Inside London's first Ketamine therapy clinic
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This is the key takeaway from the steady stream of good news we've been getting about psychoactive drugs and how they can help with issues like addiction and depression. I can see how a skeptic might look at these reports and think "how convenient, all the fun drugs make people happier for a little while". But I think we're discovering that it isn't this or that drug that has the potential to help people, but rather the approach that is enabled by an entire class of drugs. Determining which drugs can be most useful and how to apply them will be a big ongoing project (now that we're finally able to finally do the research). The drugs we use down the line may be nothing like the drugs we're looking at today.
Once we discover the method of action of the drug then maybe we can end up in a targeted drug without the fun side effects that the rec drugs have (like you said). Figuring it out from the top down by designing a substance, and then testing it on people, sounds dangerous + difficult.
This leads to situations where patients mistake the "fun" part for the therapeutic effect, which causes a lot of problems when tolerance builds to the fun. This happens with opioid users who chase the euphoric rush instead of pain management, stimulant users who try to get a mood boost and motivation out of their stimulants instead of attention-enhancing effects, and ketamine patients who chase the dissociation instead of the antidepressant effect.
It's bad enough that you'll see addicts save up their medications so they can double-dose (or more) for more euphoria, then suffer in between doses when they go into mini-withdrawal. Terrible pattern and it would be a huge advancement if we could get past that.
The truth is that for properly-doses patients taking medication long-term, the “fun” part disappears naturally. People taking Adderall for a decade aren’t buzzing around like a college student popping their first pill during finals week. People with properly controlled chronic pain aren’t nodding off from their opioids.
The euphoric effects aren’t just a bonus. They actively interfere with establishing successful treatment. Most diligent patients will overcome this, but a lot of people will abandon the therapeutic part and chase the “fun” part to their detriment. Or alternatively, they’ll abandon the therapy when the “fun” part wears off because it’s the only thing they were paying attention to.
And after only a couple of seconds of thought, I noticed (at least) one of your points is not related to the danger of addiction and indeed very interesting. Even without danger of addiction patients might confuse short term and long term effects. On the other hand this doesn't seem to be the case with anectodal expieriences I read about the use of (hard) psychodelics, e.g. LSD, mushrooms, etc.
Edit: Also as my dismissive answer already suggested, my question was not clear.
But when looking at therapies I don’t know if my grandpa with PTSD is looking to blast off on ketamine for therapy every week. (Although to each their own haha)
And those skeptics would be both right and wrong.
Wrong in the sense that the antidepressant effect of ketamine lasts for some time after the drug leaves the system, so we know it's not just a temporary drug-induced effect.
But somewhat right because the antidepressant effect isn't very durable, so it's mostly useful in emergency situations (suicidal tendencies) and for kickstarting conventional therapy. Even the rare patients who convince their doctor to prescribe ketamine multiple times per week over the long term usually encounter diminishing effects as tolerance sets in.
Unfortunately, the high relapse rate presents a huge conflict of interest for these ketamine clinics, which are often more than happy to continue taking your money in exchange for ketamine sessions. The more ethical ones will insist that patients be enrolled in therapy and will educate them on proper maintenance antidepressant options if they choose. The less ethical ones will give patients a speech about how traditional medicine is bad and their only real option is to continue coming in for more ketamine.
There are some horror stories from one of the local ketamine clinics here. I'm actually shocked they aren't more tightly regulated at this point.
Ketamine/MDMA/LSD/Psilocybin and their derivatives are on their way to being recognized as the safest, most effective, and widely available medicines - for nearly every common mental health disorder - currently known to humanity.
Yes there will always be predatory behavior in healthcare, and regulation can help. And of course no medicine is 100% side-effect free or effective for everyone.
But shouldn’t we be complaining that many of these substances continue to remain federally outlawed in the US despite a huge body of scientific evidence and multiple companies discussing phase 3 clinical trials with the FDA this year?
I don’t really hear many folks calling for tighter regulation on these substances, especially given the current regulatory situation.
This sounds like a utopian fantasy.
Ketamine can be useful, but like I said it’s not a long-term solution.
MDMA isn’t really safe for extended use. Even the MDMA enthusiasts will agree with that one.
Psilocybin is being studied in conjunction with 10-20 therapy sessions. If you’re attributing the positive effects from studies to the drug alone, that’s incorrect. Someone taking MDMA or mushrooms on their own is nothing like what’s being studied.
I’m optimistic about future research, but if you think Ketamine, MDMA, and Psilocybin are the safest and most effective drugs available for “nearly all” mental health issues then you’re not really discussing the research, you’re discussing a utopian fantasy. Even the researchers I know in this space aren’t anywhere near that idealistic. Let’s be realistic.
> Psilocybin is being studied in conjunction with 10-20 therapy sessions
For a quick reality check, you could take a look at Compass Pathways and their phase 1 & 2 clinical trial results [1][2]:
> we have completed a phase IIb clinical trial of psilocybin therapy for TRD, in 22 sites across Europe and North America. This was the largest randomised, controlled, double-blind psilocybin therapy clinical trial ever conducted, and our topline data showed a statistically significant (p<0.001) and clinically relevant improvement for patients who received a single high dose of COMP360 psilocybin with psychological support
That is a single dose along with a single therapy session, showing positive benefits lasting 12+ weeks. For treatment resistant depression (TRD), a notoriously difficult condition to cure and one that affects many people.
There are literally no other drugs on the market that come close to the safety, efficacy, and durability profile that is being observed!
Do you think the FDA granted breakthrough therapy status in 2018 because of some collective "utopian fantasy"?
It's well known there are numerous indications for psychedelic assisted therapy showing great promise - from anxiety and addiction to end of life care [3]. It's not just psilocybin either, many of these psychedelic substances are pharmacologically related - so they act on similar receptors and areas of the brain, and thus have similar therapeutic profiles [4].
Let's be realistic. Your appeal to extremes is an uncharitable interpretation of my comment, and frankly your uninformed pessimism on this topic is a disservice to anyone interested in learning about or benefiting from these advances.
[1] https://ir.compasspathways.com/news-releases/news-release-de...
[2] https://ir.compasspathways.com/static-files/0f9fbce8-2619-43...
[3] https://www.sciencedirect.com/science/article/pii/S009286742...
The above statement does not correlate with current research
This is the unfortunate reality with all depression treatments, including SSRIs, Tricyclics, ECT, TMS, and even MAOIs.
Most people who have treatment resistant depression that is "biological" i.e. not situational will end up requiring treatment for the rest of their lives. SSRIs are well known for "pooping-out" after some number of years, and most patients will end up cycling through different treatments, sometimes finding something that works well for a long time, and other times not finding lasting relief for years at a time while experimenting with "cocktails" of meds from different psychiatrists.
The only problem with Ketamine at this time is that it is quite expensive as commonly provided (patented formulations, in-clinic requirements e.g. REMs, fusion providers, etc). If it turns out to be safe to use in lower doses via lozenges or some other compounded route, without the current associated high costs of administration and procurement, then there's no reason Ketamine can't end up being given out as a generic prescription to be used once or twice a week at just a few dollars / month, similar to what generic SSRIs or Tricyclics now cost.
But I imagine the Pharma industry and the increasing number of very profitable infusion providers will do everything they can to ensure this doesn't become mainstream anytime soon.
Hopefully that will shrink. And, this needs to move into the NHS. (this is a fully private clinic service only at this stage)
Wait lists for anxiety & depression amongst the young are pretty high. (I'm not in the UK, this is what I am told)
If you took half of that difference and applied it judicously, waiting lists would drop quite a bit.
I have Medicaid in the US and I get seen within a week to a month (sometimes even same-day) in non-emergency situations, and 100% of my medical bills are covered by the government.
The worst part of it is that for certain specialties there just aren't many doctors who accept Medicaid, so I pretty much have to take what I can get... but this shouldn't be a problem if every doctor accepted a single-payer plan.
On the other hand, for things like mental health care there's a large amount of choice in my area. So overall I'm pretty pleased.
The situation would not be the same if everyone was on the same payment plan.
The US system is worse on every single metric (unless you're rich of course - which is the point of it).
Source: someone who is willing and able to pay for services, but cannot find them
As in any peer group, I guess, there is some broken people in mine, too. I draw all my experience from that. Sometimes I feel there is way to many in my peer group. But aparently this is normal among young european people with higher aducation, I don't know. Maybe simple people talk about his more... Anyways.
Waiting at least three months for somebody with a median-type depression seems hard even without suicidal thoughts. I guess, that waiting time is even harder for the people who suddenly notice how they live their life is fucked up, and they need help. E.g. due to sudden realization of their own toxic behaviour, sudden realization of their terrific past and its effect on them, burnout (surprisingly, I have not expierienced that within my peer group, yet, apart from once rather tangientally) or even simple realization of a highly unhealthy relationship to work or significant other.
However. Aparently, finding a therapist with whome effective treatment is possible, is extremely hard. In particular, those with - let's call it - interesting past, seemed to switch therapists once or twice before finding someone with whome to work yielded noticable changes in their life. Also a good fraction of those in my peer group had questionable therapists. I can not jugde this, but I believe that achieving the art of being a good therapists (at least for some people) is among the most difficult skills one might aim for.
After finding a therapist that treatment often lasted for years. And with that as a support, they changed their life. Sometimes, entirely. Of course, this is not true for all of them, unfortunately. And maybe even only for less then half of them. Nevertheless, for some relevant fraction of them it lead to invaluable gains in their life. It lead to something, that is definitely worth to wait for a couple of months.
I noticed a problem is missing opportunities for non-pharmaceutic intermediate help for "non-urgent" cases waiting for "real" therapy. E.g. group-therapy with the clear intent of being for people that wait for something else. While this doesn't solve the problem of too little "supply" when compared to the "demand", it may help those people a lot. Even if only to show them, we care, even though resources are scarse (or terribly organized, whatever of these two).
Also I wrote "demand" with some kind of thruth behind this. At least for some in my peer group zi feel like their desire to be "sick" and their demands for help is a (possibly pathological - I cannot jugde this) problem in itself.
During the actual treatment itself it removed ~90% of my daily pain, and then it persists after I leave and slowly ramps back up over the following couple months.
Psychedelics in general have such a vast amount of ways they can improve peoples lives if we gave them a chance (and the appropriate study/experimentation).
It's fascinating to see the progress we're observing with psychiatric therapies through things like psylocibin, MDMA, and ketamine. Hopefully we'll get more progress on the legislative side to open those therapies up to more users, because the evidence is starting to pile up that they can have a real substantive impact.
Of course, from a military perspective, knowledge is power so I'm not surprised countries are getting into this line of study. Humans are inherently lazy which is why we build labour saving devices, but Govt's also need to keep the population busy to avoid trouble which will take many guises.
So whilst the focus is on depression treatment, spin off knowledge will almost certainly be obtained and used in less obvious ways.
A simple point, I've always found the cannabis culture in Uni's to be highly tolerated, but considering weed puts the brain in a state almost identical to a schizophrenic episode, what new insights will be solicited.
A history lesson, Crick, took LSD to help visualise or gain an insight into the double helix.
Drugs make you think!
What’s the evidence for this?