4 ms·

Isn't the "trip" just a side effect of it having some impact on the brain and if you adjust dosage and protocol so that the trip doesn't happen you are basicall

Isn't the "trip" just a side effect of it having some impact on the brain and if you adjust dosage and protocol so that the trip doesn't happen you are basically left with placebo effect proportional to hope of improvement which is positively correlated with opinions on ketamine? I'm not sure if I remember correctly but I think I've read ketamine makes neurons groe new dendrites in petri dish. I have no idea how this effect could happen in the brain without making a patient trip.

CodeCounselor 3y ago
I apologize if I misunderstand you, which is very possible. I interpret you as saying that unless there is a "trip" there is only a placebo effect left on the table so to speak. I think this is somewhat refuted by the fact that the standard ketamine infusion protocol (that does not normaly induce "trips") has an effect size that dwarfs the effect size of placebo (say 0.2 - 0.4). Some studies have shown ketamine approaching ECT-effect sizes. This makes me sound like a ketamine nut, which I am not. I am a bit of an ECT nut though. I have just not excluded the fact that the phenomenology of certain treatments actually mediate the treatment effects in a non-placebo way.
- tudorw 3y ago
  Thanks for all the detail, I'm interested to know if you have explored CYP gene expression (polymorphism) and it's impact on metabolising ketamine as factor in treatment?
  - CodeCounselor 3y ago
    Hello. Sadly no. This is something that is probably overlooked and/or neglected on a regular basis. Often when the question comes up the most pragmatic next step is to switch drug or modality to something that doesn't rely on the suspected metabolic pathway in question...
- scotty79 3y ago
  But in the light of the study we are commenting on it might be that the effect of ketamine in previous non-doubleblinded studies was due to placebo effect heightened by the positive expectations towards ketamine of both patients and doctors. At least it is what authors of this study consider.
nicoburns 3y ago
There are all sorts of effects that drugs can have on the brain/body that aren't a "trip". Consider the effects of caffeine and alcohol for example. Also consider the difference between high and low doses of alcohol: just because having 1 beer won't make you blind drunk doesn't mean that the effect is a placebo.

CodeCounselor 3y ago

I apologize if I misunderstand you, which is very possible. I interpret you as saying that unless there is a "trip" there is only a placebo effect left on the table so to speak. I think this is somewhat refuted by the fact that the standard ketamine infusion protocol (that does not normaly induce "trips") has an effect size that dwarfs the effect size of placebo (say 0.2 - 0.4). Some studies have shown ketamine approaching ECT-effect sizes. This makes me sound like a ketamine nut, which I am not. I am a bit of an ECT nut though. I have just not excluded the fact that the phenomenology of certain treatments actually mediate the treatment effects in a non-placebo way.

tudorw 3y ago
Thanks for all the detail, I'm interested to know if you have explored CYP gene expression (polymorphism) and it's impact on metabolising ketamine as factor in treatment?
- CodeCounselor 3y ago
  Hello. Sadly no. This is something that is probably overlooked and/or neglected on a regular basis. Often when the question comes up the most pragmatic next step is to switch drug or modality to something that doesn't rely on the suspected metabolic pathway in question...
scotty79 3y ago
But in the light of the study we are commenting on it might be that the effect of ketamine in previous non-doubleblinded studies was due to placebo effect heightened by the positive expectations towards ketamine of both patients and doctors. At least it is what authors of this study consider.

nicoburns 3y ago

There are all sorts of effects that drugs can have on the brain/body that aren't a "trip". Consider the effects of caffeine and alcohol for example. Also consider the difference between high and low doses of alcohol: just because having 1 beer won't make you blind drunk doesn't mean that the effect is a placebo.