13 ms·

What's wrong is psychedelics already work as-is, but due to stigma around "fun" alterations of consciousness possibly being beneficial (along with desire for a

by themgt 6y ago

What's wrong is psychedelics already work as-is, but due to stigma around "fun" alterations of consciousness possibly being beneficial (along with desire for a patentable compound that can get through FDA regs), most of the focus has been on how we can go about removing the wetness from water while preserving water's essential useful properties. Regardless of how many years go by and self-reporting along with scientific evidence accumulates that water's wetness is mostly the entire point, and all while people are being thrown in jail for water possession.

varjag 6y ago
It's not "stigma". People treated from clinical depression hope to be able to function in their normal day lives at work and at home, not just be on a never-ending psychedelic trip.
- themgt 6y ago
  Research has focused on long-term (months to years/permanent) benefits from just one or a small handful of psychedelic experiences. It would even be difficult to find marginally responsible "psychonauts" who would recommend attempting a "never-ending psychedelic trip", which regardless wouldn't be physically plausible due to how rapidly the short-term tolerance increases. In short, perhaps do more research on this topic because you're arguing against a position no one has taken.
- erispoe 6y ago
  This is not how psychedelics for treatment resistant depression is tested. The most common treatment protocol is a single psychedelics session assisted by 2 therapists (preceded by a few therapy sessions and some follow-ups). Overwhelmingly the evidence point to very significant effects lasting months after the session. This is far from "a never-ending psychedelic trip". If you follow the evidence for the most researched treatment protocol, this would involve a session every year or half-year.
  - ketamine__ 6y ago
    > The most common treatment protocol is a single psychedelics session assisted by 2 therapists (preceded by a few therapy sessions and some follow-ups). Ketamine is approved by the FDA for depression and also has a history, albeit shady, of being prescribed off-label at IV clinics. This is far more common than psychotherapy while taking medication and much less expensive too. > If you follow the evidence for the most researched treatment protocol, this would involve a session every year or half-year. In this small survey 60% of patients returned once a month or more for maintenance infusions. A Survey of the Clinical, Off-Label Use of Ketamine as a Treatment for Psychiatric Disorders https://pubmed.ncbi.nlm.nih.gov/28669202 https://pubmed.ncbi.nlm.nih.gov/28669202
    - bluntfang 6y ago
      FWIW, Ketamine is not a psychedelic. It's a dissociative.
      - stallmanite 6y ago
        It doesn’t affect the same receptors as “classic” psychedelics (LSD, DMT, Mescaline) but dissociatives aka dissociative psychedelics are wildly psychedelic at high doses. It seems ludicrous to insist otherwise. Is Salvinorin-A not a psychedelic?
        WalterSear 6y ago
        I have a prescription and take it every three days. A clinically effective intranasal dose is about as psychedelic as a couple of beers.
        deleted 6y ago
        [deleted]
        bluntfang 6y ago
        I think you have it a little backwards. IME, psychedelics give dissociative effects along with the psychedelic experience and the dissociative experience is solely dissociative on its own. I think there's a lot of confusion on what a psychedelic experience is and it gets confused with a hallucinogenic experience, which both classes of substance can offer.
- HighlandSpring 6y ago
  This is exactly the stigma psychedelic enthusiasts have in mind. Psychedelic-assisted therapy doesn't need to rely on patients being administered psychedelic doses on a daily basis. What's actually happening (either in trials or by underground practictioners) is that the super-malleable/open to self-analysis mental states that can be induced by psychedelics can be a catalyst for significant long-term shifts in perspectives and thinking patterns. An amazing book to give you a cursory understanding of the state of the field is How to Change Your Mind: The New Science of Psychedelics by Michael Pollan. It'll give you a good understanding of what psychedelic research may be able to achieve (and what it's achieved so far).
  - luckylion 6y ago
    > This is exactly the stigma psychedelic enthusiasts have in mind. Psychedelic-assisted therapy doesn't need to rely on patients being administered psychedelic doses on a daily basis. Why does it have to include the psychedelic component though (even sub-trip-levels)? Some seem to think that you absolutely must not divide the psychedelic qualities from other qualities, even if you could. As if "you only deserve to enjoy the anti-depressant benefits if you embrace the trippy potential of it". That sounds too religious to me. I find that a weird stance, and I'm very pro-psychedelics and would like to see them regulated but legally available. But I wouldn't want to keep depressed people who are afraid of the psychedelic experience from the benefits just because it won't help with legalization efforts. Again, I'm not suggesting that you can split them into "trip drug" and "anti-depressant drug". But if you could, I'm absolutely for doing so. I'll still take the trip drug, but people who are afraid of tripping can take the safe one and still get benefits.
    - pharke 6y ago
      I believe the sentiment most people are expressing when they say you cannot separate the "trip" from the beneficial effects is that they both have the same origin or causative agent. Personally I'm in the "neural annealing" camp and it makes sense to me from personal experience that the benefits are due to psychedelics being a drug that essentially induces a state that you would normally only experience during profound and meaningful experiences. Those are the only other circumstances where I have felt the same as I have with psychedelics, experiencing a deep connection with the awesome scale and complexity of the natural world, falling in love, reading a life changing book, being transported emotionally and mentally by a symphony, getting caught up in the experience of a great movie, the physical rush of pushing yourself to your limits when exercising. We have drugs that seem to be able to produce the same life altering experiences that they can on demand. That's why it seems perverse to many people when it's argued that we should distill just the dregs of chemicals that produce the change without realizing that the actual mental and physical journey, the story that you weave around that experience that includes yourself, your thoughts, your environment and the people around you is probably the most important part. You can't just be happy all the time without having a reason to be happy, you can't be in love without someone to love and if you could it would seem more like a nightmare than an improvement.
- kortex 6y ago
  "Life is the never-ending psychedelic trip, maaaan" On a serious note, this isn't what GP is referring to. Generally psychedelics in the work day are self-limiting. A microdose that is more of a mesodose makes for some interesting Zoom meetings. People learn the right dose to get a boost without excess distraction/warping. Fadiman's research [0] suggests the best dose is well below the threshold of "trip" effects. So there's no risk of never-ending daytrips, unless one desires that thing. So why limit access? Aspects of American culture have a strong stigma against "fun", euphoria, and to an extent, any effect beyond "restoring normal". eg nootropics are popular in young, hip crowds like HN, but kinda sketch among many MDs, from "I don't think these are safe" to "why do you need that?" It's a "if it feels good, stop" sentiment that runs as an undercurrent through American history and you can see signs of it in Protestant work ethic, Prohibition (of alcohol and cannabis), and of course the war on drugs. Keep in mind, LSD and MDMA were very hotly researched back in the day, but when subcultures started associating them with parties, that's when things started getting the kabash. "But addiction bad" - this would be a fair argument if it weren't for the near lack of correlation between DEA schedule and addiction potential [1], as well as the rapid action to ban analog drugs without any consideration to addiction potential. This is the fate of most Shulgin compounds, many exhibiting the typical rapid tolerance of psychedelics. That leaves the theraputic dose. These are typically administered in a guided setting, either in the clinical sense, or trip-sitters/sherpas, in the informal. This is the best mitigation against trips that leave lasting psychological harm (the term "bad trip" is very loaded, as it doesn't distinct "hard lesson trips" from "no this actually messed them up long term"). If the concern is really "harm trips", then the solution is logically harm-reduction, not prohibition. Wew, that turned out longer than expected. Edit: added more [0] - https://www.thecut.com/2018/05/microdosing-guide-and-explainer.html https://www.thecut.com/2018/05/microdosing-guide-and-explain... [1] pdf - http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.868.9239&rep=rep1&type=pdf http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.868...
ketamine__ 6y ago
I agree with your statement on principle that we should make these drugs widely available when we find efficacy. I disagree that we shouldn't try to separate psychedelic effects from therapeutic action. There is a body of research on ketamine metabolites. Some of these metabolites may have less psychedelic effects and more anti-depressant action. I need to take ketamine almost every day. This means there are several hours when my ability to read, think, and remember things is impaired. I hope we are able to discover better drugs.
- dahfizz 6y ago
  > This means there are several hours when my ability to read, think, and remember things is impaired. I hope we are able to discover better drugs. I don't think people give this enough consideration. Tripping on mushrooms might be enjoyable to some, but having it as a regimented treatment means you are losing a lot of time where you cannot be productive, cannot enjoy the company of your sober friends and family, etc.
- luckydata 6y ago
  The psychedelic effect IS the therapeutic action.
PragmaticPulp 6y ago
> What's wrong is psychedelics already work as-is The current research into psychedelic medicine is better described as intense therapy with a psychedelic adjunct for some sessions. They aren't just giving people psychedelics and hoping everything turns out okay. The psychedelic dosing is combined with therapy, and the sessions are both preceded by and followed with additional therapy without psychedelics. It's a mistake to assume that the psychedelic drugs are curing depression on their own. In fact, many people experience worsening depression or derealization if they take psychedelics without professional guidance while suffering from mental illness.
- ta1234567890 6y ago
  > They aren't just giving people psychedelics and hoping everything turns out okay. The psychedelic dosing is combined with therapy, and the sessions are both preceded by and followed with additional therapy without psychedelics. And historically, that's exactly the way psychedelics have been used, for thousands of years. A shaman/guide would provide the medicine and help the people go through the experience, usually in a tight community where there's follow up and support. Unfortunately that was suppressed, first by the Catholic Church when the Spanish arrived to America, and now more recently by making psychedelics illegal. The idea of psychedelics being some sort of party drug is a problem of the current state of affairs, politically and culturally, where we have abandoned or forgotten their origins.
  - luigibosco 6y ago
    Maybe just the "tight community where there's follow up and support" may help.

by themgt 6y ago

varjag 6y ago

It's not "stigma". People treated from clinical depression hope to be able to function in their normal day lives at work and at home, not just be on a never-ending psychedelic trip.

themgt 6y ago
Research has focused on long-term (months to years/permanent) benefits from just one or a small handful of psychedelic experiences. It would even be difficult to find marginally responsible "psychonauts" who would recommend attempting a "never-ending psychedelic trip", which regardless wouldn't be physically plausible due to how rapidly the short-term tolerance increases. In short, perhaps do more research on this topic because you're arguing against a position no one has taken.
erispoe 6y ago
This is not how psychedelics for treatment resistant depression is tested. The most common treatment protocol is a single psychedelics session assisted by 2 therapists (preceded by a few therapy sessions and some follow-ups). Overwhelmingly the evidence point to very significant effects lasting months after the session. This is far from "a never-ending psychedelic trip". If you follow the evidence for the most researched treatment protocol, this would involve a session every year or half-year.
- ketamine__ 6y ago
  > The most common treatment protocol is a single psychedelics session assisted by 2 therapists (preceded by a few therapy sessions and some follow-ups). Ketamine is approved by the FDA for depression and also has a history, albeit shady, of being prescribed off-label at IV clinics. This is far more common than psychotherapy while taking medication and much less expensive too. > If you follow the evidence for the most researched treatment protocol, this would involve a session every year or half-year. In this small survey 60% of patients returned once a month or more for maintenance infusions. A Survey of the Clinical, Off-Label Use of Ketamine as a Treatment for Psychiatric Disorders https://pubmed.ncbi.nlm.nih.gov/28669202 https://pubmed.ncbi.nlm.nih.gov/28669202
  - bluntfang 6y ago
    FWIW, Ketamine is not a psychedelic. It's a dissociative.
    - stallmanite 6y ago
      It doesn’t affect the same receptors as “classic” psychedelics (LSD, DMT, Mescaline) but dissociatives aka dissociative psychedelics are wildly psychedelic at high doses. It seems ludicrous to insist otherwise. Is Salvinorin-A not a psychedelic?
      - WalterSear 6y ago
        I have a prescription and take it every three days. A clinically effective intranasal dose is about as psychedelic as a couple of beers.
        deleted 6y ago
        [deleted]
      - bluntfang 6y ago
        I think you have it a little backwards. IME, psychedelics give dissociative effects along with the psychedelic experience and the dissociative experience is solely dissociative on its own. I think there's a lot of confusion on what a psychedelic experience is and it gets confused with a hallucinogenic experience, which both classes of substance can offer.
HighlandSpring 6y ago
This is exactly the stigma psychedelic enthusiasts have in mind. Psychedelic-assisted therapy doesn't need to rely on patients being administered psychedelic doses on a daily basis. What's actually happening (either in trials or by underground practictioners) is that the super-malleable/open to self-analysis mental states that can be induced by psychedelics can be a catalyst for significant long-term shifts in perspectives and thinking patterns. An amazing book to give you a cursory understanding of the state of the field is How to Change Your Mind: The New Science of Psychedelics by Michael Pollan. It'll give you a good understanding of what psychedelic research may be able to achieve (and what it's achieved so far).
- luckylion 6y ago
  > This is exactly the stigma psychedelic enthusiasts have in mind. Psychedelic-assisted therapy doesn't need to rely on patients being administered psychedelic doses on a daily basis. Why does it have to include the psychedelic component though (even sub-trip-levels)? Some seem to think that you absolutely must not divide the psychedelic qualities from other qualities, even if you could. As if "you only deserve to enjoy the anti-depressant benefits if you embrace the trippy potential of it". That sounds too religious to me. I find that a weird stance, and I'm very pro-psychedelics and would like to see them regulated but legally available. But I wouldn't want to keep depressed people who are afraid of the psychedelic experience from the benefits just because it won't help with legalization efforts. Again, I'm not suggesting that you can split them into "trip drug" and "anti-depressant drug". But if you could, I'm absolutely for doing so. I'll still take the trip drug, but people who are afraid of tripping can take the safe one and still get benefits.
  - pharke 6y ago
    I believe the sentiment most people are expressing when they say you cannot separate the "trip" from the beneficial effects is that they both have the same origin or causative agent. Personally I'm in the "neural annealing" camp and it makes sense to me from personal experience that the benefits are due to psychedelics being a drug that essentially induces a state that you would normally only experience during profound and meaningful experiences. Those are the only other circumstances where I have felt the same as I have with psychedelics, experiencing a deep connection with the awesome scale and complexity of the natural world, falling in love, reading a life changing book, being transported emotionally and mentally by a symphony, getting caught up in the experience of a great movie, the physical rush of pushing yourself to your limits when exercising. We have drugs that seem to be able to produce the same life altering experiences that they can on demand. That's why it seems perverse to many people when it's argued that we should distill just the dregs of chemicals that produce the change without realizing that the actual mental and physical journey, the story that you weave around that experience that includes yourself, your thoughts, your environment and the people around you is probably the most important part. You can't just be happy all the time without having a reason to be happy, you can't be in love without someone to love and if you could it would seem more like a nightmare than an improvement.
kortex 6y ago
"Life is the never-ending psychedelic trip, maaaan" On a serious note, this isn't what GP is referring to. Generally psychedelics in the work day are self-limiting. A microdose that is more of a mesodose makes for some interesting Zoom meetings. People learn the right dose to get a boost without excess distraction/warping. Fadiman's research [0] suggests the best dose is well below the threshold of "trip" effects. So there's no risk of never-ending daytrips, unless one desires that thing. So why limit access? Aspects of American culture have a strong stigma against "fun", euphoria, and to an extent, any effect beyond "restoring normal". eg nootropics are popular in young, hip crowds like HN, but kinda sketch among many MDs, from "I don't think these are safe" to "why do you need that?" It's a "if it feels good, stop" sentiment that runs as an undercurrent through American history and you can see signs of it in Protestant work ethic, Prohibition (of alcohol and cannabis), and of course the war on drugs. Keep in mind, LSD and MDMA were very hotly researched back in the day, but when subcultures started associating them with parties, that's when things started getting the kabash. "But addiction bad" - this would be a fair argument if it weren't for the near lack of correlation between DEA schedule and addiction potential [1], as well as the rapid action to ban analog drugs without any consideration to addiction potential. This is the fate of most Shulgin compounds, many exhibiting the typical rapid tolerance of psychedelics. That leaves the theraputic dose. These are typically administered in a guided setting, either in the clinical sense, or trip-sitters/sherpas, in the informal. This is the best mitigation against trips that leave lasting psychological harm (the term "bad trip" is very loaded, as it doesn't distinct "hard lesson trips" from "no this actually messed them up long term"). If the concern is really "harm trips", then the solution is logically harm-reduction, not prohibition. Wew, that turned out longer than expected. Edit: added more [0] - https://www.thecut.com/2018/05/microdosing-guide-and-explainer.html https://www.thecut.com/2018/05/microdosing-guide-and-explain... [1] pdf - http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.868.9239&rep=rep1&type=pdf http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.868...

ketamine__ 6y ago

I agree with your statement on principle that we should make these drugs widely available when we find efficacy. I disagree that we shouldn't try to separate psychedelic effects from therapeutic action. There is a body of research on ketamine metabolites. Some of these metabolites may have less psychedelic effects and more anti-depressant action. I need to take ketamine almost every day. This means there are several hours when my ability to read, think, and remember things is impaired. I hope we are able to discover better drugs.

dahfizz 6y ago
> This means there are several hours when my ability to read, think, and remember things is impaired. I hope we are able to discover better drugs. I don't think people give this enough consideration. Tripping on mushrooms might be enjoyable to some, but having it as a regimented treatment means you are losing a lot of time where you cannot be productive, cannot enjoy the company of your sober friends and family, etc.
luckydata 6y ago
The psychedelic effect IS the therapeutic action.

PragmaticPulp 6y ago

> What's wrong is psychedelics already work as-is The current research into psychedelic medicine is better described as intense therapy with a psychedelic adjunct for some sessions. They aren't just giving people psychedelics and hoping everything turns out okay. The psychedelic dosing is combined with therapy, and the sessions are both preceded by and followed with additional therapy without psychedelics. It's a mistake to assume that the psychedelic drugs are curing depression on their own. In fact, many people experience worsening depression or derealization if they take psychedelics without professional guidance while suffering from mental illness.

ta1234567890 6y ago
> They aren't just giving people psychedelics and hoping everything turns out okay. The psychedelic dosing is combined with therapy, and the sessions are both preceded by and followed with additional therapy without psychedelics. And historically, that's exactly the way psychedelics have been used, for thousands of years. A shaman/guide would provide the medicine and help the people go through the experience, usually in a tight community where there's follow up and support. Unfortunately that was suppressed, first by the Catholic Church when the Spanish arrived to America, and now more recently by making psychedelics illegal. The idea of psychedelics being some sort of party drug is a problem of the current state of affairs, politically and culturally, where we have abandoned or forgotten their origins.
- luigibosco 6y ago
  Maybe just the "tight community where there's follow up and support" may help.