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> psychedelics are, at best, only a modest improvement over the current state-of-the-art. Is this measured in terms of efficacy alone, or are you also counting

> psychedelics are, at best, only a modest improvement over the current state-of-the-art. Is this measured in terms of efficacy alone, or are you also counting both literal $$ cost, and "cost" in things like side effects? Genuine question - apologies if the tone comes across as harsh at all - you seem like you know this stuff pretty well, and AFAIK those are the other major claims that psychedelics make against pharmaceuticals.

jdietrich 3y ago
Escitalopram is generic, as are most of the common antidepressant drugs; I'm not sure what the cost is in the US, but in the UK it costs the health service about five cents per dose. Psychedelic therapy is (for the moment) inherently expensive, because established protocols involve a lot of clinical time before, during and after the treatment to protect the safety and wellbeing of the patient. There's simply too much uncertainty to perform a meaningful cost-benefit analysis, but it is plausible that psychedelics could be more cost-effective for more severely and chronically unwell patients who have not responded to other treatments. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9760680/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9760680/ We don't yet know enough about the safety profile of psychedelics to draw any firm conclusions regarding side-effects, because of the very small number of patients who have participated in clinical trials. If even a very small proportion of patients treated with psychedelics experience serious harms - and it's very plausible that they could, given the subjective intensity of the experience and the vulnerability of the patient cohort - then that could outweigh the more common but less dangerous side-effects of SSRIs. There are also potential risks that might not be apparent in carefully controlled clinical trials but might materialise in real clinical practice, for example the risk of patients with undiagnosed psychotic traits being prescribed psychedelics.

jdietrich 3y ago

Escitalopram is generic, as are most of the common antidepressant drugs; I'm not sure what the cost is in the US, but in the UK it costs the health service about five cents per dose. Psychedelic therapy is (for the moment) inherently expensive, because established protocols involve a lot of clinical time before, during and after the treatment to protect the safety and wellbeing of the patient. There's simply too much uncertainty to perform a meaningful cost-benefit analysis, but it is plausible that psychedelics could be more cost-effective for more severely and chronically unwell patients who have not responded to other treatments. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9760680/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9760680/ We don't yet know enough about the safety profile of psychedelics to draw any firm conclusions regarding side-effects, because of the very small number of patients who have participated in clinical trials. If even a very small proportion of patients treated with psychedelics experience serious harms - and it's very plausible that they could, given the subjective intensity of the experience and the vulnerability of the patient cohort - then that could outweigh the more common but less dangerous side-effects of SSRIs. There are also potential risks that might not be apparent in carefully controlled clinical trials but might materialise in real clinical practice, for example the risk of patients with undiagnosed psychotic traits being prescribed psychedelics.