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This is rubbish. Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting. It is not magic and does not work

This is rubbish. Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting. It is not magic and does not work in every case, but the effects are proven across countless studies. S-ketamine has even gone fully through FDA approval. Personally I have used it at home, and at a treatment center. There is no difference in the antidepressant properties, whether someone was helping me administer it in a medical setting, or not. The antidepressant properties do not relate to the effects of simply being in a clinical trial. I strongly believe the antidepressant properties arise from the psychedelic/dissociative experience, and not directly from the physical effects. I'm not terribly surprised that ketamine may not produce strong antidepressant effects if the patient is not conscious. Anyone looking to read more about ketamine antidepressant properties should read "The Ketamine Papers: Science, Therapy, and Transformation" by Phil Wolfson, M.D., and Glenn Hartelius, Ph.D.

arthur2e5 3y ago
The study actually shows ketamine works as well with anesthetia (45%) as without (40%), if you read the non-anesthetia study linked in https://news.ycombinator.com/item?id=36030251 https://news.ycombinator.com/item?id=36030251. (Of course you can argue they are not using enough K at the 0.5 mg/kg mark, because disccociation starts at 1 to 3 mg/kg per StatPearls.)
- PragmaticPulp 3y ago
  > Of course you can argue they are not using enough K at the 0.5 mg/kg mark, because disccociation starts at 1 to 3 mg/kg Dissociation isn’t necessary for the antidepressant effect, according to studies. In fact, many of the more responsible clinics target longer duration, lower peak dose infusions for this reason.
  - arthur2e5 3y ago
    Well, yeah. But the parent comment is insisting that the spiritual bits is doing something, and I was just way too lazy to look for a dose response study.
FollowingTheDao 3y ago
> It is not magic and does not work in every case, That is exactly what they are saying in the study. No better than placebo means Ketamine does not cure depression. If ketamine cured depression it would work in every case. Increasing serotonin receptor density trough Ketamine use may relieve depression, but so can being cared for. Your beliefs do not matter, biology matters. And it may in fact be that your "strong beliefs" in ketamine are why it helps you.
- cypherpunks01 3y ago
  The FDA does not approve medicine based on beliefs. I am sharing my personal perspective, alongside the fact that controlled studies have proven it is one of the most effective treatments known to exist. Nobody thinks ketamine cures depression, it is one treatment.
  - FollowingTheDao 3y ago
    > The FDA does not approve medicine based on beliefs. Yes, sometimes they do. https://www.pbs.org/newshour/health/fda-increasingly-approves-drugs-without-conclusive-proof-they-work https://www.pbs.org/newshour/health/fda-increasingly-approve...
    - FollowingTheDao 3y ago
      Downvoted! For a fact! The internet is filled with crooked bots, captured bots, bots that want capitalism and governmental collusion to seem "silly".
- tasty_freeze 3y ago
  I don't have a position on the paper (I haven't even read it), but this statement you just made seems unjustified: > If ketamine cured depression it would work in every case. Depression can have many different causes, and people have many different biological variables, so it should not be surprising that a given treatment isn't 100% effective. There are many example of this in the real world. With your logic, one might say: the sars covid-19 virus doesn't cause illness because some exposed people showed no symptoms. The families of the dead people would disagree.
PragmaticPulp 3y ago
> Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting. It’s really not uncommon for some trials to fail to differentiate from placebo when it comes to depression studies. That doesn’t make this study “rubbish”, it just shows that you need to examine the body of evidence rather than cherry-picking studies that appear to match the outcome you want while dismissing those that say the opposite. Ketamine is a temporary boost for some people, but it has also been overhyped in recent years. The single biggest downside is that it’s not a long-term solution. The duration of the antidepressant effect is relatively short (days to weeks) and the antidepressant effect appears to diminish with repeated dosing. It can be a great help for suicidal patients or for getting traditional treatment started, but it’s not a singular solution to depression for most people. Ketamine prescribing also got out of control fast. I traveled to a city where Ketamine clinics were advertising on the radio and billboards and competing with coupons and discounts and exaggerated promises of efficacy. Reddit and other forums are also filling up with stories of people who think their ketamine “stopped working” because they weren’t properly informed that it was a temporary effect for most people that needed to be combined with traditional therapy. Way too many clinics and influencers looking to ride the hype train without honestly assessing the situation.
- Rookie42 3y ago
  I couldnt disagree more with your second paragraph. I have a partner who has been prescribed Ketamine for the last 3 years. I firmly believe that the drugs ability to rebuild neural pathways and thus work around / resolve damage to be the only reason why partner is still alive today, and is now ready to return to work after so many years and such a brutal road. In Australia, being prescribed Ketamine is very difficult, and thus very uncommon. While I do not believe it should be opened up to everyone, my experience over the last few years makes me a massive fan of the drug for specific situations.
- 35997279 3y ago
  > It can be a great help for suicidal patients or for getting traditional treatment started, but it’s not a singular solution to depression for most people. Is there any singular solution to depression for most people?
throwawaylinux 3y ago
Did you read the article? It explains the study is attempting to narrow down the mechanism for ketamine's effects, not disprove them. The title is misleading though, unfortunately. What the study found is that Ketamine-while-unconscious is no better.
automatic6131 3y ago
>Ketamine is a life-saver Anyone who talks in such terms shouldn't have their opinions on medicine listened to. There's a reason that medicine typically sticks to such terms as QALY (quality adjusted life year) and other such terms to produce the best outcomes in a resource constrained environment. By your reasoning, many things are "life savers", but not every intervention is equal, is it?
- hugatest 3y ago
  > >Ketamine is a life-saver > Anyone who talks in such terms shouldn't have their opinions on medicine listened to. Criticizing hyperbole by using hyperbole is a questionable strategy.
cpncrunch 3y ago
>I'm not terribly surprised that ketamine may not produce strong antidepressant effects if the patient is not conscious. That's incorrect, it actually produced larger antidepressant effects (50% response rate and 40% remission [1]) than when the patient is conscious (40% response rate and 30% remission according to a large meta-analysis [2]). [1] https://www.medrxiv.org/content/10.1101/2023.04.28.23289210v1.full-text https://www.medrxiv.org/content/10.1101/2023.04.28.23289210v... [2] https://pubmed.ncbi.nlm.nih.gov/35688035/ https://pubmed.ncbi.nlm.nih.gov/35688035/ But that large response had nothing to do with ketamine, as the non-ketamine group had the same or higher response.
- bagacrap 3y ago
  They only measured response for the next three days. Is it possible k has an effect for longer than three days while placebo only lasts three days or so?
  - cpncrunch 3y ago
    Unlikely. I see another comment says "The duration of the antidepressant effect is relatively short (days to weeks) and the antidepressant effect appears to diminish with repeated dosing."

arthur2e5 3y ago

The study actually shows ketamine works as well with anesthetia (45%) as without (40%), if you read the non-anesthetia study linked in https://news.ycombinator.com/item?id=36030251 https://news.ycombinator.com/item?id=36030251. (Of course you can argue they are not using enough K at the 0.5 mg/kg mark, because disccociation starts at 1 to 3 mg/kg per StatPearls.)

PragmaticPulp 3y ago
> Of course you can argue they are not using enough K at the 0.5 mg/kg mark, because disccociation starts at 1 to 3 mg/kg Dissociation isn’t necessary for the antidepressant effect, according to studies. In fact, many of the more responsible clinics target longer duration, lower peak dose infusions for this reason.
- arthur2e5 3y ago
  Well, yeah. But the parent comment is insisting that the spiritual bits is doing something, and I was just way too lazy to look for a dose response study.

FollowingTheDao 3y ago

> It is not magic and does not work in every case, That is exactly what they are saying in the study. No better than placebo means Ketamine does not cure depression. If ketamine cured depression it would work in every case. Increasing serotonin receptor density trough Ketamine use may relieve depression, but so can being cared for. Your beliefs do not matter, biology matters. And it may in fact be that your "strong beliefs" in ketamine are why it helps you.

cypherpunks01 3y ago
The FDA does not approve medicine based on beliefs. I am sharing my personal perspective, alongside the fact that controlled studies have proven it is one of the most effective treatments known to exist. Nobody thinks ketamine cures depression, it is one treatment.
- FollowingTheDao 3y ago
  > The FDA does not approve medicine based on beliefs. Yes, sometimes they do. https://www.pbs.org/newshour/health/fda-increasingly-approves-drugs-without-conclusive-proof-they-work https://www.pbs.org/newshour/health/fda-increasingly-approve...
  - FollowingTheDao 3y ago
    Downvoted! For a fact! The internet is filled with crooked bots, captured bots, bots that want capitalism and governmental collusion to seem "silly".
tasty_freeze 3y ago
I don't have a position on the paper (I haven't even read it), but this statement you just made seems unjustified: > If ketamine cured depression it would work in every case. Depression can have many different causes, and people have many different biological variables, so it should not be surprising that a given treatment isn't 100% effective. There are many example of this in the real world. With your logic, one might say: the sars covid-19 virus doesn't cause illness because some exposed people showed no symptoms. The families of the dead people would disagree.

PragmaticPulp 3y ago

> Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting. It’s really not uncommon for some trials to fail to differentiate from placebo when it comes to depression studies. That doesn’t make this study “rubbish”, it just shows that you need to examine the body of evidence rather than cherry-picking studies that appear to match the outcome you want while dismissing those that say the opposite. Ketamine is a temporary boost for some people, but it has also been overhyped in recent years. The single biggest downside is that it’s not a long-term solution. The duration of the antidepressant effect is relatively short (days to weeks) and the antidepressant effect appears to diminish with repeated dosing. It can be a great help for suicidal patients or for getting traditional treatment started, but it’s not a singular solution to depression for most people. Ketamine prescribing also got out of control fast. I traveled to a city where Ketamine clinics were advertising on the radio and billboards and competing with coupons and discounts and exaggerated promises of efficacy. Reddit and other forums are also filling up with stories of people who think their ketamine “stopped working” because they weren’t properly informed that it was a temporary effect for most people that needed to be combined with traditional therapy. Way too many clinics and influencers looking to ride the hype train without honestly assessing the situation.

Rookie42 3y ago
I couldnt disagree more with your second paragraph. I have a partner who has been prescribed Ketamine for the last 3 years. I firmly believe that the drugs ability to rebuild neural pathways and thus work around / resolve damage to be the only reason why partner is still alive today, and is now ready to return to work after so many years and such a brutal road. In Australia, being prescribed Ketamine is very difficult, and thus very uncommon. While I do not believe it should be opened up to everyone, my experience over the last few years makes me a massive fan of the drug for specific situations.
35997279 3y ago
> It can be a great help for suicidal patients or for getting traditional treatment started, but it’s not a singular solution to depression for most people. Is there any singular solution to depression for most people?

throwawaylinux 3y ago

Did you read the article? It explains the study is attempting to narrow down the mechanism for ketamine's effects, not disprove them. The title is misleading though, unfortunately. What the study found is that Ketamine-while-unconscious is no better.

automatic6131 3y ago

>Ketamine is a life-saver Anyone who talks in such terms shouldn't have their opinions on medicine listened to. There's a reason that medicine typically sticks to such terms as QALY (quality adjusted life year) and other such terms to produce the best outcomes in a resource constrained environment. By your reasoning, many things are "life savers", but not every intervention is equal, is it?

hugatest 3y ago
> >Ketamine is a life-saver > Anyone who talks in such terms shouldn't have their opinions on medicine listened to. Criticizing hyperbole by using hyperbole is a questionable strategy.

cpncrunch 3y ago

>I'm not terribly surprised that ketamine may not produce strong antidepressant effects if the patient is not conscious. That's incorrect, it actually produced larger antidepressant effects (50% response rate and 40% remission [1]) than when the patient is conscious (40% response rate and 30% remission according to a large meta-analysis [2]). [1] https://www.medrxiv.org/content/10.1101/2023.04.28.23289210v1.full-text https://www.medrxiv.org/content/10.1101/2023.04.28.23289210v... [2] https://pubmed.ncbi.nlm.nih.gov/35688035/ https://pubmed.ncbi.nlm.nih.gov/35688035/ But that large response had nothing to do with ketamine, as the non-ketamine group had the same or higher response.

bagacrap 3y ago
They only measured response for the next three days. Is it possible k has an effect for longer than three days while placebo only lasts three days or so?
- cpncrunch 3y ago
  Unlikely. I see another comment says "The duration of the antidepressant effect is relatively short (days to weeks) and the antidepressant effect appears to diminish with repeated dosing."