3 ms·

Well sure, but I don't see how that contradicts anything I said.

by NickM 3y ago

dv_dt 3y ago
True, (sorry friends sometimes tell me I sound like I’m aggressively agreeing with them - it’s something I’m trying to improve on) the long period to take effect and evaluate if combos are “working” make it really difficult to understand if a drug or something else is fixing anything. The main interesting thing about ketamine was that there were some anecdotes that the effects were very rapid - and that should be at least something to make it easier to assess a change. But maybe harder to separate placebo.
- NickM 3y ago
  Yeah, fair, maybe we are in violent agreement :) I agree it is interesting that ketamine seems to work very quickly for some people. Re: your placebo comment, I also agree it's hard to separate it out. One of the tricky things with the placebo effect is that there are really multiple distinct types of placebo effect; on the one hand, you have objective measurable biological changes that placebos can trigger, but on the other hand placebos can also affect peoples' subjective perceptions of the symptoms they're experiencing. In the case of depression though, the subjective perception of misery is the core problem we're trying to fix. Hence why treatments that have no biological effect (like, e.g., therapy) are still considered valid approaches. So, then the question is, does it matter whether ketamine is just a placebo? Maybe all antidepressants are placebos, in which case the important thing is to find the safest, most effective, fastest-acting placebo we can. Really though I do kind of think peoples' subjective experiences matters in a more concrete way than folks give credit for. Even though it's not directly modifying your brain chemistry, I wouldn't call therapy a placebo, for example. Maybe sometimes medications help people because beliefs like "someone is trying to help me" or "I've found an explanation for why I feel bad and there's a treatment for it" actually help people break out of their self-destructive patterns, regardless of the actual efficacy of the meds. It's more questionable though whether those beliefs actually help with long-term root-cause fixes though, or if they just trap people in a local maxima.

Well sure, but I don't see how that contradicts anything I said.

by NickM 3y ago

Well sure, but I don't see how that contradicts anything I said.

True, (sorry friends sometimes tell me I sound like I’m aggressively agreeing with them - it’s something I’m trying to improve on) the long period to take effect and evaluate if combos are “working” make it really difficult to understand if a drug or something else is fixing anything. The main interesting thing about ketamine was that there were some anecdotes that the effects were very rapid - and that should be at least something to make it easier to assess a change. But maybe harder to separate placebo.

NickM 3y ago
Yeah, fair, maybe we are in violent agreement :) I agree it is interesting that ketamine seems to work very quickly for some people. Re: your placebo comment, I also agree it's hard to separate it out. One of the tricky things with the placebo effect is that there are really multiple distinct types of placebo effect; on the one hand, you have objective measurable biological changes that placebos can trigger, but on the other hand placebos can also affect peoples' subjective perceptions of the symptoms they're experiencing. In the case of depression though, the subjective perception of misery is the core problem we're trying to fix. Hence why treatments that have no biological effect (like, e.g., therapy) are still considered valid approaches. So, then the question is, does it matter whether ketamine is just a placebo? Maybe all antidepressants are placebos, in which case the important thing is to find the safest, most effective, fastest-acting placebo we can. Really though I do kind of think peoples' subjective experiences matters in a more concrete way than folks give credit for. Even though it's not directly modifying your brain chemistry, I wouldn't call therapy a placebo, for example. Maybe sometimes medications help people because beliefs like "someone is trying to help me" or "I've found an explanation for why I feel bad and there's a treatment for it" actually help people break out of their self-destructive patterns, regardless of the actual efficacy of the meds. It's more questionable though whether those beliefs actually help with long-term root-cause fixes though, or if they just trap people in a local maxima.