Comment by Enginerrrd | Hacker News Reader

Comment by Enginerrrd | Hacker News Reader

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>This, to me. means that a microdose is a gamble not worth taking.

This has always been the problem with psychedelics as a therapeutic approach. It's hard to reconcile being a responsible clinician and recommending a therapy with such mixed and often-negative results. They are in charge of a person's mental well-being in a way that people evangelizing psychedelic therapy don't seem to properly appreciate. If a patient is interested in that therapy, they might be a better candidate, but even then... if the results aren't great it's hard to justify.

Don't get me wrong, I have no problem with psychedelics for personal use, and I've seen them do wonderful things for people. But I've also seen them do horrific things to people and I feel like a lot of young people have a great trip and then immediately conclude that literally every human being NEEDS to go out and trip without any more consideration. That same sort of evangelism carries over to the microdosing realm. It may have a place! But personally, I've tried it with psiolocybin, and I found that typical microdoses have a very detrimental effect on my ability to focus.

Keep in mind this is study is evaluating the claims that microdosing lead to specific outcomes such as enhanced wellness and cognitive enhancements, which people seek out while microdosing. That's different from using strong doses of psychedelics to, say for example, break entrenched thought patterns (addiction, depression, OCD).

In the former case, a positive outcome is expected and therefore negative outcomes are in a sense less tolerable, especially since a false positive would lead to people repeatedly microdosing over an extended period of time, to their long-term detriment.

In the latter case, a "negative experience" does not preclude getting the desired results. And an acute negative experience in a one-time dose may be tolerable when contrasted with the long-term severity of the pathology it is meant to treat.

As far as I know experiments of CBT + psychedelics have shown very promising results for treating PTSD and certain kinds of depression, specially in people that are about to die and need to come to terms with that.

These are not microdosing experiments though. The usual way it is handled is that you get a few weeks of CBT then you get half a dose and the following week you get a full dose followed by more weeks of CBT. There is no placebo effect here that's possible because, well, it is impossible for someone to believe they have taken a full dose of pscychodelic drugs and not feel anything. But you still have a control in this case because you have a group that goes through CBT and another group that goes through CBT + drugs.

In fact, from these studies there have been very little "bad trips", mostly I guess because you have the half-dose session and then the full dose session in a very controlled environment and so on. These experiments are obviously done quite responsibly.

So I think you're mixing things up a little bit and I would suggest doing a little more research in the topic. Psychodelic therapy, at least the kind that is being explored seriously is not really done through microdosing.

> There is no placebo effect here that's possible because, well, it is impossible for someone to believe they have taken a full dose of pscychodelic drugs and not feel anything.

From what I recall, a low dose of methylphenidate is used as a control in many studies because it has some of the same side effects without the trip. For psychedelic-naive people who don’t really know what to expect, I could see it being an ok control. Once you’ve experienced a single high-dose trip though… yeah… you’re never going to trick someone with it.

Just a small note but my understanding is that “CBT” aka cognitive behavioral therapy is a specific form of therapy, while most research around psychedelic assisted therapy centers around traditional talk therapy rather than a more specific technique.

Just because you know for sure you got the drug DOES NOT mean "no placebo effect is possible" (!)

That just means you can't possibly have a proper control. BIG difference.

I wonder how much of this is true for therapy in general. When I've looked into it, the evidence for cognitive behavioral therapy (CBT) is a lot less than I would have expected, and there seems to be some question about how much of its effect is due to the placebo effect. This study on microdosing makes the point that if an experiment isn't double-blind - if the researchers know what is the placebo and what isn't - than this will have an impact on the results (and they seem to think this is the reason their double-blind experiment got different results). But I'm not sure it's possible to have double blind experiments when it comes to therapy (someone correct me if I'm wrong), and would likely make many single-blind studies of therapy appear more useful.

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