CodeCounselor

2 years agodiscuss

I remember how this was one of my first ”tech” fascinations in early childhood and a few years before the first dial-up modem arrived to the house. Something magical about how the tv turned och into something different and semi-interactive. Lovely reminder.

CodeCounselor

3 years agodiscuss

Hello. Sadly no. This is something that is probably overlooked and/or neglected on a regular basis. Often when the question comes up the most pragmatic next step is to switch drug or modality to something that doesn't rely on the suspected metabolic pathway in question...

CodeCounselor

3 years agodiscuss

I apologize if I misunderstand you, which is very possible.

I interpret you as saying that unless there is a "trip" there is only a placebo effect left on the table so to speak. I think this is somewhat refuted by the fact that the standard ketamine infusion protocol (that does not normaly induce "trips") has an effect size that dwarfs the effect size of placebo (say 0.2 - 0.4). Some studies have shown ketamine approaching ECT-effect sizes. This makes me sound like a ketamine nut, which I am not. I am a bit of an ECT nut though. I have just not excluded the fact that the phenomenology of certain treatments actually mediate the treatment effects in a non-placebo way.

CodeCounselor

3 years agodiscuss

I am happy to be sorted into the "responsible" category, since I prescribe IV ketamine with the mentioned 40 minute slow IV infusion at 0,5mg per kg of body weight.

I would like to chime in a thought about the choice of words... I think that we might be doing us a disservice when reducing the whole discussion down to "trip" or "no trip". Some patients have mild sensory experiences from the treatment, some have unpleasant dissociative-ish experiences, some done feel much at all. My belief is that the subjective experience, or the phenomenology of the treatment, is of importance even if the experience is far from a "trip". My patient who thus far has had the most convincing response did not "trip", but described a calm feeling of "everything will be alright" during the treatment - a response that none of 20-ish drugs or ECT had given.

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