have omitted placebo control groups completely, which is unfortunate. It gets more complicated, though. In the case of psychedelics, the placebo effect may actually play a central role in the anti-depressant effects. Psychedelics are known to induce suggestibility and create a false sense of enlightenment. If that suggestibility and sense of enlightenment is deliberately framed in the context of depression treatment and actively guided by clinicians, as in the studies, then perhaps it's possible that the psychedelics are at least partially acting as an instrument for amplifying the placebo effect. To the depressed patient, it doesn't matter if the result is placebo effect or not, as long as the end result is the same. At that point, the real question is whether or not the end result is the same. > However, it also gives people the false impression that all they need to do is chew on some shrooms and listen to the Grateful Dead for a couple of hours and suddenly they will be free of all addiction and depression forever. I completely agree that public and media perception of these experimental depression treatments is completely off base. There is a lot of interesting potential in here, but many people are walking away with an idea that they can self-medicate their problems away by themselves in their basements. There are many people in forums and subreddits chasing ill-conceived plans to treat themselves with psychedelics or NMDA antagonists in ways that don't match the study protocols at all, and it's all very concerning. > Every time a study like this comes out there is a predictable pattern in patients' depression scores: immediately after psychedelic treatment, depression signs plunge, wade around the low end for a while, then steadily creep back up. Unfortunately, the same pattern is observed in placebo control groups for depression studies. That's why it's so critical to have a placebo control group such in depression studies. > With the exception of people whose brains simply do not work as they should (I have a friend who is chronically depressed because his body can't produce enough serotonin even with antidepressants), depression is often as influenced by external factors as internal ones. Your comments on external factors are spot-on. Training the brain to have healthy responses and coping mechanisms, as in CBT, is critical to depression treatment. However, the comments about your friend's brain not producing enough serotonin is more pseudo-science than real science. I don't doubt that doctors have told your friend that, but it's a metaphor at best. SSRIs don't cause the brain to produce more serotonin, they modify the dynamics of serotonin transmission. The anti-depressant effects come from downstream changes that result from that alteration in serotonin dynamics, which are complex and multi-faceted. But depression isn't simply a function of serotonin levels or balances like the over-simplified explanations would suggest. It's entirely possible to increase extra-synaptic serotonin functions well beyond normal, healthy ranges with medications without making the patient "feel" good. Depression is massively complex, and we modulate serotonin because it's one of the easiest and safest paths to manipulate brain function, not necessarily because patients don't have "enough" of it. > mental health will always be vastly more complex and harder to cure than any physical ailment. You're absolutely right that effective mental health treatment requires more than just a pill. But having effective medications to augment healthy mental habits, coping mechanisms, and CBT-type treatments makes it a whole lot easier.
witty_username 10y ago
> stress of the modern, always-on world There was stress in the old world too. Also, we work less than historically. I'd argue today's world is less stressed.
- qntty 10y ago
  We work less than people did during the industrial revolution, yes. But not less than before the industrial revolution. http://groups.csail.mit.edu/mac/users/rauch/worktime/hours_workweek.html http://groups.csail.mit.edu/mac/users/rauch/worktime/hours_w...
GavinMcG 10y ago
Doesn't a finding like this move us a big step away from that double-edged problem? I would dispute your claim that people think all they need to do is chew on some shrooms, etc. – I've never seen an article that suggested anything of the sort. But even if that were the case, discovering that the psychedelic effects may be separable from the antidepressant effect moves us away from that idea. Yet you seem to treat this news negatively.
- rm_-rf_slash 10y ago
  Sadly, you seem to have missed my point, which is not to say that there is anything wrong with the science, but rather folks who would read the same article and think "maybe all I need is a good trip and I don't need no stinkin' doctor to tell me what to do or how much to take."
  - aminorex 10y ago
    At a guess, the majority would be correct. In general, physicians, like all humans, are incompetent and self-interested. Absolving yourself of personal responsibility by ceding your autonomy to an authority figure rarely works out. This is why I hate compulsory government healthcare: Physicians cease to be employees or voluntary servants who help, and become police (or tax farmers) who control and exploit. It is human nature.
    - GavinMcG 10y ago
      > In general, physicians, like all humans, are incompetent and self-interested Self-interested, perhaps. But assuming that physicians are representative of the broader population when it comes to incompetence is really poorly-grounded.
      - aminorex 10y ago
        I have had close friends killed by grossly incompetent diagnosticians, and seen numerous botched and often superfluous surgeries. Completely anecdotal, but evidently typical of rural environs.
psbp 10y ago
"depression is often as influenced by external factors as internal ones. A spectacular drug trip won't change the reality of having a death in the family, not being able to find a job after being laid off at 45, or simply the stress of the modern, always-on world." Have you ever taken hallucinogens? You don't experience a "spectacular drug trip" and suddenly feel better, you actively work on your problems and have a seemingly raw, uncompromising perspective on the external/internal factors that affect your life. It's a bit like expedited therapy. It's a trying, intentional experience that you have to put effort into in order to get any benefit.

RankingMember 10y ago

> A spectacular drug trip won't change the reality of having a death in the family, not being able to find a job after being laid off at 45, or simply the stress of the modern, always-on world. It's true that drugs won't change reality, but our interpretation and reaction to reality is what's important, and therapy/drugs can certainly change that.

rincebrain 10y ago
One of the more interesting properties of ketamine that underscores your statement is its effectiveness in treating PTSD...[1] ...as well as lowering the incidence of PTSD among people who had been treated with ketamine as an anesthetic prior to a traumatic experience. [2] [3] [1] - https://www.ncbi.nlm.nih.gov/pubmed/24740528 https://www.ncbi.nlm.nih.gov/pubmed/24740528 [2] - http://www.biologicalpsychiatryjournal.com/article/S0006-3223(15)00360-1/abstract http://www.biologicalpsychiatryjournal.com/article/S0006-322... [3] - http://www.dtic.mil/get-tr-doc/pdf?AD=ADA480518 http://www.dtic.mil/get-tr-doc/pdf?AD=ADA480518

llamataboot 10y ago

#1) The serotonin theory of depression has seen way better days. There's simply no way you (or anyone) can say with such reductive certainty that your friend is "not producing enough serotonin" http://bigthink.com/devil-in-the-data/the-chemical-imbalance-myth http://bigthink.com/devil-in-the-data/the-chemical-imbalance... #2) The novel method of ketamine doesn't really appear to be related to the psychedelic trip itself -- indeed many people are using regular sub-threshold doses of ketamine in their self-designed regimens and seem to be getting good results. LSD and psilocybin treatment seems to be mostly about insights gained during the experience -- much like a supercharged therapy session. Ketamine on the other hand, appears to have some sort of mode of action that isn't about insight and is more about a "brain reset" of sorts. #3) I do agree with you that mental health issues defy reductivity simply because they encompass biological, psychological, and sociological systems that all interact.

rm_-rf_slash 10y ago
All good points, although I would supplement that "microdosing" tiny amounts of powerful hallucinogens (with doses so low that psychoactive effects can barely be registered) has also gained traction in recent years. Proponents of microdosing argue that taking 1/20th of a tab of acid every few days allows them to remain productive while under the influence, and that the effects are more positive and profound than they have experienced with traditional antidepressants. It's no silver bullet but it is an option that merits further study. http://motherboard.vice.com/read/a-brief-history-of-microdosing http://motherboard.vice.com/read/a-brief-history-of-microdos...

drumdance 10y ago

> With the exception of people whose brains simply do not work as they should Exactly the people these treatments target. I'm on of those people and I have never thought I could "chew on some shrooms and listen to the Grateful Dead for a couple of hours." Quite the opposite. Depression makes you think nothing will work. When I'm in a depressed state it takes a tremendous amount of will to do anything, including taking medication of any sort or even getting out of bed for that matter. Fortunately SSRIs work for me, as well as tight control of my diet and exercise. Exercise alone has never made a difference for me, though. One of the worst episodes I ever had came at a time when I was in the best shape of my life, working out everyday.

martin1975 10y ago
that mirrors my experience w/depression prior to having it diagnosed. I knew something was up, and tried to self medicate in a number of ways, among which dieting, exercising and long term fasting was present. Everything seemed to help a bit, kind of mask the turmoil of the anxiety and panic that was going on, but eventually my 'nature' took over and I'd go back to feeling like doomsday's around the corner... SSRI seems to have done the trick. Apparently we all produce "normal amounts" of serotonin, but with depressed folk like myself, the serotonin doesn't hang on the synapse long enough ...i.e. our specific biology depletes it faster. Looking at my wider family, this condition is so pervasive ... and inherited, it's not even funny in all the ways it wreaked havoc on people's lives in many ways. Glad I caught a break.
- stuxnet79 10y ago
  Based on your description it seems like we suffer (or in your case 'suffered') from the same condition. I've been suffering from panic-disorder since my mid-teens and it is only recently when I tried an MAOI that my doctor recommended that I've seen the condition lift a bit. There is some co-morbid depression but I believe that is a result of the anxiety and not the reverse. The MAOI is effective but my anxiety still flares up from time to time, and I've been thinking of other ways I can try to improve my state of mind. I'm not even sure how I would broach the subject of ECT, as I haven't experimented with enough drugs to know if they are all ineffective. However, these trials give me hope that in the future we will have better ways of dealing with anxiety / panic disorders. > Looking at my wider family, this condition is so pervasive ... and inherited, it's not even funny in all the ways it wreaked havoc on people's lives in many ways. Glad I caught a break. I agree, it is quite sad. Like right now I'm certain that my father is depressed although the reasons for this are somewhat interconnected with real life events like unemployment, loss of loved ones, etc ...

PragmaticPulp 10y ago

Ketamine is quite different than psychedelics, so the two can't be compared. It's also important to note that the recent study of psilocybin in treatment-resistant depression was extremely preliminary and not of good quality. The sample size was very small (n=12), there was no placebo control group (huge red flag in any depression study), and nearly half of the patients indicated previous psilocybin use. Placebo control groups are absolutely critical in depression studies because the placebo response rate for depression is incredibly high. Moreover, placebo response rates are actually rising in recent years for unknown reasons. It's not uncommon for the placebo control group in a depression study to have response rates upwards of 60%, at least in the short-term timeframes of clinical studies. When you read sensational news articles about how SSRIs are barely better than placebo, remember that placebo is pretty damn good (again, in the short-term) at producing a response in depression studies. The story changes in clinical practice over the long-term, of course, but the point is that separating placebo response from actual treatment effects is critical for assessing anti-depressant efficacy, and psychedelic (not ketamine) studies lately have omitted placebo control groups completely, which is unfortunate. It gets more complicated, though. In the case of psychedelics, the placebo effect may actually play a central role in the anti-depressant effects. Psychedelics are known to induce suggestibility and create a false sense of enlightenment. If that suggestibility and sense of enlightenment is deliberately framed in the context of depression treatment and actively guided by clinicians, as in the studies, then perhaps it's possible that the psychedelics are at least partially acting as an instrument for amplifying the placebo effect. To the depressed patient, it doesn't matter if the result is placebo effect or not, as long as the end result is the same. At that point, the real question is whether or not the end result is the same. > However, it also gives people the false impression that all they need to do is chew on some shrooms and listen to the Grateful Dead for a couple of hours and suddenly they will be free of all addiction and depression forever. I completely agree that public and media perception of these experimental depression treatments is completely off base. There is a lot of interesting potential in here, but many people are walking away with an idea that they can self-medicate their problems away by themselves in their basements. There are many people in forums and subreddits chasing ill-conceived plans to treat themselves with psychedelics or NMDA antagonists in ways that don't match the study protocols at all, and it's all very concerning. > Every time a study like this comes out there is a predictable pattern in patients' depression scores: immediately after psychedelic treatment, depression signs plunge, wade around the low end for a while, then steadily creep back up. Unfortunately, the same pattern is observed in placebo control groups for depression studies. That's why it's so critical to have a placebo control group such in depression studies. > With the exception of people whose brains simply do not work as they should (I have a friend who is chronically depressed because his body can't produce enough serotonin even with antidepressants), depression is often as influenced by external factors as internal ones. Your comments on external factors are spot-on. Training the brain to have healthy responses and coping mechanisms, as in CBT, is critical to depression treatment. However, the comments about your friend's brain not producing enough serotonin is more pseudo-science than real science. I don't doubt that doctors have told your friend that, but it's a metaphor at best. SSRIs don't cause the brain to produce more serotonin, they modify the dynamics of serotonin transmission. The anti-depressant effects come from downstream changes that result from that alteration in serotonin dynamics, which are complex and multi-faceted. But depression isn't simply a function of serotonin levels or balances like the over-simplified explanations would suggest. It's entirely possible to increase extra-synaptic serotonin functions well beyond normal, healthy ranges with medications without making the patient "feel" good. Depression is massively complex, and we modulate serotonin because it's one of the easiest and safest paths to manipulate brain function, not necessarily because patients don't have "enough" of it. > mental health will always be vastly more complex and harder to cure than any physical ailment. You're absolutely right that effective mental health treatment requires more than just a pill. But having effective medications to augment healthy mental habits, coping mechanisms, and CBT-type treatments makes it a whole lot easier.

witty_username 10y ago

> stress of the modern, always-on world There was stress in the old world too. Also, we work less than historically. I'd argue today's world is less stressed.

qntty 10y ago
We work less than people did during the industrial revolution, yes. But not less than before the industrial revolution. http://groups.csail.mit.edu/mac/users/rauch/worktime/hours_workweek.html http://groups.csail.mit.edu/mac/users/rauch/worktime/hours_w...

GavinMcG 10y ago

Doesn't a finding like this move us a big step away from that double-edged problem? I would dispute your claim that people think all they need to do is chew on some shrooms, etc. – I've never seen an article that suggested anything of the sort. But even if that were the case, discovering that the psychedelic effects may be separable from the antidepressant effect moves us away from that idea. Yet you seem to treat this news negatively.

rm_-rf_slash 10y ago
Sadly, you seem to have missed my point, which is not to say that there is anything wrong with the science, but rather folks who would read the same article and think "maybe all I need is a good trip and I don't need no stinkin' doctor to tell me what to do or how much to take."
- aminorex 10y ago
  At a guess, the majority would be correct. In general, physicians, like all humans, are incompetent and self-interested. Absolving yourself of personal responsibility by ceding your autonomy to an authority figure rarely works out. This is why I hate compulsory government healthcare: Physicians cease to be employees or voluntary servants who help, and become police (or tax farmers) who control and exploit. It is human nature.
  - GavinMcG 10y ago
    > In general, physicians, like all humans, are incompetent and self-interested Self-interested, perhaps. But assuming that physicians are representative of the broader population when it comes to incompetence is really poorly-grounded.
    - aminorex 10y ago
      I have had close friends killed by grossly incompetent diagnosticians, and seen numerous botched and often superfluous surgeries. Completely anecdotal, but evidently typical of rural environs.

psbp 10y ago

"depression is often as influenced by external factors as internal ones. A spectacular drug trip won't change the reality of having a death in the family, not being able to find a job after being laid off at 45, or simply the stress of the modern, always-on world." Have you ever taken hallucinogens? You don't experience a "spectacular drug trip" and suddenly feel better, you actively work on your problems and have a seemingly raw, uncompromising perspective on the external/internal factors that affect your life. It's a bit like expedited therapy. It's a trying, intentional experience that you have to put effort into in order to get any benefit.