5 ms·

"Psychedelics, like ketamine, also have the ability to produce neuroplasticity – encouraging the brain to grow synapses and nerve connections which then opens u

"Psychedelics, like ketamine, also have the ability to produce neuroplasticity – encouraging the brain to grow synapses and nerve connections which then opens up the potential to lay down new patterns of behaviour" This is the key takeaway from the steady stream of good news we've been getting about psychoactive drugs and how they can help with issues like addiction and depression. I can see how a skeptic might look at these reports and think "how convenient, all the fun drugs make people happier for a little while". But I think we're discovering that it isn't this or that drug that has the potential to help people, but rather the approach that is enabled by an entire class of drugs. Determining which drugs can be most useful and how to apply them will be a big ongoing project (now that we're finally able to finally do the research). The drugs we use down the line may be nothing like the drugs we're looking at today.

hemloc_io 5y ago
My personal (unprofessional) opinion is recreational drugs are great for research b/c they're unlikely to kill people, people wouldn't take drugs for that will kill them, and they haven't been able to be researched before, meaning there's almost certainly a discovery there. Once we discover the method of action of the drug then maybe we can end up in a targeted drug without the fun side effects that the rec drugs have (like you said). Figuring it out from the top down by designing a substance, and then testing it on people, sounds dangerous + difficult.
- k0k0r0 5y ago
  Honest question: Why should we kill the fun? I mean addiction is a problem, but having a great time definitely isn't, right? Or do I miss something?
  - hemloc_io 5y ago
    oh no reason, recreational drugs are fine for recreation imo. But when looking at therapies I don’t know if my grandpa with PTSD is looking to blast off on ketamine for therapy every week. (Although to each their own haha)
  - ggm 5y ago
    It can feed the addictive behaviour. Sometimes, the coping mechanism between swings of mood isn't to push to the peak experience you want. The goal is to get to a more stable medium
    - k0k0r0 5y ago
      See my comment to a sibling.
  - PragmaticPulp 5y ago
    Because the "fun" effect is immediately apparent, but the therapeutic effect may take some time to notice. This leads to situations where patients mistake the "fun" part for the therapeutic effect, which causes a lot of problems when tolerance builds to the fun. This happens with opioid users who chase the euphoric rush instead of pain management, stimulant users who try to get a mood boost and motivation out of their stimulants instead of attention-enhancing effects, and ketamine patients who chase the dissociation instead of the antidepressant effect. It's bad enough that you'll see addicts save up their medications so they can double-dose (or more) for more euphoria, then suffer in between doses when they go into mini-withdrawal. Terrible pattern and it would be a huge advancement if we could get past that.
    - hndamien 5y ago
      Sounds like trying to take play out of learning. you can do it, but it's probably suboptimal and may be partially necessary.
      - PragmaticPulp 5y ago
        Not really. If the patient learns to seek the side effects of the drug at the expense of the therapeutic effects, it’s disincentivizing proper use. The truth is that for properly-doses patients taking medication long-term, the “fun” part disappears naturally. People taking Adderall for a decade aren’t buzzing around like a college student popping their first pill during finals week. People with properly controlled chronic pain aren’t nodding off from their opioids. The euphoric effects aren’t just a bonus. They actively interfere with establishing successful treatment. Most diligent patients will overcome this, but a lot of people will abandon the therapeutic part and chase the “fun” part to their detriment. Or alternatively, they’ll abandon the therapy when the “fun” part wears off because it’s the only thing they were paying attention to.
        hndamien 5y ago
        If the therapist/shaman is doing their job well then proper use should align incentives without actively trying to diminish enjoyable positive psychological affect. Thats all I'm saying. The potential you mention for missing the point is obviously present, but not worth actively minimising imho.
PragmaticPulp 5y ago
> I can see how a skeptic might look at these reports and think "how convenient, all the fun drugs make people happier for a little while" And those skeptics would be both right and wrong. Wrong in the sense that the antidepressant effect of ketamine lasts for some time after the drug leaves the system, so we know it's not just a temporary drug-induced effect. But somewhat right because the antidepressant effect isn't very durable, so it's mostly useful in emergency situations (suicidal tendencies) and for kickstarting conventional therapy. Even the rare patients who convince their doctor to prescribe ketamine multiple times per week over the long term usually encounter diminishing effects as tolerance sets in. Unfortunately, the high relapse rate presents a huge conflict of interest for these ketamine clinics, which are often more than happy to continue taking your money in exchange for ketamine sessions. The more ethical ones will insist that patients be enrolled in therapy and will educate them on proper maintenance antidepressant options if they choose. The less ethical ones will give patients a speech about how traditional medicine is bad and their only real option is to continue coming in for more ketamine. There are some horror stories from one of the local ketamine clinics here. I'm actually shocked they aren't more tightly regulated at this point.
- criticaltinker 5y ago
  I know you comment on a wide range of topics here, and perhaps you’re jaded by some personal experiences with local ketamine clinics - but IMO your tone comes across as unnecessarily pessimistic and a smidge anecdotal. Ketamine/MDMA/LSD/Psilocybin and their derivatives are on their way to being recognized as the safest, most effective, and widely available medicines - for nearly every common mental health disorder - currently known to humanity. Yes there will always be predatory behavior in healthcare, and regulation can help. And of course no medicine is 100% side-effect free or effective for everyone. But shouldn’t we be complaining that many of these substances continue to remain federally outlawed in the US despite a huge body of scientific evidence and multiple companies discussing phase 3 clinical trials with the FDA this year? I don’t really hear many folks calling for tighter regulation on these substances, especially given the current regulatory situation.
  - PragmaticPulp 5y ago

hemloc_io 5y ago

My personal (unprofessional) opinion is recreational drugs are great for research b/c they're unlikely to kill people, people wouldn't take drugs for that will kill them, and they haven't been able to be researched before, meaning there's almost certainly a discovery there. Once we discover the method of action of the drug then maybe we can end up in a targeted drug without the fun side effects that the rec drugs have (like you said). Figuring it out from the top down by designing a substance, and then testing it on people, sounds dangerous + difficult.

k0k0r0 5y ago
Honest question: Why should we kill the fun? I mean addiction is a problem, but having a great time definitely isn't, right? Or do I miss something?
- hemloc_io 5y ago
  oh no reason, recreational drugs are fine for recreation imo. But when looking at therapies I don’t know if my grandpa with PTSD is looking to blast off on ketamine for therapy every week. (Although to each their own haha)
- ggm 5y ago
  It can feed the addictive behaviour. Sometimes, the coping mechanism between swings of mood isn't to push to the peak experience you want. The goal is to get to a more stable medium
  - k0k0r0 5y ago
    See my comment to a sibling.
- PragmaticPulp 5y ago
  Because the "fun" effect is immediately apparent, but the therapeutic effect may take some time to notice. This leads to situations where patients mistake the "fun" part for the therapeutic effect, which causes a lot of problems when tolerance builds to the fun. This happens with opioid users who chase the euphoric rush instead of pain management, stimulant users who try to get a mood boost and motivation out of their stimulants instead of attention-enhancing effects, and ketamine patients who chase the dissociation instead of the antidepressant effect. It's bad enough that you'll see addicts save up their medications so they can double-dose (or more) for more euphoria, then suffer in between doses when they go into mini-withdrawal. Terrible pattern and it would be a huge advancement if we could get past that.
  - hndamien 5y ago
    Sounds like trying to take play out of learning. you can do it, but it's probably suboptimal and may be partially necessary.
    - PragmaticPulp 5y ago
      Not really. If the patient learns to seek the side effects of the drug at the expense of the therapeutic effects, it’s disincentivizing proper use. The truth is that for properly-doses patients taking medication long-term, the “fun” part disappears naturally. People taking Adderall for a decade aren’t buzzing around like a college student popping their first pill during finals week. People with properly controlled chronic pain aren’t nodding off from their opioids. The euphoric effects aren’t just a bonus. They actively interfere with establishing successful treatment. Most diligent patients will overcome this, but a lot of people will abandon the therapeutic part and chase the “fun” part to their detriment. Or alternatively, they’ll abandon the therapy when the “fun” part wears off because it’s the only thing they were paying attention to.
      - hndamien 5y ago
        If the therapist/shaman is doing their job well then proper use should align incentives without actively trying to diminish enjoyable positive psychological affect. Thats all I'm saying. The potential you mention for missing the point is obviously present, but not worth actively minimising imho.

PragmaticPulp 5y ago

> I can see how a skeptic might look at these reports and think "how convenient, all the fun drugs make people happier for a little while" And those skeptics would be both right and wrong. Wrong in the sense that the antidepressant effect of ketamine lasts for some time after the drug leaves the system, so we know it's not just a temporary drug-induced effect. But somewhat right because the antidepressant effect isn't very durable, so it's mostly useful in emergency situations (suicidal tendencies) and for kickstarting conventional therapy. Even the rare patients who convince their doctor to prescribe ketamine multiple times per week over the long term usually encounter diminishing effects as tolerance sets in. Unfortunately, the high relapse rate presents a huge conflict of interest for these ketamine clinics, which are often more than happy to continue taking your money in exchange for ketamine sessions. The more ethical ones will insist that patients be enrolled in therapy and will educate them on proper maintenance antidepressant options if they choose. The less ethical ones will give patients a speech about how traditional medicine is bad and their only real option is to continue coming in for more ketamine. There are some horror stories from one of the local ketamine clinics here. I'm actually shocked they aren't more tightly regulated at this point.

criticaltinker 5y ago
I know you comment on a wide range of topics here, and perhaps you’re jaded by some personal experiences with local ketamine clinics - but IMO your tone comes across as unnecessarily pessimistic and a smidge anecdotal. Ketamine/MDMA/LSD/Psilocybin and their derivatives are on their way to being recognized as the safest, most effective, and widely available medicines - for nearly every common mental health disorder - currently known to humanity. Yes there will always be predatory behavior in healthcare, and regulation can help. And of course no medicine is 100% side-effect free or effective for everyone. But shouldn’t we be complaining that many of these substances continue to remain federally outlawed in the US despite a huge body of scientific evidence and multiple companies discussing phase 3 clinical trials with the FDA this year? I don’t really hear many folks calling for tighter regulation on these substances, especially given the current regulatory situation.
- PragmaticPulp 5y ago