Hacker News Reader

Comment by themgt | Hacker News Reader

What's wrong is psychedelics already work as-is, but due to stigma around "fun" alterations of consciousness possibly being beneficial (along with desire for a patentable compound that can get through FDA regs), most of the focus has been on how we can go about removing the wetness from water while preserving water's essential useful properties. Regardless of how many years go by and self-reporting along with scientific evidence accumulates that water's wetness is mostly the entire point, and all while people are being thrown in jail for water possession.

View on HN

I agree with your statement on principle that we should make these drugs widely available when we find efficacy.

I disagree that we shouldn't try to separate psychedelic effects from therapeutic action. There is a body of research on ketamine metabolites. Some of these metabolites may have less psychedelic effects and more anti-depressant action.

I need to take ketamine almost every day. This means there are several hours when my ability to read, think, and remember things is impaired. I hope we are able to discover better drugs.

> This means there are several hours when my ability to read, think, and remember things is impaired. I hope we are able to discover better drugs.

I don't think people give this enough consideration. Tripping on mushrooms might be enjoyable to some, but having it as a regimented treatment means you are losing a lot of time where you cannot be productive, cannot enjoy the company of your sober friends and family, etc.

The psychedelic effect IS the therapeutic action.

> What's wrong is psychedelics already work as-is

The current research into psychedelic medicine is better described as intense therapy with a psychedelic adjunct for some sessions.

They aren't just giving people psychedelics and hoping everything turns out okay. The psychedelic dosing is combined with therapy, and the sessions are both preceded by and followed with additional therapy without psychedelics.

It's a mistake to assume that the psychedelic drugs are curing depression on their own. In fact, many people experience worsening depression or derealization if they take psychedelics without professional guidance while suffering from mental illness.

> They aren't just giving people psychedelics and hoping everything turns out okay. The psychedelic dosing is combined with therapy, and the sessions are both preceded by and followed with additional therapy without psychedelics.

And historically, that's exactly the way psychedelics have been used, for thousands of years. A shaman/guide would provide the medicine and help the people go through the experience, usually in a tight community where there's follow up and support.

Unfortunately that was suppressed, first by the Catholic Church when the Spanish arrived to America, and now more recently by making psychedelics illegal.

The idea of psychedelics being some sort of party drug is a problem of the current state of affairs, politically and culturally, where we have abandoned or forgotten their origins.

Maybe just the "tight community where there's follow up and support" may help.

It's not "stigma". People treated from clinical depression hope to be able to function in their normal day lives at work and at home, not just be on a never-ending psychedelic trip.

Research has focused on long-term (months to years/permanent) benefits from just one or a small handful of psychedelic experiences. It would even be difficult to find marginally responsible "psychonauts" who would recommend attempting a "never-ending psychedelic trip", which regardless wouldn't be physically plausible due to how rapidly the short-term tolerance increases.

In short, perhaps do more research on this topic because you're arguing against a position no one has taken.

This is not how psychedelics for treatment resistant depression is tested. The most common treatment protocol is a single psychedelics session assisted by 2 therapists (preceded by a few therapy sessions and some follow-ups). Overwhelmingly the evidence point to very significant effects lasting months after the session.

This is far from "a never-ending psychedelic trip". If you follow the evidence for the most researched treatment protocol, this would involve a session every year or half-year.

> The most common treatment protocol is a single psychedelics session assisted by 2 therapists (preceded by a few therapy sessions and some follow-ups).

Ketamine is approved by the FDA for depression and also has a history, albeit shady, of being prescribed off-label at IV clinics. This is far more common than psychotherapy while taking medication and much less expensive too.

> If you follow the evidence for the most researched treatment protocol, this would involve a session every year or half-year.

In this small survey 60% of patients returned once a month or more for maintenance infusions.

A Survey of the Clinical, Off-Label Use of Ketamine as a Treatment for Psychiatric Disorders https://pubmed.ncbi.nlm.nih.gov/28669202

FWIW, Ketamine is not a psychedelic. It's a dissociative.

It doesn’t affect the same receptors as “classic” psychedelics (LSD, DMT, Mescaline) but dissociatives aka dissociative psychedelics are wildly psychedelic at high doses. It seems ludicrous to insist otherwise. Is Salvinorin-A not a psychedelic?

I have a prescription and take it every three days. A clinically effective intranasal dose is about as psychedelic as a couple of beers.

I think you have it a little backwards. IME, psychedelics give dissociative effects along with the psychedelic experience and the dissociative experience is solely dissociative on its own.

I think there's a lot of confusion on what a psychedelic experience is and it gets confused with a hallucinogenic experience, which both classes of substance can offer.

I’ve been following this stuff since the mid 90s and am familiar with the terminology.

What do you assert is the difference between a psychedelic experience and a hallucinogenic experience then? Dissociative I agree only partially overlaps with psychedelic on a venn diagram but hallucinogen and psychedelic I understand as synonymous.

Hallucinations are pretty concretely defined, medically. Seeing stuff that isn't there. Hearing stuff that isn't there. Things moving when they aren't.

For me, the psychedelic experience is more about the "Ah hah! we're all in this together! We're all the same thing! I've removed the veil and barriers I've built up all my life and can finally see clearly what it's All About." I'm sure it's different for others, but I don't experience that "oneness" or "connection" on dissociative. It feels like I am born again, free to be vulnerable and experience the world without the lenses that society and myself have placed over my eyes.

I think the term there is "entheogenic" a la DMT:

https://www.vice.com/en_us/article/ep4dxk/its-official-dmt-m...

Psychotherapy is seen as prohibitively expensive because of the way it is currently practiced where the patient must see the therapist on an ongoing basis. This isn't necessarily a bad thing, it's a lot like seeing a personal trainer on a regular basis but it's certainly an expensive way to stay fit. Psychedelic therapy seems to be an option that helps make a much smaller number of sessions "stick". If you only have to do 3 sessions a year then it means the therapists can see a much larger number of patients and the overall cost for each patient could go down.

My opinion is that most people could handle (small) group therapy as well which could further reduce cost and might actually have a number of benefits for those involved.

This is exactly the stigma psychedelic enthusiasts have in mind. Psychedelic-assisted therapy doesn't need to rely on patients being administered psychedelic doses on a daily basis.

What's actually happening (either in trials or by underground practictioners) is that the super-malleable/open to self-analysis mental states that can be induced by psychedelics can be a catalyst for significant long-term shifts in perspectives and thinking patterns.

An amazing book to give you a cursory understanding of the state of the field is How to Change Your Mind: The New Science of Psychedelics by Michael Pollan. It'll give you a good understanding of what psychedelic research may be able to achieve (and what it's achieved so far).

> This is exactly the stigma psychedelic enthusiasts have in mind. Psychedelic-assisted therapy doesn't need to rely on patients being administered psychedelic doses on a daily basis.

Why does it have to include the psychedelic component though (even sub-trip-levels)? Some seem to think that you absolutely must not divide the psychedelic qualities from other qualities, even if you could. As if "you only deserve to enjoy the anti-depressant benefits if you embrace the trippy potential of it". That sounds too religious to me.

I find that a weird stance, and I'm very pro-psychedelics and would like to see them regulated but legally available. But I wouldn't want to keep depressed people who are afraid of the psychedelic experience from the benefits just because it won't help with legalization efforts.

Again, I'm not suggesting that you can split them into "trip drug" and "anti-depressant drug". But if you could, I'm absolutely for doing so. I'll still take the trip drug, but people who are afraid of tripping can take the safe one and still get benefits.

I believe the sentiment most people are expressing when they say you cannot separate the "trip" from the beneficial effects is that they both have the same origin or causative agent. Personally I'm in the "neural annealing" camp and it makes sense to me from personal experience that the benefits are due to psychedelics being a drug that essentially induces a state that you would normally only experience during profound and meaningful experiences. Those are the only other circumstances where I have felt the same as I have with psychedelics, experiencing a deep connection with the awesome scale and complexity of the natural world, falling in love, reading a life changing book, being transported emotionally and mentally by a symphony, getting caught up in the experience of a great movie, the physical rush of pushing yourself to your limits when exercising. We have drugs that seem to be able to produce the same life altering experiences that they can on demand. That's why it seems perverse to many people when it's argued that we should distill just the dregs of chemicals that produce the change without realizing that the actual mental and physical journey, the story that you weave around that experience that includes yourself, your thoughts, your environment and the people around you is probably the most important part. You can't just be happy all the time without having a reason to be happy, you can't be in love without someone to love and if you could it would seem more like a nightmare than an improvement.

>> You can't just be happy all the time without having a reason to be happy, you can't be in love without someone to love and if you could it would seem more like a nightmare than an improvement.

What you are describing is the state of enlightenment, and those who have had sustained experiences with it would disagree.

it's hard to argue with a buddha I guess

I completely agree that the profound experiences you can have during psychedelic trips can be life-altering. I don't know whether it's the experience that leads to the other benefits, and if it doesn't, I see no reason why one would have to get them bundled.

The OP's comment reminded me of a some people I've come across that were into meditation and were anti-psychedelics, and to me it seemed like their main issue was that you could get these very deep experiences like ego-death but you didn't earn it, you didn't sit and quiet yourself for months and years, you just popped something into your mouth, experienced a bit of nausea and were teleported into a different dimension. It always seemed to me that they felt cheated because they took the hard road and felt that it's unfair that others took a short cut. Needless to say that it was even weirder given that they also tend to talk about compassion and inner peace a lot.

I totally understand if you believe that you simply cannot separate the psychedelic from other parts because it is what gives the benefits. I did get the feeling that that's not quite it though, that there's a lot of "and you shouldn't try to", and that feels like "you shouldn't get the benefits without embracing the experience, potentially encountering your demons etc", or a religious practice surrounding it.

> I believe the sentiment most people are expressing when they say you cannot separate the "trip" from the beneficial effects is that they both have the same origin or causative agent.

Perhaps I've swallowed too much propaganda, but this seems like a testable belief. What if it's not true? What if psychadelic-assisted therapy is just one of multiple viable psychadelic-assisted treatment approaches? What if people want to be able to use store-bought neurotransmitters to regulate their minds without going through the trip-induced emotional or spiritual experience that they may not want?

Would achieving a deeper understanding of the relevant neurochemistry and allowing people to make their own choices be so bad? Would more treatment options be a negative?

I don't oppose the research or having more treatment options, I'm sure they would be necessary in many cases. My perception of it is a bit negative though at least when imagined to be an easy to access option for everyone, it's the same sort of opposition I feel towards the idea of taking steroids to promote muscle growth.

the psychedelic effect is simply (so to speak) the outcome of shutting down your executive function (that one that creates your internal monologue and gives you the perception of the self) so that the rest of your brain function that normally are "kept together and normalized" become more accessible for analysis and introspection.

Psychedelics are not anti-depressant, are just a potent accelerator for discovering WHY you're depressed. The psychedelic experience is necessary to the therapy. If you ever did a dose once you would understand exactly what I'm talking about, it's pretty hard not to understand what's happening once you experience it, just as it is essentially impossible before doing it.

> If you ever did a dose once you would understand exactly what I'm talking about, it's pretty hard not to understand what's happening once you experience it, just as it is essentially impossible before doing it.

Sorry, that sounds religious. I've experimented with psychedelics quite a bit, I've had very different intense experiences on them that have strongly affected me for long periods of time. That said, psychedelics do not unveil truths to you, not about the universe, not about yourself, but it can absolutely feel like it. You don't discover "why" you're depressed (as if there was a why, and understanding it would magically take the weight off of your shoulders; it's not a Hollywood movie).

That's just mysticism and naive religious interpretation imho.

You understood very little of what I was saying and it looks on purpose. If you like to go around feeling morally superior to people of faith (I’m not one of them btw) then leave me out of that please.

"Life is the never-ending psychedelic trip, maaaan"

On a serious note, this isn't what GP is referring to. Generally psychedelics in the work day are self-limiting. A microdose that is more of a mesodose makes for some interesting Zoom meetings. People learn the right dose to get a boost without excess distraction/warping. Fadiman's research [0] suggests the best dose is well below the threshold of "trip" effects. So there's no risk of never-ending daytrips, unless one desires that thing. So why limit access?

Aspects of American culture have a strong stigma against "fun", euphoria, and to an extent, any effect beyond "restoring normal". eg nootropics are popular in young, hip crowds like HN, but kinda sketch among many MDs, from "I don't think these are safe" to "why do you need that?" It's a "if it feels good, stop" sentiment that runs as an undercurrent through American history and you can see signs of it in Protestant work ethic, Prohibition (of alcohol and cannabis), and of course the war on drugs.

Keep in mind, LSD and MDMA were very hotly researched back in the day, but when subcultures started associating them with parties, that's when things started getting the kabash.

"But addiction bad" - this would be a fair argument if it weren't for the near lack of correlation between DEA schedule and addiction potential [1], as well as the rapid action to ban analog drugs without any consideration to addiction potential. This is the fate of most Shulgin compounds, many exhibiting the typical rapid tolerance of psychedelics.

That leaves the theraputic dose. These are typically administered in a guided setting, either in the clinical sense, or trip-sitters/sherpas, in the informal. This is the best mitigation against trips that leave lasting psychological harm (the term "bad trip" is very loaded, as it doesn't distinct "hard lesson trips" from "no this actually messed them up long term"). If the concern is really "harm trips", then the solution is logically harm-reduction, not prohibition.

Wew, that turned out longer than expected.

Edit: added more

[0] - https://www.thecut.com/2018/05/microdosing-guide-and-explain...

[1] pdf - http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.868...

Reply on news.ycombinator.com