9 ms·

Ecstasy and psilocybin are shaking up psychiatry

233 points by nabla9 6y ago

contingencies 6y ago
Fostering PLURalism? https://news.ycombinator.com/item?id=25963589 https://news.ycombinator.com/item?id=25963589
mkmk 6y ago
Not ecstasy and psilocybin, but a few years ago, I met a psychiatrist who had worked in the armed forces and then alongside a crisis SWAT team. After decades of seeing people hit rock bottom, he learned about ketamine therapy as a treatment for treatment-resistant depression. He described it to me, a psychedelic skeptic, as “the closest thing to a miracle drug that I’ve seen in my career.” I’m not sure why, maybe because he seemed so much like the opposite of a “woo-woo” clinician, but the way he said it stuck with me. It has been fascinating to watch this space and the forward-thinking mental health companies that have been developing in this space.
- Natsu 6y ago
  Yes, ketamine can shut off depression like a light switch. That's really, really good for the population it works for. Of course, it can also cause psychosis. As someone who nearly got murdered in their sleep by someone on one such ketamine-caused psychosis, I think that caution is warranted when prescribing it. Waking up to take a knife away from a crying person is not something I would recommend to others. I've heard that there are studies on a metabolite of ketamine that's supposed to avoid the psycosis. I really hope that works so we get something this powerful without the downside.
  - irq 6y ago
    Without making light of your experience, the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics. So yes, too much of a good thing is bad. Ketamine clinics use doses much lower than that which is used for general anesthesia, and ketamine is used for general anesthesia all over the world on a daily basis. It's on the World Health Organization's Essential Medicines List and has a very safe 50+ year track record.
    - JulianMorrison 6y ago
      Also don't take powerful drugs off-label, with no monitoring or supervision, and expect them to do the same thing they would at controlled doses in a controlled environment.
      - ketamine__ 6y ago
        I take doctor prescribed ketamine at home. It's incredibly safe and as a bonus it's much more comfortable to be laying in your own bed.
        Natsu 6y ago
        They let people take it at home now? We had to go into a clinic and they would monitor you the entire time. There was a couch to lay on, but not much in the way of amenities.
        ketamine__ 6y ago
        I've been taking lozenges for over 2 years now.
      - Natsu 6y ago
        We didn't! It was a licensed esketamine trial under medical supervision for treatment-resistant depression.
    - Natsu 6y ago
      > Without making light of your experience, the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics. This was a licensed esketamine (s-ketamine) trial under medical supervision which, as you might imagine, left us excluded from the trial afterwards. So I am going to have to disagree with you regarding whether or not that is possible at theraputic doses. I realize that it's normally safe, and I hope that it helps a lot of people.
      - 6y ago
  - airstrike 6y ago
    Basically the premise of the mini-series The Night Of
  - nosmokewhereiam 6y ago
    Set and setting comes from Mindset and setting. Sounds like that person wasn't using K correctly (they were abusing it). I don't feel as if your anecdote applies to many others in a controlled setting.
    - Natsu 6y ago
      You would be wrong about that, it was a licensed esketamine trial under strict medical supervision.
      - hn_asker 6y ago
        strict medical supervision is sometimes a terrifying experience. Set and setting matter but so does any drugs they are currently on. I would say that your experience is atypical.
        Natsu 6y ago
        As I understand it, the "K hole" was terrifying, the setting for taking this was a doctor's office that let you relax on a couch afterwards.
- fossuser 6y ago
  Gary Gulman talks a bit about the relief he got from it. Unfortunately for him it was only short term relief, but it really did seem to work. He’s doing well now, so maybe that short term relief helped in some way as part of everything else.
  - purrplexed 6y ago
    Did 12 sessions, after the first session I had instant relief. Even the urge to drink was completely gone. I should have gone back in for boosters but just let it slide, mostly due to the continued cost. About 3 months later I was back into a depressive state. I was able to get out of that one on my own but I don't think it would have been possible without the ketamine treatments. It is hands down the most effective medicine to treat depression I have taken. The maintenance is the downside, however the minimal side effects are worth it.
  - ketamine__ 6y ago
    Are you saying he abandoned the therapy because of the short-term relief? Most people return to their depressed state when they stop taking their anti-depressants.
    - fossuser 6y ago
      The doc told him he wouldn’t continue it because it wasn’t helping outside of the therapy session (and each session was quite expensive).
- mrcartmenez 6y ago
  Worked for me after I had become incredibly depressed while attempting to rescue my daughter from an abuse situation (I succeeded yay!). I went from having tunnel vision, hearing music as just noise, severe dissociation etc. to being just fine and normal two hours later. Best bio-hack I’ve ever done. I personally wouldn’t use it as a recreational drug often though as it does have some known side effects from habitual use and regular drug use is always a bad idea, yes folks that includes weed and alcohol.
  - TaylorAlexander 6y ago
    Thank you for your story. I just wanted to offer an alternative view on regular drug use. I vape marijuana every day. After college I became an alcoholic after having stayed totally sober until age 21. Binge drinking college parties left me and my friends binge drinking well after college. It was bad, though I never lost a job. I’d tried marijuana several times and often felt overwhelmed with it. It would take me more than ten years to realize why those incidents happened - group pressure to take huge hits of marijuana left me feeling way too high. A deeply uncomfortable feeling. But marijuana helped me quit alcohol. I do not consider it the healthiest option nor do I recommend to anyone that they consume marijuana. But I would push back that it is always a bad idea. For my health I only vape marijuana and I keep the doses very small. I know it may still lead to health problems and I hope some day I don’t feel the need to do it. But it seems to help. I’ve stopped for weeks at a time and it’s fine. But I seem to prefer having a bit of marijuana every day. And I really don’t think that’s bad for me personally. I’m a successful robotics engineer. I worked for two years at Google X robotics while consuming marijuana daily and they filed two patents for my work during that time. Since then I’ve gone off to co-found a farming robotics organization that is about to announce our open source farming robot that I designed and built pretty much all myself. I think we should take a more open minded approach to drug use. Some people may find that certain drugs work for them. Certainly I am achieving my life goals while vaping marijuana daily. I don’t really think it’s best for me long term, but it seems to be what’s working for me now.
    - kortilla 6y ago
      It’s not clear to me from your post what the upside was for daily marijuana use is. It sounds like it kept you from reaching for the bottle, which I’m supporting of; but, what does it provide for someone who is not an alcoholic?
- coderintherye 6y ago
  The Center for Transformational Psychotherapy in SF leverages ketamine as part of their treatment, to good effect. Hopefully continued use and research will continue to mainstream its use (when appropriate).
- dialamac 6y ago
  Ketamine is a not uncommon thing in psych today. It is routinely prescribed. The problems are that it does seem for most people the effect is short lived (weeks) and psychosis is a thing (the poster below saying it’s never an issue even in pain setting is simply mistaken). The thing is that neither of these are uncommon problems for psych meds in general so ketamine shouldn’t be singled out for this, but it’s more complicated then some of the armchair docs here make it seem. There is continuing research into regimens that might minimize the tachyphylaxis, but it’s an ongoing problem.
  - Tenoke 6y ago
    >psychosis is a thing Looking through Google scholar + personal experience I don't see evidence that this is an issue for non-schizophrenics.
    - dialamac 6y ago
      You need to look harder. Schizophrenia and psychotic features are relative contraindications for use of ketamine per APA guidelines. “It is unclear whether patients with depression that is not treatment- refractory or patients with other psychiatric illnesses are ap- propriate candidates for ketamine treatment, and extreme caution must be exercised in patients with psychotic or substance use disorders.” Side-effects associated with ketamine use in depression: a systematic review, Short 2018. To summarize: A review of 60 studies found dissociation and psychotomimetic effects >70 percent of the studies at varying rates. And note that the time courses of observation were variable. Furthermore most of these studies excluded participants with psychotic features or known psychotic disorder. But for any provider considering ketamine this is literally top of the list in consideration of adverse effects.
      - Tenoke 6y ago
        This review doesn't say all that much. I just took another look at it and it merely reports what % of the studies mention those effects without effect sizes or anything of the sort. Also they clump psychotomimetic and dissociation effects together which is really weird as ketamine is a dissociative. It's literally the highest number in their analysis (72%) because dissociation is to be expected from a dissociative.
- PragmaticPulp 6y ago
  Ketamine treatment for depression doesn’t require a psychedelic experience. Many clinics prefer to keep doses low enough to avoid full psychedelic experiences. Of course, some clinics blast patients with excessive doses and send them into full-blown psychedelic trips, but it’s definitely not necessary for the anti-depressant effect. Ketamine’s effects on depression are almost certainly mediated by something other than any psychedelic effects. Ideally we’ll find a safer medication which accomplishes the same thing without disorienting the patient Unfortunately, the effects of this therapy are rather short lived. There’s a growing industry of ketamine clinics that are happy to continue charging patients for endless ketamine infusions. Some offer outpatient prescriptions of ketamine. However, repeated treatment isn’t quite as effective as tolerance develops. The best approach appears to be using ketamine as a way to kickstart more sustainable, long-term depression treatments, such as therapy programs.
  - hn_asker 6y ago
    There's a growing industry of therapy clinics that are happy to continue charging patients for endless sessions. Some offer anti-depressants and anti-psychotics. However, repeated treatment isn't quite as effective as the wrong mix of drugs are prescribed, the therapy re-enforces the trauma, and it is quite costly for patients to afford.
- joshxyz 6y ago
  I've done both back then, those stuff really changed my life perspective in terms of depth. Recreationally some of them can be misused (ketamine, extasy), but for the medically desperate I'm hella convinced these substances deserves more research.
- johnchristopher 6y ago
  I don't know. Every generalist doctor I have known got a alt phase aound 50. Homeopathiy, bach's flower, essential oils, etc. I chalk it up to "they have seen bad stuff and can't help some of their patients going through rough times and they look up for alternatives and settle for something for a few years".
artur_makly 6y ago
Just wait until they start unlocking Ayahuasca en masse...
deleted 6y ago
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kibwen 6y ago
Good to see the blanket anti-drug hysteria of the last century being slowly dismantled. > Placebo controls pose another challenge because the drugs have such powerful effects. This is fascinating and something I haven't considered before. Are there other example of major studies that have inherent difficulty forming a control group like this?
- anchpop 6y ago
  Relevant XKCD: https://xkcd.com/1462/ https://xkcd.com/1462/
  - matthberg 6y ago
    Equally related yet much less relevant XKCD: https://xkcd.com/790/ https://xkcd.com/790/
    - esperent 6y ago
      That suggests to me that Randall Munroe has never taken psychedelics.
      - heavenlyblue 6y ago
        Spiders and inability to scale things is one of the most common types of hallucination that is common to all paychedelics.
- _jcrossley 6y ago
  I found this fascinating as well. Sounds like a hard problem to solve - I'm skeptical and surprised that "niacin, which elicits a physical sensation — usually a flushing response in the skin" was effective as a placebo
  - LocalH 6y ago
    I can't imagine it would be an effective placebo with any person who has ever had prior psychedelic experience, once enough time has passed. Perhaps in the pre-peak period where it's already kind of fuzzy when the effects start to kick in, but not anywhere near the peak
neonate 6y ago
https://archive.is/1IkV3 https://archive.is/1IkV3
veb 6y ago
This actually does help. The problem I have is it all returns years later which is why some people have LSD once a year or shrooms once a year or whatever. I'd love to trial this in a clinical situation but it's gonna be a long time until we see that I imagine.
- ytwySXpMbS 6y ago
  The Imperial College London trials looked at this. In the first trial, people were given 1 dose of psilocybin, and while some people recovered fully, many went back to being depressed after some months. In the second trial, they gave people 2 doses spaced a few weeks apart, and focused more on integration after the experience. They had much more success in sustained recovery with that. Here’s a podcast episode all about it if anyone’s interested (soundcloud link at the bottom of the page): https://www.mindmanifestpodcast.com/news/sureshmuthukumaraswamy-epdgd https://www.mindmanifestpodcast.com/news/sureshmuthukumarasw...
ouid 6y ago
>"He explained that he would have on hand a drug that could neutralize the hallucinogen, if necessary." How is right now the first time I have heard of this?
- TylerE 6y ago
  Because it doesn’t exist. What they really mean when they say something like this is a high dose benzodiazepine.
  - _jcrossley 6y ago
    They might be referring to an antipsychotic like olanzapine https://pubmed.ncbi.nlm.nih.gov/26216558/ https://pubmed.ncbi.nlm.nih.gov/26216558/
    - loves_mangoes 6y ago
      This echoes the popular wisdom that benzos can only mollify hallucinations to make them bearable, and then force a black-out at higher dosage. Antipsychotics (like Seroquel & Olanzapine) on the other hand make the visuals and 'shadow people' (hallucinations resulting from lack of sleep) disappear, forcefully flinging people back to a semblance of reality, and then to uncomfortable sleep.
- loceng 6y ago
  Maps.org founder Rick Doblin's recommendation if someone is having a bad experience with Ayahuasca [or other psychedelic] is to give them a half therapeutic dose of MDMA; therapeutic dose is 100-125mg.
api 6y ago
More rediscovery of avant-garde technology and ideas from the 1960s.
vga805 6y ago
The Psychedelics ETF PSYK hit the Canadian market the day this was published. Nice timing.
_jcrossley 6y ago
I thought the infographic of # trials per year is really interesting - amazing that in January 2021 there have been 12 trials, when there were 11 in 2019 and 17 in 2020
frongpik 6y ago
I find it entertaining that lsd and mushrooms is a no no in the US, while drugs like Ambien that often cause somnambulism are "safe" to treat sleep problems.
- loceng 6y ago
  It's all regulatory capture, lobbying money from big pharma industrial complex - likely tied to the prison industrial complex who are happy to fill prisons, along with a few other complexes.
Wistar 6y ago
Related: See (hear) author Michael Pollan's 2018 Fresh Air interview on NPR about his experiments with mushrooms, LSD and other psychedelics while researching his book, "How to Change Your Mind." https://www.npr.org/2019/05/24/726085011/reluctant-psychonaut-michael-pollan-embraces-new-science-of-psychedelics https://www.npr.org/2019/05/24/726085011/reluctant-psychonau...
underseacables 6y ago
I just picked up some psilocybin and I’m very curious to try it got the first time. My PTSD compounds my depression and fuels my anxiety. Very interested to see where this research goes.
- makeitrein 6y ago
  Best of luck stranger! Perhaps explore starting with a microdose see how you feel on that before scaling up.
deleted 6y ago
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LatteLazy 6y ago
I think I'm going to sign up for one of these, or just start trying things (I heard ketamine is also effective) in March. I've had severe clinical depression on and off for 12 years now. I've had all the SSRIs, none worked. I've tried the SNRIs and they worked a bit 8 years ago, but aren't working at all now. I started lithium a week ago, that's not having much effect so far (dose should be reviewed next week). I think the latest term in the US is Major Mood Disorder. Only around 30% of people with depression ever find an antidepressant that works for them. So for all the SSRIs, SNRIs, Tricyclics and other, the SUM effectiveness is 30%. There's really very little left on the menu and I have no expectation it will work. So, anyone got any experience with self treatment?
- loceng 6y ago
  There are less known causes of depression, where medications won't help - for example, if I ask you did you ever have ear infections as a child and were any of them painful - if your answer is yes, then I'd direct you to a specific therapy and a book that explains how that can lead to blocks in development and a depressed nervous system. Ayahuasca has helped me, MDMA as well, and a sound therapy I did in my early 20s dramatically shifted my life - as to what I'm referring to in my previous paragraph; prior to the sound therapy, which you can actually do a diagnostic audiogram to check for imbalances in hearing to confirm an issue, I would have been considered to have Aspergers - though never formally diagnosed, after the sound therapy I connected to emotion and my body again that I didn't know I was partially to fully disconnected/blocked from, which had an effect of hypersensitivities as well.
  - embodiments 6y ago
    I’ve actually struggled a lot with depression and had many many painful ear infections as a child. Do you mind sharing that information on the book and therapy with me? Thanks!
    - loceng 6y ago
      The book is called "Hearing Equals Behaviour: Updated and Expanded" - can be found on Amazon - and the sound therapy is called Berard AIT or Auditory Integration Training; unfortunately there are people who claim to offer it, or have "at home" sessions they'll sell you where you rent equipment - however it's not the same high-end equipment that should be used, so "buyer beware." There are other sound therapies on the market that are reaching mainstream via well-written books, however the actual products they released don't seem to actually follow the AIT protocol and logically they shouldn't have anywhere near the same level of efficacy due to a few factors. I do know of a gentle old man in Montreal, Quebec, who was trained directly by Dr. Berard.
Avicebron 6y ago
I love these they, basically turn into: "when I was absolutely ripped on [blank] I discovered I could fly, am genius, nobel prize when" gold EDIT: breaking news, Crack cocaine discovered to hold the secrets of the universe, says man on crack cocaine.
- dorkwood 6y ago
  Your argument appears to be that people under the influence of a drug aren't able to accurately judge its positive benefits due to being intoxicated. But that doesn't really apply if a person is reflecting on an event from years prior, does it? A lot of the responses here are about a drug having a long-lasting effect on their depression, for example, which doesn't seem to fit with your theory.
  - hypertele-Xii 6y ago
    Trauma causes your mind/body to bury its sensitive and vulnerable parts under a survival cocoon - metaphorically, a way of thinking that helps you cope. Psychoactives like MDMA, LSD, psilocybin, ketamine, and others temporarily confuse and override your normal mode of thinking, revealing and releasing buried truths. For me personally I was surprised that such strong emotions of love and empathy could even exist, and I vowed to tap into that channel which the drug unlocked after its effects had waned. I can still, years later, activate those emotions on command by consciously choosing to do so.
    - dorkwood 6y ago
      I had a similar experience. I used to turn my nose up at recreational drug use, because I thought of it as a purely pleasure-seeking activity. One day, I took some MDMA out of curiosity, and found that within a few hours I had a strong sense of empathy for everyone else in the room. It amazed me that it was even possible to feel that way -- I actually wanted to interact with people rather than shy away from them. It left a strong impression on me, and made me wonder whether some people naturally walk around feeling that way by default.
herodoturtle 6y ago
Will be interesting when we begin to simulate these effects in artificial neural networks.
deleted 6y ago
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mahathu 6y ago
“People get locked into disorders like depression because they develop this system of thinking which is efficient, but wrong,” <-- I take some issue with the above statement and I'm very surprised to see it came from a doctor! I'm a neuroscience grad student and would like to do research on psychedelics in the future, therefore this article was an interesting read otherwise. Coincidentally I also suffer from a state of depression, and have been for years. Mostly I can do fine but some times I can't even get out of bed until the evening, and on many nights I wasn't convinced I'd live to see the next day. The way the sentence above is presented, to me, feels like people suffer from depression just as a result of thinking "wrong". I'm sure your judgement is clouded by such a serious mental condition in some ways. But in others, I like to think that I with my depressive POV might have more realistic view points on some things than an unaffected person. I would hate to not even have this one tiny little advantage from all this, and that in fact I'm not "sadder but wiser" [than some]. Am I wrong?
- nostrademons 6y ago
  There's been a fair bit of research on "depressive realism", the hypothesis that depressed people's view of reality is actually more accurate and it's "normal" people who have a system of thinking which is efficient, but wrong: https://en.wikipedia.org/wiki/Depressive_realism https://en.wikipedia.org/wiki/Depressive_realism I think that this may be an example of the tension between what's accurate vs. what's adaptive. There are a number of other social phenomena - like lying, exaggeration, overconfidence, risk-taking, perceptual bias, etc. - where individuals espouse views that are wrong because being wrong is more effective (in the sense of better social status or reproductive success) than being correct. Depression is likely the inverse of that: depressed people see the world accurately, but all of the mechanisms biasing toward survival involve distorting our perception of the world.
  - patcon 6y ago
    YES. Thanks for saying this. I reflect on this a lot when I try to imagine how I should "expect" the society to tend toward some pseudo-stability... A related TED talk by Donald Hoffman has stuck with me: https://www.ted.com/talks/donald_hoffman_do_we_see_reality_as_it_is/transcript?language=en https://www.ted.com/talks/donald_hoffman_do_we_see_reality_a... > Well, I hate to break it to you, but perception of reality goes extinct. In almost every simulation, organisms that see none of reality but are just tuned to fitness drive to extinction all the organisms that perceive reality as it is. So the bottom line is, evolution does not favor veridical, or accurate perceptions. Those perceptions of reality go extinct. Written format: https://www.quantamagazine.org/the-evolutionary-argument-against-reality-20160421/ https://www.quantamagazine.org/the-evolutionary-argument-aga...
loveJesus 6y ago
God is good. My experience is it would be best to stay away from these things. God has helped me be psych med free since 2014 even caffeine, not mormon btw. For me, it was a lack of knowing what was better out there that encouraged me to take them, and finally ended up in a hospital needing all kinds of treatments for adhd/bipolar etc. Needing to recover from things that only 'bad people' did. Eventually with doctor's approval was how the medication was removed, after a person came and prophesied for me to stop medications, at a moment the Lord had impressed that it would happen, interesting long story [1]. I had to learn to lead an orderly life and work with doctors while in treatment. It's really nice to be free from the illness and the meds, though grateful for the meds (at the end it was only a small amount of haldol vs lots of zyprexa at the beginning) when they were needed, However it can be an encouragement in the Lord Jesus to people. [1] https://soundcloud.com/brianlovejesus/testimony-of-jesus-working-me-outwards-of-my-rotten-life https://soundcloud.com/brianlovejesus/testimony-of-jesus-wor...
egypturnash 6y ago
best thing ever for my chronic depression was a hit of E at a furry con, it basically kicked me out of a loop I'd been in for years and I've never been back in it since.
- greenonions 6y ago
  What a unique experience, and quite good that it had that effect! What was that like?
  - egypturnash 6y ago
    I spent all night wandering around the hotel with a couple of friends who I would later end up in a relationship with, babbling about some deep deep holes in my brain. Several times I said that I felt wonderful and amazing, and that I was not allowed to go looking for this stuff again for at least a year, as I could see how it could get addictive. This was something like fifteen years ago and I still haven’t had any urge to hunt down more. If I need it badly enough I figure it will show up in my life again. (Also it was at a furry con, which I guess is kind of a weird and magical space for most people; it was far from my first one, and there’s a strong component of work to them for me as I’m an artist who spends most of them hanging out behind a table drawing stuff!)
every 6y ago
A veteran of the 60's here. Silly-cybin was definitely the hallucinogen of choice. Nary a bad time and days upon days of sweetness and light afterwards. I can readily understand how it might be efficacious for depression. LSD however, normally left you feeling like your dog had died. And ecstacy, at least outside of some secluded lab, didn't exist on the street...
chiefgeek 6y ago
Rant - it's not Ecstasy, it's MDMA. Ecstasy is a street drug. I wish these reporters would get their facts straight. Also, I did a guided therapeutic session two years ago and it was sublime. Top three experiences of my life. Transformative. This stuff needs to be legalized at least for prescription use, minimum.
- KitDuncan 6y ago
  Yeah the street drug often contains amphetamines or other stimulants. MDMA might be one ingredient, but often isn't.
asiachick 6y ago
That reminds me of this https://slatestarcodex.com/2019/05/09/is-there-a-case-for-skepticism-of-psychedelic-therapy/ https://slatestarcodex.com/2019/05/09/is-there-a-case-for-sk... Which tries to point out almost all treatments work and don't work and almost all papers that claim to do are by the true believers of the treatment.
4AoZqrH2fsk5UB 6y ago
I’m torn on this. On one hand I see the value in helping people who are sick, which is clearly a good. On the other hand I’ve seen how casually antidepressants can be consumed and seen them offered in social contexts and can’t help but suspect that pervasive mind-altering drugs could have a negative effect on society. Reminds me very much of Brave New Worlds Soma

233 points by nabla9 6y ago

Fostering PLURalism? https://news.ycombinator.com/item?id=25963589 https://news.ycombinator.com/item?id=25963589

mkmk 6y ago

Not ecstasy and psilocybin, but a few years ago, I met a psychiatrist who had worked in the armed forces and then alongside a crisis SWAT team. After decades of seeing people hit rock bottom, he learned about ketamine therapy as a treatment for treatment-resistant depression. He described it to me, a psychedelic skeptic, as “the closest thing to a miracle drug that I’ve seen in my career.” I’m not sure why, maybe because he seemed so much like the opposite of a “woo-woo” clinician, but the way he said it stuck with me. It has been fascinating to watch this space and the forward-thinking mental health companies that have been developing in this space.

Natsu 6y ago
Yes, ketamine can shut off depression like a light switch. That's really, really good for the population it works for. Of course, it can also cause psychosis. As someone who nearly got murdered in their sleep by someone on one such ketamine-caused psychosis, I think that caution is warranted when prescribing it. Waking up to take a knife away from a crying person is not something I would recommend to others. I've heard that there are studies on a metabolite of ketamine that's supposed to avoid the psycosis. I really hope that works so we get something this powerful without the downside.
- irq 6y ago
  Without making light of your experience, the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics. So yes, too much of a good thing is bad. Ketamine clinics use doses much lower than that which is used for general anesthesia, and ketamine is used for general anesthesia all over the world on a daily basis. It's on the World Health Organization's Essential Medicines List and has a very safe 50+ year track record.
  - JulianMorrison 6y ago
    Also don't take powerful drugs off-label, with no monitoring or supervision, and expect them to do the same thing they would at controlled doses in a controlled environment.
    - ketamine__ 6y ago
      I take doctor prescribed ketamine at home. It's incredibly safe and as a bonus it's much more comfortable to be laying in your own bed.
      - Natsu 6y ago
        They let people take it at home now? We had to go into a clinic and they would monitor you the entire time. There was a couch to lay on, but not much in the way of amenities.
        ketamine__ 6y ago
        I've been taking lozenges for over 2 years now.
    - Natsu 6y ago
      We didn't! It was a licensed esketamine trial under medical supervision for treatment-resistant depression.
  - Natsu 6y ago
    > Without making light of your experience, the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics. This was a licensed esketamine (s-ketamine) trial under medical supervision which, as you might imagine, left us excluded from the trial afterwards. So I am going to have to disagree with you regarding whether or not that is possible at theraputic doses. I realize that it's normally safe, and I hope that it helps a lot of people.
    - 6y ago
- airstrike 6y ago
  Basically the premise of the mini-series The Night Of
- nosmokewhereiam 6y ago
  Set and setting comes from Mindset and setting. Sounds like that person wasn't using K correctly (they were abusing it). I don't feel as if your anecdote applies to many others in a controlled setting.
  - Natsu 6y ago
    You would be wrong about that, it was a licensed esketamine trial under strict medical supervision.
    - hn_asker 6y ago
      strict medical supervision is sometimes a terrifying experience. Set and setting matter but so does any drugs they are currently on. I would say that your experience is atypical.
      - Natsu 6y ago
        As I understand it, the "K hole" was terrifying, the setting for taking this was a doctor's office that let you relax on a couch afterwards.
fossuser 6y ago
Gary Gulman talks a bit about the relief he got from it. Unfortunately for him it was only short term relief, but it really did seem to work. He’s doing well now, so maybe that short term relief helped in some way as part of everything else.
- purrplexed 6y ago
  Did 12 sessions, after the first session I had instant relief. Even the urge to drink was completely gone. I should have gone back in for boosters but just let it slide, mostly due to the continued cost. About 3 months later I was back into a depressive state. I was able to get out of that one on my own but I don't think it would have been possible without the ketamine treatments. It is hands down the most effective medicine to treat depression I have taken. The maintenance is the downside, however the minimal side effects are worth it.
- ketamine__ 6y ago
  Are you saying he abandoned the therapy because of the short-term relief? Most people return to their depressed state when they stop taking their anti-depressants.
  - fossuser 6y ago
    The doc told him he wouldn’t continue it because it wasn’t helping outside of the therapy session (and each session was quite expensive).
mrcartmenez 6y ago
Worked for me after I had become incredibly depressed while attempting to rescue my daughter from an abuse situation (I succeeded yay!). I went from having tunnel vision, hearing music as just noise, severe dissociation etc. to being just fine and normal two hours later. Best bio-hack I’ve ever done. I personally wouldn’t use it as a recreational drug often though as it does have some known side effects from habitual use and regular drug use is always a bad idea, yes folks that includes weed and alcohol.
- TaylorAlexander 6y ago
  Thank you for your story. I just wanted to offer an alternative view on regular drug use. I vape marijuana every day. After college I became an alcoholic after having stayed totally sober until age 21. Binge drinking college parties left me and my friends binge drinking well after college. It was bad, though I never lost a job. I’d tried marijuana several times and often felt overwhelmed with it. It would take me more than ten years to realize why those incidents happened - group pressure to take huge hits of marijuana left me feeling way too high. A deeply uncomfortable feeling. But marijuana helped me quit alcohol. I do not consider it the healthiest option nor do I recommend to anyone that they consume marijuana. But I would push back that it is always a bad idea. For my health I only vape marijuana and I keep the doses very small. I know it may still lead to health problems and I hope some day I don’t feel the need to do it. But it seems to help. I’ve stopped for weeks at a time and it’s fine. But I seem to prefer having a bit of marijuana every day. And I really don’t think that’s bad for me personally. I’m a successful robotics engineer. I worked for two years at Google X robotics while consuming marijuana daily and they filed two patents for my work during that time. Since then I’ve gone off to co-found a farming robotics organization that is about to announce our open source farming robot that I designed and built pretty much all myself. I think we should take a more open minded approach to drug use. Some people may find that certain drugs work for them. Certainly I am achieving my life goals while vaping marijuana daily. I don’t really think it’s best for me long term, but it seems to be what’s working for me now.
  - kortilla 6y ago
    It’s not clear to me from your post what the upside was for daily marijuana use is. It sounds like it kept you from reaching for the bottle, which I’m supporting of; but, what does it provide for someone who is not an alcoholic?
coderintherye 6y ago
The Center for Transformational Psychotherapy in SF leverages ketamine as part of their treatment, to good effect. Hopefully continued use and research will continue to mainstream its use (when appropriate).
dialamac 6y ago
Ketamine is a not uncommon thing in psych today. It is routinely prescribed. The problems are that it does seem for most people the effect is short lived (weeks) and psychosis is a thing (the poster below saying it’s never an issue even in pain setting is simply mistaken). The thing is that neither of these are uncommon problems for psych meds in general so ketamine shouldn’t be singled out for this, but it’s more complicated then some of the armchair docs here make it seem. There is continuing research into regimens that might minimize the tachyphylaxis, but it’s an ongoing problem.
- Tenoke 6y ago
  >psychosis is a thing Looking through Google scholar + personal experience I don't see evidence that this is an issue for non-schizophrenics.
  - dialamac 6y ago
    You need to look harder. Schizophrenia and psychotic features are relative contraindications for use of ketamine per APA guidelines. “It is unclear whether patients with depression that is not treatment- refractory or patients with other psychiatric illnesses are ap- propriate candidates for ketamine treatment, and extreme caution must be exercised in patients with psychotic or substance use disorders.” Side-effects associated with ketamine use in depression: a systematic review, Short 2018. To summarize: A review of 60 studies found dissociation and psychotomimetic effects >70 percent of the studies at varying rates. And note that the time courses of observation were variable. Furthermore most of these studies excluded participants with psychotic features or known psychotic disorder. But for any provider considering ketamine this is literally top of the list in consideration of adverse effects.
    - Tenoke 6y ago
      This review doesn't say all that much. I just took another look at it and it merely reports what % of the studies mention those effects without effect sizes or anything of the sort. Also they clump psychotomimetic and dissociation effects together which is really weird as ketamine is a dissociative. It's literally the highest number in their analysis (72%) because dissociation is to be expected from a dissociative.
PragmaticPulp 6y ago
Ketamine treatment for depression doesn’t require a psychedelic experience. Many clinics prefer to keep doses low enough to avoid full psychedelic experiences. Of course, some clinics blast patients with excessive doses and send them into full-blown psychedelic trips, but it’s definitely not necessary for the anti-depressant effect. Ketamine’s effects on depression are almost certainly mediated by something other than any psychedelic effects. Ideally we’ll find a safer medication which accomplishes the same thing without disorienting the patient Unfortunately, the effects of this therapy are rather short lived. There’s a growing industry of ketamine clinics that are happy to continue charging patients for endless ketamine infusions. Some offer outpatient prescriptions of ketamine. However, repeated treatment isn’t quite as effective as tolerance develops. The best approach appears to be using ketamine as a way to kickstart more sustainable, long-term depression treatments, such as therapy programs.
- hn_asker 6y ago
  There's a growing industry of therapy clinics that are happy to continue charging patients for endless sessions. Some offer anti-depressants and anti-psychotics. However, repeated treatment isn't quite as effective as the wrong mix of drugs are prescribed, the therapy re-enforces the trauma, and it is quite costly for patients to afford.
joshxyz 6y ago
I've done both back then, those stuff really changed my life perspective in terms of depth. Recreationally some of them can be misused (ketamine, extasy), but for the medically desperate I'm hella convinced these substances deserves more research.
johnchristopher 6y ago
I don't know. Every generalist doctor I have known got a alt phase aound 50. Homeopathiy, bach's flower, essential oils, etc. I chalk it up to "they have seen bad stuff and can't help some of their patients going through rough times and they look up for alternatives and settle for something for a few years".

artur_makly 6y ago

Just wait until they start unlocking Ayahuasca en masse...

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kibwen 6y ago

Good to see the blanket anti-drug hysteria of the last century being slowly dismantled. > Placebo controls pose another challenge because the drugs have such powerful effects. This is fascinating and something I haven't considered before. Are there other example of major studies that have inherent difficulty forming a control group like this?

anchpop 6y ago
Relevant XKCD: https://xkcd.com/1462/ https://xkcd.com/1462/
- matthberg 6y ago
  Equally related yet much less relevant XKCD: https://xkcd.com/790/ https://xkcd.com/790/
  - esperent 6y ago
    That suggests to me that Randall Munroe has never taken psychedelics.
    - heavenlyblue 6y ago
      Spiders and inability to scale things is one of the most common types of hallucination that is common to all paychedelics.
_jcrossley 6y ago
I found this fascinating as well. Sounds like a hard problem to solve - I'm skeptical and surprised that "niacin, which elicits a physical sensation — usually a flushing response in the skin" was effective as a placebo
- LocalH 6y ago
  I can't imagine it would be an effective placebo with any person who has ever had prior psychedelic experience, once enough time has passed. Perhaps in the pre-peak period where it's already kind of fuzzy when the effects start to kick in, but not anywhere near the peak

neonate 6y ago

https://archive.is/1IkV3 https://archive.is/1IkV3

veb 6y ago

This actually does help. The problem I have is it all returns years later which is why some people have LSD once a year or shrooms once a year or whatever. I'd love to trial this in a clinical situation but it's gonna be a long time until we see that I imagine.

ytwySXpMbS 6y ago
The Imperial College London trials looked at this. In the first trial, people were given 1 dose of psilocybin, and while some people recovered fully, many went back to being depressed after some months. In the second trial, they gave people 2 doses spaced a few weeks apart, and focused more on integration after the experience. They had much more success in sustained recovery with that. Here’s a podcast episode all about it if anyone’s interested (soundcloud link at the bottom of the page): https://www.mindmanifestpodcast.com/news/sureshmuthukumaraswamy-epdgd https://www.mindmanifestpodcast.com/news/sureshmuthukumarasw...

ouid 6y ago

>"He explained that he would have on hand a drug that could neutralize the hallucinogen, if necessary." How is right now the first time I have heard of this?

TylerE 6y ago
Because it doesn’t exist. What they really mean when they say something like this is a high dose benzodiazepine.
- _jcrossley 6y ago
  They might be referring to an antipsychotic like olanzapine https://pubmed.ncbi.nlm.nih.gov/26216558/ https://pubmed.ncbi.nlm.nih.gov/26216558/
  - loves_mangoes 6y ago
    This echoes the popular wisdom that benzos can only mollify hallucinations to make them bearable, and then force a black-out at higher dosage. Antipsychotics (like Seroquel & Olanzapine) on the other hand make the visuals and 'shadow people' (hallucinations resulting from lack of sleep) disappear, forcefully flinging people back to a semblance of reality, and then to uncomfortable sleep.
loceng 6y ago
Maps.org founder Rick Doblin's recommendation if someone is having a bad experience with Ayahuasca [or other psychedelic] is to give them a half therapeutic dose of MDMA; therapeutic dose is 100-125mg.

api 6y ago

More rediscovery of avant-garde technology and ideas from the 1960s.

vga805 6y ago

The Psychedelics ETF PSYK hit the Canadian market the day this was published. Nice timing.

_jcrossley 6y ago

I thought the infographic of # trials per year is really interesting - amazing that in January 2021 there have been 12 trials, when there were 11 in 2019 and 17 in 2020

frongpik 6y ago

I find it entertaining that lsd and mushrooms is a no no in the US, while drugs like Ambien that often cause somnambulism are "safe" to treat sleep problems.

loceng 6y ago
It's all regulatory capture, lobbying money from big pharma industrial complex - likely tied to the prison industrial complex who are happy to fill prisons, along with a few other complexes.

Wistar 6y ago

Related: See (hear) author Michael Pollan's 2018 Fresh Air interview on NPR about his experiments with mushrooms, LSD and other psychedelics while researching his book, "How to Change Your Mind." https://www.npr.org/2019/05/24/726085011/reluctant-psychonaut-michael-pollan-embraces-new-science-of-psychedelics https://www.npr.org/2019/05/24/726085011/reluctant-psychonau...

underseacables 6y ago

I just picked up some psilocybin and I’m very curious to try it got the first time. My PTSD compounds my depression and fuels my anxiety. Very interested to see where this research goes.

makeitrein 6y ago
Best of luck stranger! Perhaps explore starting with a microdose see how you feel on that before scaling up.

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LatteLazy 6y ago

I think I'm going to sign up for one of these, or just start trying things (I heard ketamine is also effective) in March. I've had severe clinical depression on and off for 12 years now. I've had all the SSRIs, none worked. I've tried the SNRIs and they worked a bit 8 years ago, but aren't working at all now. I started lithium a week ago, that's not having much effect so far (dose should be reviewed next week). I think the latest term in the US is Major Mood Disorder. Only around 30% of people with depression ever find an antidepressant that works for them. So for all the SSRIs, SNRIs, Tricyclics and other, the SUM effectiveness is 30%. There's really very little left on the menu and I have no expectation it will work. So, anyone got any experience with self treatment?

loceng 6y ago
There are less known causes of depression, where medications won't help - for example, if I ask you did you ever have ear infections as a child and were any of them painful - if your answer is yes, then I'd direct you to a specific therapy and a book that explains how that can lead to blocks in development and a depressed nervous system. Ayahuasca has helped me, MDMA as well, and a sound therapy I did in my early 20s dramatically shifted my life - as to what I'm referring to in my previous paragraph; prior to the sound therapy, which you can actually do a diagnostic audiogram to check for imbalances in hearing to confirm an issue, I would have been considered to have Aspergers - though never formally diagnosed, after the sound therapy I connected to emotion and my body again that I didn't know I was partially to fully disconnected/blocked from, which had an effect of hypersensitivities as well.
- embodiments 6y ago
  I’ve actually struggled a lot with depression and had many many painful ear infections as a child. Do you mind sharing that information on the book and therapy with me? Thanks!
  - loceng 6y ago
    The book is called "Hearing Equals Behaviour: Updated and Expanded" - can be found on Amazon - and the sound therapy is called Berard AIT or Auditory Integration Training; unfortunately there are people who claim to offer it, or have "at home" sessions they'll sell you where you rent equipment - however it's not the same high-end equipment that should be used, so "buyer beware." There are other sound therapies on the market that are reaching mainstream via well-written books, however the actual products they released don't seem to actually follow the AIT protocol and logically they shouldn't have anywhere near the same level of efficacy due to a few factors. I do know of a gentle old man in Montreal, Quebec, who was trained directly by Dr. Berard.

Avicebron 6y ago

I love these they, basically turn into: "when I was absolutely ripped on [blank] I discovered I could fly, am genius, nobel prize when" gold EDIT: breaking news, Crack cocaine discovered to hold the secrets of the universe, says man on crack cocaine.

dorkwood 6y ago
Your argument appears to be that people under the influence of a drug aren't able to accurately judge its positive benefits due to being intoxicated. But that doesn't really apply if a person is reflecting on an event from years prior, does it? A lot of the responses here are about a drug having a long-lasting effect on their depression, for example, which doesn't seem to fit with your theory.
- hypertele-Xii 6y ago
  Trauma causes your mind/body to bury its sensitive and vulnerable parts under a survival cocoon - metaphorically, a way of thinking that helps you cope. Psychoactives like MDMA, LSD, psilocybin, ketamine, and others temporarily confuse and override your normal mode of thinking, revealing and releasing buried truths. For me personally I was surprised that such strong emotions of love and empathy could even exist, and I vowed to tap into that channel which the drug unlocked after its effects had waned. I can still, years later, activate those emotions on command by consciously choosing to do so.
  - dorkwood 6y ago
    I had a similar experience. I used to turn my nose up at recreational drug use, because I thought of it as a purely pleasure-seeking activity. One day, I took some MDMA out of curiosity, and found that within a few hours I had a strong sense of empathy for everyone else in the room. It amazed me that it was even possible to feel that way -- I actually wanted to interact with people rather than shy away from them. It left a strong impression on me, and made me wonder whether some people naturally walk around feeling that way by default.

herodoturtle 6y ago

Will be interesting when we begin to simulate these effects in artificial neural networks.

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mahathu 6y ago

“People get locked into disorders like depression because they develop this system of thinking which is efficient, but wrong,” <-- I take some issue with the above statement and I'm very surprised to see it came from a doctor! I'm a neuroscience grad student and would like to do research on psychedelics in the future, therefore this article was an interesting read otherwise. Coincidentally I also suffer from a state of depression, and have been for years. Mostly I can do fine but some times I can't even get out of bed until the evening, and on many nights I wasn't convinced I'd live to see the next day. The way the sentence above is presented, to me, feels like people suffer from depression just as a result of thinking "wrong". I'm sure your judgement is clouded by such a serious mental condition in some ways. But in others, I like to think that I with my depressive POV might have more realistic view points on some things than an unaffected person. I would hate to not even have this one tiny little advantage from all this, and that in fact I'm not "sadder but wiser" [than some]. Am I wrong?

nostrademons 6y ago
There's been a fair bit of research on "depressive realism", the hypothesis that depressed people's view of reality is actually more accurate and it's "normal" people who have a system of thinking which is efficient, but wrong: https://en.wikipedia.org/wiki/Depressive_realism https://en.wikipedia.org/wiki/Depressive_realism I think that this may be an example of the tension between what's accurate vs. what's adaptive. There are a number of other social phenomena - like lying, exaggeration, overconfidence, risk-taking, perceptual bias, etc. - where individuals espouse views that are wrong because being wrong is more effective (in the sense of better social status or reproductive success) than being correct. Depression is likely the inverse of that: depressed people see the world accurately, but all of the mechanisms biasing toward survival involve distorting our perception of the world.
- patcon 6y ago
  YES. Thanks for saying this. I reflect on this a lot when I try to imagine how I should "expect" the society to tend toward some pseudo-stability... A related TED talk by Donald Hoffman has stuck with me: https://www.ted.com/talks/donald_hoffman_do_we_see_reality_as_it_is/transcript?language=en https://www.ted.com/talks/donald_hoffman_do_we_see_reality_a... > Well, I hate to break it to you, but perception of reality goes extinct. In almost every simulation, organisms that see none of reality but are just tuned to fitness drive to extinction all the organisms that perceive reality as it is. So the bottom line is, evolution does not favor veridical, or accurate perceptions. Those perceptions of reality go extinct. Written format: https://www.quantamagazine.org/the-evolutionary-argument-against-reality-20160421/ https://www.quantamagazine.org/the-evolutionary-argument-aga...

loveJesus 6y ago

God is good. My experience is it would be best to stay away from these things. God has helped me be psych med free since 2014 even caffeine, not mormon btw. For me, it was a lack of knowing what was better out there that encouraged me to take them, and finally ended up in a hospital needing all kinds of treatments for adhd/bipolar etc. Needing to recover from things that only 'bad people' did. Eventually with doctor's approval was how the medication was removed, after a person came and prophesied for me to stop medications, at a moment the Lord had impressed that it would happen, interesting long story [1]. I had to learn to lead an orderly life and work with doctors while in treatment. It's really nice to be free from the illness and the meds, though grateful for the meds (at the end it was only a small amount of haldol vs lots of zyprexa at the beginning) when they were needed, However it can be an encouragement in the Lord Jesus to people. [1] https://soundcloud.com/brianlovejesus/testimony-of-jesus-working-me-outwards-of-my-rotten-life https://soundcloud.com/brianlovejesus/testimony-of-jesus-wor...

egypturnash 6y ago

best thing ever for my chronic depression was a hit of E at a furry con, it basically kicked me out of a loop I'd been in for years and I've never been back in it since.

greenonions 6y ago
What a unique experience, and quite good that it had that effect! What was that like?
- egypturnash 6y ago
  I spent all night wandering around the hotel with a couple of friends who I would later end up in a relationship with, babbling about some deep deep holes in my brain. Several times I said that I felt wonderful and amazing, and that I was not allowed to go looking for this stuff again for at least a year, as I could see how it could get addictive. This was something like fifteen years ago and I still haven’t had any urge to hunt down more. If I need it badly enough I figure it will show up in my life again. (Also it was at a furry con, which I guess is kind of a weird and magical space for most people; it was far from my first one, and there’s a strong component of work to them for me as I’m an artist who spends most of them hanging out behind a table drawing stuff!)

every 6y ago

A veteran of the 60's here. Silly-cybin was definitely the hallucinogen of choice. Nary a bad time and days upon days of sweetness and light afterwards. I can readily understand how it might be efficacious for depression. LSD however, normally left you feeling like your dog had died. And ecstacy, at least outside of some secluded lab, didn't exist on the street...

chiefgeek 6y ago

Rant - it's not Ecstasy, it's MDMA. Ecstasy is a street drug. I wish these reporters would get their facts straight. Also, I did a guided therapeutic session two years ago and it was sublime. Top three experiences of my life. Transformative. This stuff needs to be legalized at least for prescription use, minimum.

KitDuncan 6y ago
Yeah the street drug often contains amphetamines or other stimulants. MDMA might be one ingredient, but often isn't.

asiachick 6y ago

That reminds me of this https://slatestarcodex.com/2019/05/09/is-there-a-case-for-skepticism-of-psychedelic-therapy/ https://slatestarcodex.com/2019/05/09/is-there-a-case-for-sk... Which tries to point out almost all treatments work and don't work and almost all papers that claim to do are by the true believers of the treatment.

4AoZqrH2fsk5UB 6y ago

I’m torn on this. On one hand I see the value in helping people who are sick, which is clearly a good. On the other hand I’ve seen how casually antidepressants can be consumed and seen them offered in social contexts and can’t help but suspect that pervasive mind-altering drugs could have a negative effect on society. Reminds me very much of Brave New Worlds Soma