Comment by throw18376 | Hacker News Reader

Comment by throw18376 | Hacker News Reader

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i generally consider myself an enemy of psychedelic advocates, because I think they want to make it effectively socially mandatory to do these drugs, which is really bad.

("sure, it's your choice what you put in your body, but a really enlightened person wouldn't be so frightened and closed-minded that they don't want to see what psychedelics can show them...")

of course ketamine for depression has this giant downside risk of adverse effects and psychosis, and we should talk about it more, not just sell it as a safe miracle drug.

however... safe, neutral, bland, boring well-tolerated SSRIs, also have a massive downside risk, in that they can trigger a manic episode, which in severe cases also involves psychosis.

so i find myself in the position of being glad there are different depression treatments for different people, including psychedelics and dissociatives, and hopefully we can find a way to make sure people get sorted to the treatments where they are least exposed to the tail risk side effects.

SSRIs are by no means safe or well-tolerated. They have all sorts of severe, life-altering, mostly permanent side effects: https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...

There are countless heartbreaking stories of people who were prescribed these drugs not knowing what they were subscribing to. In many cases, the effects of those drugs are worse than the symptoms they are supposed to alleviate. With "I Don't Wanna Be Me" there's even a song by Type O Negative (from Peter Steele's own experience with Prozac) about the devastating effects SSRIs can have on a person's life.

These drugs are handed out like candy while the physicians prescribing them often point-blank deny any side effects or even attribute those to the illness they are meant to treat.

Psychedelics, on the other hand, have actually been proven to be effective for many syndromes SSRIs are commonly used for and by comparison are very safe when used with proper preparation, medical surveillance, and in the right setting.

The only reason psychedelics are still widely shunned is a Puritan attitude to human well-being: You're not supposed to feel better than the common neutral base level. Any drugs achieving that (alongside with other, more specific and intended medical effects) are maligned and ostracized.

You're saying this as if psychedelics cannot 'have all sorts of severe, life-altering, mostly permanent side effects'.

Yes, they certainly can.

However, the prevalence of side effects with psychedelics is in the single-digit range, whereas with SSRIs you're almost certain to be experiencing some sort of - often severe - side effects for the rest of your life.

this is more or less exactly what i was trying to say. for most people SSRIs are safe, they experience manageable side effects and little health risk. psychedelics and dissociatives seem like they must be really drastic and risky. but actually SSRIs are pretty risky too, there are all these terrible low-probability outcomes.

so it's good we have all options, but ideally we'd have a better way of judging who is safest with which treatment.

With SSRIs you have a one in three chance for any number of the following side effects; many of them permanent, even after discontinuing medication (if you actually manage to do so, since SSRI come with severe withdrawal symptoms):

- sexual dysfunction

- loss of emotion and creativity

- drowsiness

- insomnia (including real fun stuff like night terrors)

- fatigue

- nausea

- tremors

I'd hardly call that safe or manageable.

With even the most potent psychedelics such as LSD, on the other hand, there's merely a one in thousand chance for severe side effects.

I'd go as far as prohibiting the prescription of SSRIs for all but the most severe cases (such as a severe depression where the patient is actually suicidal). For everything else these drugs are commonly used for, e.g., mild depression, OCD, or IBS, there are other - in many cases better - options with far less devastating (if any) adverse effects.

> many of them permanent

Almost none of these would be permanent, and you certainly don't have a 1 in 3 chance of them being permanent. Where did you get that number?

> With even the most potent psychedelics such as LSD, on the other hand, there's merely a one in thousand chance for severe side effects.

This is fucking nuts. We're in a thread about how taking too much can clearly cause weeks of psychosis, and how easy it is to do that. There's nothing wrong with warning about the risks of SSRIs, but to claim you have a 1 in 3 chance of having permanent nausea while, in the same breath, claiming psychedelics are 100x safer, is beyond irresponsible.

> Almost none of these would be permanent

Sexual dysfunction caused by SSRIs in many cases persists for the rest of the patient's life.

> and you certainly don't have a 1 in 3 chance of them being permanent. Where did you get that number?

Those are actual numbers from scientific studies: https://pmc.ncbi.nlm.nih.gov/articles/PMC2719451/

> in the same breath, claiming psychedelics are 100x safer, is beyond irresponsible.

Stating mere facts isn't irresponsible and those are the facts:

When taking SSRIs you have a one in three chance to permanently and severely change your life for the worse.

When taking LSD you have a 1 in 1,000 chance of suffering a psychotic break.

What's irresponsible - and unethical - is twisting and misrepresenting these facts - to the extent of outright lying about the purported innocuousness of SSRI, as is wont in the psychiatric community.

> Sexual dysfunction caused by SSRIs in many cases persists for the rest of the patient's life

You said most symptoms were permanent, don't back down now. Sexual Dysfunction is a pretty broad term, how would you even link it to being affected by an SSRI?

> Those are actual numbers from scientific studies: https://pmc.ncbi.nlm.nih.gov/articles/PMC2719451/

Literally says NOTHING about being permanent, this is about symptoms experienced while on SSRIs. Did you read your own source?

> When taking LSD you have a 1 in 1,000 chance of suffering a psychotic break

Where are you getting this number? It lacks so much context. What dosage gives you a 1/1000 chances of a psychotic break? Are you aware people are just taking whatever amount of Ketamine they feel like?

You seem to be arguing that Ketamine is somehow 300+ times safer than SSRIs as if you can compare the two 1:1. That is now how medication works.

> You said most symptoms were permanent, don't back down now. Sexual Dysfunction is a pretty broad term, how would you even link it to being affected by an SSRI?

There you go: https://www.tga.gov.au/news/safety-updates/updated-warnings-...

https://annals-general-psychiatry.biomedcentral.com/articles...

https://pmc.ncbi.nlm.nih.gov/articles/PMC8061302/

https://rxisk.org/post-ssri-sexual-dysfunction-pssd/

> Where are you getting this number?

There you go (for instance): "Cohen suggests a low rate of prolonged psychotic reactions in LSD users (1.8 per 1000) [19]"

https://www.nature.com/articles/s41380-024-02800-5#Sec35

> Are you aware people are just taking whatever amount of Ketamine they feel like?

Ketamine is a totally different type of drug. Deriving anything about psychedelics from the amount of Ketamine people take is entirely nonsensical.

Buddy, you're doing something called Source Bombing. I've read through 3 of these links and they directly contradict what you argued. I'm not going to waste my free time reading through the rest if you aren't going to bother reading at least one of them yourself.

With regards to Ketamine.

> There you go (for instance): "Cohen suggests a low rate of prolonged psychotic reactions in LSD users (1.8 per 1000) [19]"

That is a description of one of the many studies included in this meta-analysis. This is from the same article.

> Taken together, the effective risk of psychedelic-induced psychosis or worsening of pre-existing psychotic symptoms in schizophrenia -as well as in the early stages of the psychosis spectrum- remains incompletely understood

Also

> Overall quality of studies was low and only few studies (n = 9) could be included in the meta-analysis, hence the presented findings should be interpreted with caution.

> Buddy, you're doing something called Source Bombing.

You're doing something called "Moving the goalposts" by first asking for sources and then complaining because those sources don't support the very narrow construal you seem to be applying to my argument.

Those sources are scientific studies, which by the very nature of the scientific processes of course are open-ended.

> The only reason psychedelics are still widely shunned is ..

no, more complicated than that..

> i generally consider myself an enemy of psychedelic advocates, because I think they want to make it effectively socially mandatory to do these drugs, which is really bad. > ("sure, it's your choice what you put in your body, but a really enlightened person wouldn't be so frightened and closed-minded that they don't want to see what psychedelics can show them...")

I'm sorry WHAT? I've been to many open airs and other events where MOST of the people around have been under the effect of psychedelic and in other drug-friendly places, and I have never hear manipulative shit like that ever. On the contrary, if I heard people talk about this drugs it was always "it worked for me but might be a bad experience for you", "be safe, don't take it if you're not sure" and "you can always have a great time here completely sober".

i think that "we all want to get high on drugs" situations, like festivals, are actually a lot better. it's about personal choice.

when i talk about psychedelic advocates, i mean the people who think that widespread use of psychedelic drugs would massively improve mental health, make people more productive and happier, etc.

Confusing a minority of fringe members with the reasonable group of "psychedelic advocates" as a whole just delegitimizes the whole movement. There will always be some who take reasonable ideas to absurd extremes.

As a point of comparison: "social drinking advocates" vs. those who like to get blackout drunk every night.

The idea that everyone should be pressured into taking psychedelics is an absurd extreme. Psychedelics can be a powerful catalyst to growing as a person, but they're not a magic potion that makes you grow emotionally, spiritually, and intellectually.

They're likely going to bring your unprocessed ideas and personal issues to the forefront which can be very productive if you want to face them. But those who carry around demons that they've repressed and absolutely don't want to face would probably have a terrible time on psychedelics.

yes agree, and also underlying medical conditions, brain chemistry, long lists of who knows what..

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