3 ms·

I'm very thankful we have more options. And there was even a study in recent years by John Krystal on combining another drug with ketamine to increase remissio

I'm very thankful we have more options. And there was even a study in recent years by John Krystal on combining another drug with ketamine to increase remission time. But we aren't learning anything from these trials about the nature of depression. They can't tell us anything about the non-responders.

tbalsam 4y ago
That's because depression is (as best as I believe) a low dimensional projection of a high dimensional issue. It's like saying "we aren't learning more about fever from acetaminophen" (or ibuprofen, for example). Of course we aren't! It's a symptom of something else. Depression (I personally believe) is never a standalone syndrome. Ever. Not unless something is wacked out crazy physiologically, in which case for those cases at least you should see a near 0% success rate for talk therapy, I believe (barring a few minor exceptions, perhaps). Depression can often come from a variety of confounding factors, but the nigh-monotropic tendencies of the field to focus on a singular cause is how we end up with a series of medications where four rounds of different adaptive, extremely well funded and supported antidepressant therapies ended up in an extended remission rate of only ~25% or so. 25%. I do, oddly enough, disagree that they can't tell us about non responders as the overtly psychedelic nature of the compound does leak information about the underlying system (s) at play. But I think with this reductive approach that many of us (almost necessarily have due to resource constraints) use when trying to tackle the issue, we're going to miss the bigger side of the issue. On the plus side, in some trials, Ketamine is showing an efficacy of ~%69 or so, or so I've heard, which is quite good. One provider that I've heard about seems to note good long-term results in patients who are initially resistant, which could be for a variety of factors, some of those including simply extremely hardened belief systems that are less game-theoretically compatible with a smooth(er/ish) transition to a less tense-with-the-world strategy set.

tbalsam 4y ago

That's because depression is (as best as I believe) a low dimensional projection of a high dimensional issue. It's like saying "we aren't learning more about fever from acetaminophen" (or ibuprofen, for example). Of course we aren't! It's a symptom of something else. Depression (I personally believe) is never a standalone syndrome. Ever. Not unless something is wacked out crazy physiologically, in which case for those cases at least you should see a near 0% success rate for talk therapy, I believe (barring a few minor exceptions, perhaps). Depression can often come from a variety of confounding factors, but the nigh-monotropic tendencies of the field to focus on a singular cause is how we end up with a series of medications where four rounds of different adaptive, extremely well funded and supported antidepressant therapies ended up in an extended remission rate of only ~25% or so. 25%. I do, oddly enough, disagree that they can't tell us about non responders as the overtly psychedelic nature of the compound does leak information about the underlying system (s) at play. But I think with this reductive approach that many of us (almost necessarily have due to resource constraints) use when trying to tackle the issue, we're going to miss the bigger side of the issue. On the plus side, in some trials, Ketamine is showing an efficacy of ~%69 or so, or so I've heard, which is quite good. One provider that I've heard about seems to note good long-term results in patients who are initially resistant, which could be for a variety of factors, some of those including simply extremely hardened belief systems that are less game-theoretically compatible with a smooth(er/ish) transition to a less tense-with-the-world strategy set.