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Psychedelics and mental illness

180 点作者 DantesKite大约 3 年前

29 条评论

btilly大约 3 年前
I agree with the basic point of the article entirely.<p>However he shows the same kind of bias that he is speaking out again by not discussing the best known branch of such research. And that is MDMA for PTSD.<p>It is best known simply because it is, in fact, demonstrating that it works. The FDA has been repeatedly calling it a &quot;breakthrough therapy&quot; since 2017. It is in multiple phase 3 trials around the world that are going well, and full approval is expected this year. Research papers on it, like <a href="https:&#x2F;&#x2F;www.nature.com&#x2F;articles&#x2F;s41591-021-01336-3" rel="nofollow">https:&#x2F;&#x2F;www.nature.com&#x2F;articles&#x2F;s41591-021-01336-3</a>, are appearing in the top science journal in the world and are no less enthusiastic than a press release. Let me quote, &quot;These data indicate that, compared with manualized therapy with inactive placebo, MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation.&quot;<p>So no matter how much questionable research there may be - and I&#x27;m sure it is a lot - let&#x27;s not throw out the baby with the bathwater. There is also good research, and these drugs have the potential to make a huge difference.
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slibhb大约 3 年前
I like the article. With psychedelics, it&#x27;s clear that much of the excitement comes from people (including scientists) who have used them and found their experiences helpful. That&#x27;s not science but that doesn&#x27;t mean it&#x27;s wrong. Not everything is amenable to clinical study and this doesn&#x27;t mean we should disregard it.<p>And the issue isn&#x27;t just psychedelics being hard to study. Mental health is hard to study. An overweight man with no friends who plays computer games all day is not depressed unless he feels bad about it. Mental health depends on subjective feelings. Hard to study that!<p>My view is that we should continue to think about psychedelics from a religious or spiritual perspective. Even if that&#x27;s literally incorrect, it&#x27;s the correct metaphor. I&#x27;m also very skeptical of people who think widespread use of psychedelics can make society better. Lots of people used LSD in the 60s and 70s and as far as I can tell they didn&#x27;t usher in a new age of love, peace, and tolerance.
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h2odragon大约 3 年前
I know a lot of cannabis fans (and count myself as one). Very, very few of them acknowledge that cannabis affects people inconsistently; one person&#x27;s reaction to it can be very different than others. This is inconvenient for calling it a &quot;medicine&quot; so let&#x27;s just ignore it.<p>Psychedelics are even worse. The same dose of the same drug can produce wildly vary effects in the same person depending on factors we have trouble nailing down. &quot;Set and setting&quot; and the Erowid wisdom are all very well, but they are barely enough to describe the area and edges of the therapeutic window in a general way. <i>Your</i> trip, today, is still going to be an experiment.
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monktastic1大约 3 年前
This argument seems disingenuous:<p>&gt; Just as you’d feel extra-sceptical if all the research showing that pork is unhealthy was written by Muslims who’d already decided for religious reasons not to eat pork, you should be worried about the sheer number of studies by psychedelic researchers who are themselves aficionados of the drugs.<p>Perhaps a better analogy would be: just as you&#x27;d feel extra-skeptical if all the research showing that exercise is beneficial was written by exercisers who&#x27;d already decided for experiential reasons to exercise, ...<p>It&#x27;s not like people are born into the religion of psychedelia and have strong cultural reasons to conform. If something truly is good, <i>of course</i> the people researching it are going to be &quot;aficionados&quot; of it. And this doesn&#x27;t save it:<p>&gt; (You might wonder if they’re into psychedelics precisely because the research shows such impressive benefits, switching around cause and effect. But as we’ll see below, that evidence doesn’t exist yet. That particular horse is coming way after the cart).<p>Why can&#x27;t they be into it simply because it <i>worked</i> for them?<p>There&#x27;s nothing about the fact that psychedelic researchers are excited about psychedelics that <i>by itself</i> is suspicious, as we are strongly being led to believe.
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cmehdy大约 3 年前
The article makes a lot of good points. I&#x27;m a lover of psychedelics, I&#x27;ve apparently managed to be wired in a way that has made every single experience one that I don&#x27;t regret (whether joyous, superficial, or intricate, unexpected), but I would never make the mistake of assuming my experience directly translates to other people&#x27;s. Hype, cultists and people thinking in absolute only do a disservice to what we could extract from those experiences.<p>Serious research with people who are detached from the drugs is something we should all want, especially because we&#x27;ve only had a short time for detailed records of psychedelics experiences to exist at all and most experiences to this day aren&#x27;t really observed scientifically at all. I believe that science is the best thing we&#x27;ve got to approach the unknown, psychedelics aren&#x27;t a &quot;godly exception&quot;.<p>I also remain aware that science doesn&#x27;t always offer answers right away and we just keep on going anyway. It&#x27;s been true for most technologies, for a lot of what goes in our food every day, for how we&#x27;ve structured society, etc. We accept that there&#x27;s unknown risks, we try to mitigate what comes our way and prepare for what we can estimate, and we learn to live through what we didn&#x27;t see. But we still eat the food, use the technologies, try social systems, and so on.<p>I think that attitude is also one to have with psychedelic experiences. That happens through testing what you have, guided experiences if and when there&#x27;s a need or uncertainty, &quot;set &amp; setting&quot; and discussing them beforehand, being gentle with dosage, making a sincere attempt at an inventory of the self before deciding on taking the psychs, and so on and so forth. And some people try some of it, some people don&#x27;t, and that&#x27;s OK as long as everyone strives to have an experience they can handle with what they know. Just like with everything else.
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zafka大约 3 年前
I would be very interested to know where Stuart Ritchie&#x27;s funding is coming from these days also. I am rather surprised that he did not list all his sources of income in a show of transparency.
seanwilson大约 3 年前
&gt; A few years ago, John Ioannidis (RIP) published an article on conflicts of interest in nutrition research. The conflicts you get in this field, he said, are different from those in, say, Big Pharma-funded trials of new drugs. Not only are there those usual kinds of financial conflicts—some research is paid for by the food industry; nutrition scientists have diet books to sell—but there are “nonfinancial” conflicts, too. If you’re a strong adherent to the particular kind of diet you’re researching (vegan, Atkins, gluten-free, etc.), Ioannidis argued, you should disclose this at the end of the paper, so readers can be fully informed about how the research was produced.<p>I find it&#x27;s common to see forum comments like &quot;we know this researcher is a big advocate of X so this study is bias&quot;. I find this critique is usually very shallow and sets an impossible standard.<p>Where are you you going to find researchers pouring years of their life into researching a subject they have no interest in or opinions of?<p>If you were studying vegan or Atkins diets for example, it&#x27;s an ongoing personal choice in your day-to-day life if you&#x27;re going to switch to&#x2F;from that diet or not, where either choice could be used to imply bias in your future studies. And after a few years of research, how could the evidence you collect not impact your personal choice? And if it doesn&#x27;t, what would that say about your belief in your own research?<p>Researchers are trained to be aware of their biases, to devise experiments that reduce these biases, and peer review helps identify problems here also. Another part of peer review where the media jumps the gun is that other researchers should be able to replicate the studies themselves to check the results - if you become known for producing highly biased research that can&#x27;t be replicated this is surely going to impact your career (e.g. less citations, less funding, distrust from peers) so there&#x27;s a very strong incentive to keep this in check?<p>I think in general, the real problem here is the dysfunctional click-bait approach the media has with scientific reporting (exaggerated, sensationalist, premature, lacking any nuance&#x2F;caveats&#x2F;details) and the public&#x27;s understanding of the scientific method is very broken e.g. the notion that scientists are always changing their minds, little understanding of how to evaluate how strong evidence is before accepting it as true, which includes dismissing everything about a study because they can create a story about one researcher being bias.
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sn00tz00t大约 3 年前
<a href="https:&#x2F;&#x2F;erowid.org&#x2F;experiences&#x2F;subs&#x2F;exp_Mushrooms.shtml" rel="nofollow">https:&#x2F;&#x2F;erowid.org&#x2F;experiences&#x2F;subs&#x2F;exp_Mushrooms.shtml</a><p>Neat list of mushroom trip experiences.<p>Ranging from schizophrenic horror unimagined to unenglishable religious experiences.<p>I&#x27;ve had both experiences in the same trip. I&#x27;d hate to be on my deathbed and have a bad trip tho.
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after_care大约 3 年前
I concur with the core message -- that the current research on psychedelics is not strong. Some of the problem is that the research itself was not designed with an eye on earning FDA approval. This was hard to do because we&#x27;ll never have a true double-blind psychedelic trial for psychedelics like we can have for SSRIs. Spravato recently showed a path for FDA approval, because ketamine treatment for depression closely mirrors protocols for psychedelics.
drooby大约 3 年前
I don’t fully understand the issue with blinding.<p>How is it different than trying to double blind talk therapy. Obviously someone knows that they are getting talk therapy, likewise, people obviously know they are getting psychedelics.<p>Yet we are still able to get experimental results supporting talk therapy and no one complains, right?
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jamal-kumar大约 3 年前
&quot;This is just an anecdotal account, but there’s an interview with the psychedelics researcher Manoj Doss, who says that he “only know[s] one psychedelic researcher who’s never done psychedelics”, and notes (in an encouragingly self-critical way) that this is a conflict of interest.&quot; - Yeah that&#x27;s a good point to be honest<p>I think that some of the most interesting applications for psychedelics as medicine target treatments that aren&#x27;t strictly mental health related. Ketamine is already approved for ischemic brain damage or stroke, like you better hope that&#x27;s the first thing you get in the ambulance to prevent glutamate excitotoxicity from getting really nasty if you fall of a motorcycle or whatever - But DMT actually shows a lot of promise for recovery too, and I&#x27;m actually getting involved in a project tangent to that research right now. We&#x27;re talking sub-psychedelic micordoses to build people&#x27;s neurons back from brain damage, one of those things in modern medicine we&#x27;re still generally hopeless about. Pretty interesting stuff! [1]<p>[1] <a href="https:&#x2F;&#x2F;www.technologynetworks.com&#x2F;neuroscience&#x2F;blog&#x2F;could-the-spirit-molecule-dmt-assist-in-stroke-recovery-346249" rel="nofollow">https:&#x2F;&#x2F;www.technologynetworks.com&#x2F;neuroscience&#x2F;blog&#x2F;could-t...</a>
newbamboo大约 3 年前
It’s easier to market “psychedelics” than meditation, prayer or something like DBT. We should learn from that and try to make more things as popular as psychedelics. “Put this little square of paper on your tongue” is much less of an ask than “sit in chair for 30 minutes everyday and be mindful of your breathing.” It’s like the McDonald’s approach to mental health, and who doesn’t love McDonald’s! Over a billion served. Psychedelics scale similarly.
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ada1981大约 3 年前
I liked the article and tend to agree there is a lot of pressure to rush psychedleics to the mainstream.<p>This is from a person who used MDMA to heal bipolar &#x2F; schizophrenia in an underground setting; ran an underground clinic for 3 years; took funding from Dr. Bronner to found a non-profit to decriminalize plant medicine; and was featured in a PBS documentary administering MDMA in an underground setting.<p>Also, the author obviously hasn&#x27;t done psychedelics ;) and he states as such.<p>&quot;I’d think about taking them if I had a relevant condition and the evidence they worked was convincing.&quot; You could argue that the relevant condition is that you are a living human, and we&#x27;ve evolved to be in relationship to altered states of consciousness.
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mnkv大约 3 年前
This article is interesting but a major issue is that the vast majority of the points (and the linked articles!) are not about psychedelics. They are about pharmacology, psychology, statistical significance, and science in general. The majority of the author&#x27;s critiques can and are applied to a lot of other fields (he even takes a meta-review critical of nutrition and applies the logic to psychedelics).<p>His main three themes (author bias, statistical significance, double-blinding&#x2F;scientific rigour&#x2F;confounding) are not at all unique to research with psychedelics. If the author&#x27;s point is that we should take all studies with a grain of salt then why focus on psychedelics? If psychedelics is really such a problem field then I would expect more evidence than a couple bad actors (the MAPS stuff sounds terrible!) and light issues in a few studies that were brought up in reviews before publication.<p>It seems the main point isn&#x27;t research as much as the public&#x27;s perception and hype (partially fueled by researchers to be fair). That&#x27;s a good point and I&#x27;m totally against the psychedelics version of &quot;weed cures cancer&quot; bros. But, as the author points out, this isn&#x27;t unique to psychedelics either! Ironically, I found the intro and most of the article to sound much more critical of the research than the conclusion really is.
umvi大约 3 年前
Why are these articles so popular with HN? Any article about treating mental illnesses (including depression) with LSD&#x2F;shrooms&#x2F;cannabis&#x2F;[drug] immediately shoots to the top, and I see articles like this every other day at the top of HN. Is it just people wishing for a silver bullet that will cure their mental problems? At any rate, the number of mentally ill people on the internet must be <i>much</i> larger than I am estimating.
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VictorPath大约 3 年前
&gt;&gt; Overall, it is difficult to see how prohibition of psychedelics can be justified as a public health measure” &gt; This is activism, not science. As I said above, I actually support drug legalisation – but it’s far from appropriate to include this kind of thing so prominently in what’s supposed to be a neutral, factual scientific analysis.<p>Scientific studies that ingesting chemicals like THC are one of the reasons we have things like the Rockefeller drug laws. Activism from some in the scientific community is one reason people are rotting in jail for selling marijuana (while tobacco companies donate to politicians and in return get trade deals where it is illegal to have a law requiring warnings on cigarette packs.<p>People can be arrested for ingesting mescaline from peyote plants like Native Americans used to, scientific studies and activism is one reason for this, but scientists asking for people not to be imprisoned for getting mescaline from a cactus is not &quot;appropriate&quot;.<p>(I have never tried mescaline but don&#x27;t want to be imprisoned if I ever do)
listless大约 3 年前
Anecdotal but I did LSD when I was 19 and have been a been a huge consumer of mental health services, antidepressants and anxiety meds ever since. Prior to that horrific incident, I had no issues to speak of.<p>So we can&#x27;t say that they can cure it, but they most certainly can cause it. Perhaps the sword needs to cut both ways to be effective?
NoImmatureAdHom大约 3 年前
The author points out a bunch of problems that are present in basically all research involving human behavior. He implies that it is particular to research involving psychedelics (except for I think a single example involving diet), and that is false. He should take a look at the dumpster fire that is Social Psychology...
scrollbar大约 3 年前
The article mentions <i>Cover Story: Power Trip</i> podcast which I finished last night and enjoyed so much. It’s by New York Magazine and the folks at Psymposia. Highly recommend as a balancing counterpoint to all the positive hype about psychedelics.<p>For the record, I have been both helped and harmed by psychedelics and in net believe their return is positive. I’ve seen enough oddities in the Bay Area psychedelics and mental health scenes to warrant some serious caution about the current path we’re taking.
robbiep大约 3 年前
That’s really interesting.<p>I’m reminded of something the PhD Pharmacologist Psychiatrist told us during med school - effect size of new depression meds decreases over time (probably because you have an early positive result and then it’s pushed in and then later better quality studies show smaller difference) so the joke is ‘every time a new depression medication comes out there’s a race to use it before it stops working!’
eric4smith大约 3 年前
I’ve always wondered…<p>Do psychedelics cause mental illness or treat mental illness?<p>Our minds are so weird that I have a simple theory that we are all slightly insane in at least some small way.<p>But from what I have observed from friends who take them - they cause them to cope with troubles that are normally difficult to deal with.<p>I guess I’m not brave enough to try them to deal with my own troubles myself right now.
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leemoore大约 3 年前
One challenge around studying these drugs is efficacy is often linked to expectation. Some speculate 1 key mechanism at work is an amplification of the placebo effect. If this is the case then clearly testing of these drugs using traditional techniques to eliminate the placebo effect will be problematic
eurasiantiger大约 3 年前
The argument ”all but one psychedelics researchers have taken psychedelics” is not particularly convincing; many other researchers have taken psychedelics, too. Certainly one wouldn’t expect e.g. liberal arts, sociology or organic chem majors and their cohorts to be completely naive to them.
lighttower大约 3 年前
The author says &gt; Quite a few psychedelic drugs are naturally-occurring, and have been used for hundreds of years (this doesn’t include synthetic ones like LSD, obviously).<p>LSD occurs naturally in the Ergot mushroom: &gt; The ergot fungus contains a number of highly poisonous and psychoactive alkaloids, including lysergic acid (LSD), which was synthesized from the ergot fungus in 1938 by chemist, Albert Hoffmann [1]<p>What the author means is that it&#x27;s synthetically made these days. Psilocybin can also be synthetically made these days.<p>psychedelics are the best hope humanity treating refractory mental illness. I know at least 5 people personally that have embarked on psychedelic voyages to treat their demons. Some of them are renowned psychiatrists.<p>[1] <a href="https:&#x2F;&#x2F;www.fs.fed.us&#x2F;wildflowers&#x2F;ethnobotany&#x2F;Mind_and_Spirit&#x2F;ergot.shtml#:~:text=The%20ergot%20fungus%20contains%20a,a%20proposed%20explanation%20of%20bewitchment" rel="nofollow">https:&#x2F;&#x2F;www.fs.fed.us&#x2F;wildflowers&#x2F;ethnobotany&#x2F;Mind_and_Spiri...</a>.
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stakkur大约 3 年前
As a counterpoint, I&#x27;d read Michael Pollan. Also, a fundamental problem with this article is the lumping of &#x27;psychedelics&#x27; into a neat category so it can be critiqued. In the real world, the story of what&#x27;s happening is diverse.<p>TL;DR: This is a dangerously biased dismissal of actual science and historical progress in understanding of various &#x27;psychedelics&#x27;, and it&#x27;s exactly the kind of cherry-picking dismissal that&#x27;s been fought against for decades.
orangepurple大约 3 年前
Not mentioned anywhere, but probably the strongest effect of psychedelics, is that LSD absolutely kills the desire to drink alcohol for months.
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nomendos大约 3 年前
This article goes onto being biased on unproven allegation of bias, not exploring other possibilities
Skilbucks大约 3 年前
Do you think a disturbed work life balance could be a reason for mental illness as well?
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ComradePhil大约 3 年前
The reality is that people are open to anything that promises alleviation of suffering from what os diagnosed as &quot;mental illness&quot; because the mental health industry has proven to be a complete scam designed to keep people sick and provide them lifelong &quot;treatments&quot; that don&#x27;t work.