Psychedelic drugs reduce depressive symptoms by helping people accept emotions | Hacker News Reader

Psychedelic drugs reduce depressive symptoms by helping people accept emotions

psypost.org

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> "The only way to handle danger is to face it. If you start getting frightened of it, then you make it worse; because you project onto it all kinds of bogeys and threats that don't exist at all.

> [...]

> The rule for all terrors is head straight into them. When you are sailing in a storm, you don't let a wave hit your boat on the side. You go bow into the wave and ride it. So in the same way, old folklore says, whenever you meet a ghost don't run away, because the ghost will capture the substance of your fear and will materialize itself out of your own substance and will kill you eventually, because it will take over all your own vitality. So then, whenever confronted with a ghost, walk straight into it and it will disappear."

— Alan Watts

Coping skills: https://en.wikipedia.org/wiki/Coping

Defence mechanisms § Level 4: mature: https://en.wikipedia.org/wiki/Defence_mechanisms#Level_4:_ma...

Note that this study is not a controlled trial. It is measuring 358 people who already were going to use psychedelics, before and after their use.

What is severely missing is any report on incidence of adverse reactions, especially since they have two subsamples, one within traditional contexts and other completely self administered, which I would guess have different strategies on handling those. Anyone who experienced a bad trip can attest that set & setting matters a lot, and psychedelic experiences are far from guaranteed to be curative. For example for people high in neuroticism psychedelics can cause challenging experiences which can increase neuroticism even further. We don't know if those populations were screened out, implicitly or explicitly. [1]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540159/

"bad trip" can mean a lot of things - there are cases when people really freak out but there's others where it's a difficult trip because psychedelics force you to let go and confront things that you've pushed away or avoided

Thanks for linking the actual study.

The selection bias in studies like these is massive. Including only people who actively planned to use psychedelics is a guaranteed way to bias your results toward people who are already true believers. People who voluntarily chose to seek out psychedelics, despite high legal consequences for doing so, are likely already convinced that the psychedelics will "work" for whatever goal they're trying to achieve. Selecting these people over the internet will only further concentrate the group toward people who enjoy discussing and researching this topic online. In short, they optimized the test group for maximum placebo effect.

It's fascinating to watch how internet comments will quickly tear apart any study of prescription medication that has obvious sampling bias, lacks control groups, and relies on self-reported information gathered from internet surveys except when the study tells people what they want to hear.

I'm all for the resurgence of proper, controlled research into psychedelics for treating mental health issues in conjunction with therapy. Let's get to the bottom of this and draw some scientific conclusions on the matter. However, questionable studies like this do more harm than good for the body of research. It may feel good to see studies that claim positive results, but the more we build the body of research on top of obviously flawed studies like this, the harder it is for serious researchers and lawmakers to take it seriously.

Even with all the caveats it's still interesting. It suggests that if someone is determined to use psychedelics to self-medicate their depression, you should not try to stop them.

A priori you might think there is is a high likelihood that the drug use will just make everything worse.

I disagree -- "studies" like this give people the potentially misleading impression that psychedelics are helpful for depression and other mental health issues, so people who otherwise would have not used them may be more likely to, and we have no idea how this shakes out in an unbiased sample.

> It suggests that if someone is determined to use psychedelics to self-medicate their depression, you should not try to stop them.

That is precisely the bias and weakness of this study. Self-medication is almost always a red flag; why not do it in a context of other people that know their stuff, be it tradition, institution (therapy) or even close friends that are mutually invested in each other's long term well-being? DIY approaches to self-transformation are fragile; no one to hold you out of potential pitfalls, to protect you from re-traumatization, to call you out on your self-deception.

The title of the article that it "reduces depressive symptoms" is also telling of this bias. If symptom reduction was equivocal to enduring transformation, weed, cocaine and alcohol would have already healed the entire world. Without the study measuring if the subjects transformed their lives in a way that they were equally symptom free for the next 6 months, 1 year, 5 years, we can't conclude anything curative really took place.

Don't get me wrong, they make a theoretical link to ACT in which experiencing of chronically difficult emotions are facilitated, which does offer potentially huge benefits, but just like we don't use studies on antidepressants that show symptom reduction to go shop bunch of prozac, we shouldn't readily assume we can use this one to facilitate our own healing in a DIY fashion either.

and it does make it worse. "if someone is determined to use psychedelics to self-medicate their depression" they recognize they have a problem, are trying things to fix it, and hence have a higher chance of a control group that does nothing, or doesn't acknowledge how bad they feel, or have an urge to get better.

you select a sample of people who want to get better, and are surprised they get better more frequently than a group including people who don't? where's the test on a person depressed and not actively trying to get better taking the same drug? i bet the negative side effects and the death of extra brain cells makes it worse.

yes, if someone tries to use drugs to fix something, you absolutely should stop them. there's a reason you need a doctorate to prescribe those drugs.

new test. my test. I'm going to prove wikipedia makes you a neurosurgeon. let's take 300 highschool seniors who read a wiki article on neurosurgery. let's take another 300 from a random sampling at the dmv. send them all to school for neurosurgery. wow. just wow. the 300 who read the article - a higher percentage of them succeeded in becoming a neurosurgeon. holy crap. wikipedia is amazing.

> The more we build the body of research on top of obviously flawed studies like this, the harder it is for serious researchers and lawmakers to take it seriously.

I agree that what should be called "research" should adhere to the highest standards and actively seek to avoid biases.

But generally (not specifically about this psychedelics study), it's OK for us to act upon imperfect, biased information. The absence of a rigorous proof that something works, does not mean it doesn't work. The presence of an imperfect proof is enough to increase the probability of a positive outcome.

Accepting emotions in their whole shape and size as they are and occur is something that I've been struggling with (and am still struggling with) since childhood, especially since the way I've been brought up essentially repressed expressing or even exhibiting whole classes of emotional reactions. Psychotherapy works in my case, but is also long, painful, and tiring.

Any kind of scientific (and legal) development in other means of helping in this matter will be beneficial for future people who will need to suffer less after prolonged psychological stress and/or trauma.

What did me a lot of good was reading these two books by Alice Miller which describe how childhood trauma caused by parents causes issues and why many modern psychiatrists still overlook this crucial issue, perhaps it might help you, it definitely helped me:

Alice Miller: The Drama of the Gifted Child

Alice Miller: The Body Never Lies

Working through personal issues with the help of psychedelic mushrooms will still be emotionally painful and tiring -- that's unavoidable with this kind of work -- but it's potentially not as long because you're communicating with parts of yourself at the speed of thought and shared context rather than with another person at the speed of speech.

As for legality, if you have the means to visit certain US cities¹, you can try psychedelic mushrooms with less risk, as they have been decriminalized in those cities. They are still not legal, but the risk of legal consequences is smaller.

¹https://en.wikipedia.org/wiki/Psilocybin_decriminalization_i...

> but it's potentially not as long because you're communicating with parts of yourself at the speed of thought and shared context rather than with another person at the speed of speech.

Insight meditation is another way of pursuing this, that does nicely side-step the issue of having to rely on "mushrooms" and illegal drugs.

You can also pick your own. Only be sure to educate yourself thoroughly on how to identify them properly. Here is a fantastic starting point: [1]

But this is just a starting point. It should be the start, not the end of your education.

Remember:

There are old mushroom hunters, and there are bold mushroom hunters. But there are no old, bold mushroom hunters.

[1] - "Identifying North American Psilocybin Species" by Alan Rockefeller - https://www.youtube.com/watch?v=VcL-7u80kjs

> Any kind of scientific (and legal) development in other means of helping in this matter will be beneficial for future people who will need to suffer less after prolonged psychological stress and/or trauma.

https://en.wikipedia.org/wiki/Equanimity

"The virtue and value of equanimity is extolled and advocated by a number of major religions and ancient philosophies." (Notably, the article does have in-depth sections on Eastern philosophies such as Hinduism and Buddhism, as well as Western thought including Stoicism and Epicureanism.)

MDMA-assisted psychotherapy to rapidly treat PTSD is being fast tracked by the FDA thanks to the efforts of MAPS.org

I wrote a book on how learning the different shapes of cognition can help people live more meaningful lives. You mentioned shapes, so here are my thoughts:

Psychotherapy is difficult, but worthwhile. However, there are other psycho-technologies you can use. For example, many people resist meditation, but once they begin realizing the benefits, they end up changing their entire lives.

Here is a new and unique, evidence-based technique:

Emotional differentiation is a technology that you can employ on your own time. Naming emotions connects them to your cognition. The more connections we make between our emotions and cognition, the more effective we become. So, we don't just accept and process our emotions, we connect them and integrate them. They are telling us something, and it is good to get that information to our more nuanced and powerful cognitive center. In short, you accept them and you integrate them.

www.robertstonehill.com

From the research article:

> We conducted a prospective cohort study utilizing an online convenience sample of individuals with plans to use a psychedelic. Participants were recruited via online advertisements shared through social media (e.g., Facebook, Twitter), email newsletters, and online forums (e.g., Reddit).

> Based on when they planned to use a psychedelic, individuals were sent emails at three key time points [i.e., 1-week prior to psychedelic use (baseline), as well as 2-weeks and 4-weeks post-psychedelic use] reminding them to complete the online surveys.

I don't think this sort of phenomenon is unique to psychedelics. Anti-anxiety drugs (Benzos) used carefully for extreme anxiety issues can help reduce anxiety to a manageable level. It gives a person the opportunity to learn to manage their anxiety that would be difficult when in an extreme state. Then reduce the dose, repeat the process, etc.

I'll reiterate though: This needs to be a careful, deliberate process undertaken with both a pdoc to manage meds and a therapist to assist with coping skills, along with a close eye that the process is working rather than the drugs becoming a crutch. And it certainly won't work if the dose is high enough to eliminate anxiety instead reducing it.

Totally masking negative emotions, be it depression, anxiety, mania, etc.... that should only rarely be an initial goal. Medication should help people reach a state where those things are manageable, and work from there. Long term medication is absolutely a necessary option, but should be an approach taken when problems have been shown to be recalcitrant to various treatment options designed to help a person overcome the root causes of their problems. I fully understand that such a goal is often not attainable though. I'm often frustrated by folks who say otherwise and espouse some cure-all like a keto diet or various supplements, or plenty of other such things. It's great if it works for a person, but they are, at their core, body-changing treatments themselves, and just like all medications for these issues, whether or not they work for a person is often hit or miss.

Having taken psychedlics myself, it did a couple things for me:

1) gave me a better appreciation of my body - health, pain, stress, etc

2) helped me know what I enjoy most

I’d echo that and add that it refreshes my perception of the otherwise mundane. This is extremely helpful in allowing me to reevaluate things, internal or external. I have a bad habit of being too sure of myself, often pessimistically, and I suppose in a way this does reduce depression as the study suggests. I find it lifts weights off, provides more optimism where it was missing and less pessimism where it wasn’t helpful.

I’ve also seen it lead to trembling terror and nihilism in others so it’s very much a YMMV kind of thing.

The headline is a pretty good summary of the situation. Although it might be more accurate to say that psychedelic drugs help people see the interconnectedness between good and bad things, which helps people come to terms with difficult experiences.

For me, the ability to see that interconnectedness between good and bad largely results from a subdued reaction to how those things make me feel. I can think about it more, think about it differently than I normally would, rather than shut it out and carry on.

Drugs to repress emotions

Drugs to accept emotions

Drugs to create emotions

It does sound a bit bleak. Are these drugs better or worse than the animalistic hormones locked in our bodies? Mature adults know how to handle the surging hormones that destroy teen emotions, maybe humans can learn to deal with drugs... but only with constant exposure, just the same as we've done in all our adolescence.

I am in no way for or against such drugs, having not experienced any psychedelics or behavior control drugs in my entire life. Just a philosophical thought I had after I read your comment.

I'd like to point out something: "Mature adults know how to handle the surging hormones...."

This is not true for 99.99% of adults: proof: if adults would know how to control "hormones" they would never experience fear, doubt, anxiety,...

Issue in most cases seems to be repressed childhood emotions.

handle != control

I hope I will always be able to feel fear and doubt, and that no drug can steal that experience from me. Just as people who can't feel physical pain are in tremendous danger every moment of their life, without the ability to feel fear or doubt, you would also be ignorant of danger.

Anxiety is another beast right? Anxiety is the negative reaction to fear and doubt. Lets leave adults out, mature individuals can handle small amounts of anxiety.

Tools to build walls

Tools to put up lights near walls

Tools to break down walls

We couldn't otherwise build, light and tear down walls with just our minds. Learning how to handle and accept emotions is possible with our minds and the help of each other, but in societies where the full range of emotions are mostly suppressed in public life, and many causes for negative emotions normalized, people often rely drugs and other "workarounds".

We could use our hands!

But to answer in earnest: All I want is deep and good and rigorous science.

Personally I've had intimate knowledge of people approaching PTSD using these methods. PTSD is ... not fair. And the experience was utterly transformative, and is probably the strongest moral call to action I have encountered. It was based on science and I will unendingly call for more of the science. Rigorous, self-critical science.

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