4 ms·

The definition of treatment resistant depression is one of the filters that narrows down the list. A subject must have tried at least two different antidepress

The definition of treatment resistant depression is one of the filters that narrows down the list. A subject must have tried at least two different antidepressants for a certain length of time and within the last few years, in addition to therapy. So, someone who has taken antidepressants for years doesn't automatically qualify.

varispeed 6y ago
This is crazy. It's like cart manufacturers lobbied government that anyone who want to buy a car would first have to use a horse and a cart and only be allowed to buy a car if the cart and a horse causes significant problem. Am I the only one seeing corruption here?
- rincebrain 6y ago
  If your attempted argument is "X helps people who are not helped by other existing treatments", then limiting your selection criteria to those who have tried several existing treatments and not found success seems to follow logically. (Though the study's construction seems to fail at that argument, since the claim is that all patients, both those given the psilocybin and those given the SSRI, improved markedly.)
  - varispeed 6y ago
    When I wrote that, I had in mind a situation in my country that you can be eligible for private medical cannabis prescription if you try at least two other treatments and you find them ineffective. On the surface it doesn't sound too sinister, but for example, when it comes to chronic pain the drugs that are being given are simply nasty. I still have nightmares about the side effects that I experienced (vivid hallucinations, suicidal thoughts, derealization and more). Given how ubiquitous cannabis is, people with various problems often find, including chronic pain, that it helps massively and unfortunately they cannot bypass going through hell just to get prescription for what helps. They cannot even suggest that they look for medicinal cannabis as they still may be branded as drug seekers and be denied treatment altogether.
    - rincebrain 6y ago
      I can understand the basis for those requirements in general (e.g. for antidepressants, doctors generally won't start you with an MAOI or a TCA, they'll start you with an SSRI or SNRI or similar, then try another one if that doesn't work, then maybe resort to TCAs if a couple of those don't work, then maybe try an MAOI if a couple of _those_ don't work), though I would agree that having a hard requirement of trying several other drugs first with the toxicity profile of cannabis seems...overly harsh at best. (Especially labeling people drug seekers for it - though they might be gun-shy after the fun with opioids and worried about finding a new epidemic of cannabis addicts, which seems...unlikely.)
- say_it_as_it_is 6y ago
  Studies are being designed to reduce the possibility that a patient just didn't respond well to one medication but instead shows a general lack of improvement from antidepressants. The goal is to know that the patient improved from psilocybin, specifically. One other problem with this stacked definition of treatment resistance is that doctors are going to be coerced to always try multiple antidepressants and guinea pig the hell out of patients. Doctors are going to refuse initial psilocybin treatment and only use it as a last resort because the studies are going to show that treatment resistance is necessary. Even worse will be if doctors are coerced by regulators and medical institutes to strictly follow their protocol. And this only includes doctors who agree to add psilocybin to their treatment programs. A lot of doctors will resist using it, claiming "unearned wisdom is dangerous wisdom" and so forth. The "unearned wisdom" claim is based on the indoctrinated belief that a patient must undergo many hours of therapy and slowly peel layers of experience in order to truly understand, whereas psilocybin offers a shortcut. For these reasons and others, I believe that the vast majority of depressed people who haven't healed from traditional methods ought not pursue clinical studies as a viable pathway to psilocybin-assisted therapy.

varispeed 6y ago

This is crazy. It's like cart manufacturers lobbied government that anyone who want to buy a car would first have to use a horse and a cart and only be allowed to buy a car if the cart and a horse causes significant problem. Am I the only one seeing corruption here?

rincebrain 6y ago
If your attempted argument is "X helps people who are not helped by other existing treatments", then limiting your selection criteria to those who have tried several existing treatments and not found success seems to follow logically. (Though the study's construction seems to fail at that argument, since the claim is that all patients, both those given the psilocybin and those given the SSRI, improved markedly.)
- varispeed 6y ago
  When I wrote that, I had in mind a situation in my country that you can be eligible for private medical cannabis prescription if you try at least two other treatments and you find them ineffective. On the surface it doesn't sound too sinister, but for example, when it comes to chronic pain the drugs that are being given are simply nasty. I still have nightmares about the side effects that I experienced (vivid hallucinations, suicidal thoughts, derealization and more). Given how ubiquitous cannabis is, people with various problems often find, including chronic pain, that it helps massively and unfortunately they cannot bypass going through hell just to get prescription for what helps. They cannot even suggest that they look for medicinal cannabis as they still may be branded as drug seekers and be denied treatment altogether.
  - rincebrain 6y ago
    I can understand the basis for those requirements in general (e.g. for antidepressants, doctors generally won't start you with an MAOI or a TCA, they'll start you with an SSRI or SNRI or similar, then try another one if that doesn't work, then maybe resort to TCAs if a couple of those don't work, then maybe try an MAOI if a couple of _those_ don't work), though I would agree that having a hard requirement of trying several other drugs first with the toxicity profile of cannabis seems...overly harsh at best. (Especially labeling people drug seekers for it - though they might be gun-shy after the fun with opioids and worried about finding a new epidemic of cannabis addicts, which seems...unlikely.)
say_it_as_it_is 6y ago
Studies are being designed to reduce the possibility that a patient just didn't respond well to one medication but instead shows a general lack of improvement from antidepressants. The goal is to know that the patient improved from psilocybin, specifically. One other problem with this stacked definition of treatment resistance is that doctors are going to be coerced to always try multiple antidepressants and guinea pig the hell out of patients. Doctors are going to refuse initial psilocybin treatment and only use it as a last resort because the studies are going to show that treatment resistance is necessary. Even worse will be if doctors are coerced by regulators and medical institutes to strictly follow their protocol. And this only includes doctors who agree to add psilocybin to their treatment programs. A lot of doctors will resist using it, claiming "unearned wisdom is dangerous wisdom" and so forth. The "unearned wisdom" claim is based on the indoctrinated belief that a patient must undergo many hours of therapy and slowly peel layers of experience in order to truly understand, whereas psilocybin offers a shortcut. For these reasons and others, I believe that the vast majority of depressed people who haven't healed from traditional methods ought not pursue clinical studies as a viable pathway to psilocybin-assisted therapy.