Psychiatric risks for worsened mental health after psychedelic use(journals.sagepub.com)
journals.sagepub.com
Psychiatric risks for worsened mental health after psychedelic use
https://journals.sagepub.com/doi/10.1177/02698811241232548
119 comments
A lower power study can still lend weight to a good meta analysis.
That is true, but there are also conditions where low-powered studies degrade meta-analyses. For example, if the panel attrition is caused by self-selection on unobserved variables, then the study contains bias that is not (and cannot be) accounted for, which skews the meta analysis. But yeah, those concerns are mostly about measurement not sample size.
Meta-analyses are even less rigorous than a low power study
Reminder. Psychedelics can also lead to extremely traumatic experiences:
https://www.reddit.com/r/DMT/comments/gb9ar0/dark_dmt_trip_r...
This doesn’t get mentioned in the current “psychedelics as a cure-all” hype wave.
https://www.reddit.com/r/DMT/comments/gb9ar0/dark_dmt_trip_r...
This doesn’t get mentioned in the current “psychedelics as a cure-all” hype wave.
That’s a trauma cum redemption story. Sometimes it’s just trauma.
RIP Richard Skibinski (July 17, 2022)
https://www.reddit.com/r/Psychedelics_Society/comments/uzed2...
https://www.legacy.com/us/obituaries/legacyremembers/richard...
RIP Richard Skibinski (July 17, 2022)
https://www.reddit.com/r/Psychedelics_Society/comments/uzed2...
https://www.legacy.com/us/obituaries/legacyremembers/richard...
It gets mentioned all the time, everywhere I ever saw anything. If you really see info only in such way, stay away from those sources
Maybe not the best example as the report ends with "I’m doing great now! I think the experience despite being f* terrify was super useful", but I get what you mean. However, serious narrators or researchers usually don't fail to mention that we are not dealing with a panacea.
from the post
> and out of pure immaturity and desire to breakthrough I packed 100mg into the bowl.
https://psychonautwiki.org/wiki/DMT says heavy dosage is 60mg+.
> This doesn’t get mentioned in the current “psychedelics as a cure-all” hype wave.
No. You forgot to mention 100mg is way above heavy dosage.
> and out of pure immaturity and desire to breakthrough I packed 100mg into the bowl.
https://psychonautwiki.org/wiki/DMT says heavy dosage is 60mg+.
> This doesn’t get mentioned in the current “psychedelics as a cure-all” hype wave.
No. You forgot to mention 100mg is way above heavy dosage.
Thats not how DMT works.
it gets mentioned
Can't scary movies as well?
It’s pretty scary to me that so many people seemingly on whim are willing to upgrade their brain firmware. I often hear stuff like “and then my whole view on reality changed”. Unless there’s an easy way to upload the previous “factory image” so to speak, it feels pretty risky to experiment with that.
When I had depression I used Salvia Divinorum and re-lived fragments of my childhood, I found that seemed to reset my brain back to last known good state bridging forgotten childhood memory in the short term to feeling like it was only a week ago. Certainly cured my depression though. It felt programmable with music, suspect it maybe more controllable with research. Interesting stuff strangely I found anti-addictive. Though equally could be majorily dangerous for some as it litterally sucks you out of reality and all perception of time for a bit.
An illusive broken firmware it is. Better stay sober. Also when learning new things being sober is better. You wont get your phd using drugs. You wont get your brains to a new state using drugs. You maybe think you do, but thats a illusional defect of your brains when using drugs. Stay sober.
Is the omniscience pure rationalists experience on vanilla consciousness genuine?
Douglas Engelbart - inspired by LSD to invent computer mouse
Steve Jobs stated LSD was “one of the two or three most important things I ever did in my life”
Francis Crick saw the double helix of DNA on LSD
Kary Banks Mullis, the biochemist who won the 1993 Nobel Prize in Chemistry for his improvements to the polymerase chain reaction technique: “It [LSD] was certainly much more important than any courses I ever took.”
Ralph Abraham claimed the insights he had while on psychedelics such as LSD profoundly influenced the development of his mathematical theories.
And there's more and I am not even mentioning that most artists are using something.
So yeah, if you can get Nobel prize you can definitely get PhD. You do you, I don't know what you have achieved but don't claim you posses some universal truth.
Steve Jobs stated LSD was “one of the two or three most important things I ever did in my life”
Francis Crick saw the double helix of DNA on LSD
Kary Banks Mullis, the biochemist who won the 1993 Nobel Prize in Chemistry for his improvements to the polymerase chain reaction technique: “It [LSD] was certainly much more important than any courses I ever took.”
Ralph Abraham claimed the insights he had while on psychedelics such as LSD profoundly influenced the development of his mathematical theories.
And there's more and I am not even mentioning that most artists are using something.
So yeah, if you can get Nobel prize you can definitely get PhD. You do you, I don't know what you have achieved but don't claim you posses some universal truth.
That Francis Crick was under the influence of LSD when he discovered the double helix structure of DNA is a widely circulated myth, but I've seen no evidence for it. In “Francis Crick: Discoverer of the Genetic Code,” Matt Ridley clarifies that while Crick did experiment with LSD, it was not until several years after the discovery of the DNA structure. The discovery itself was a result of rigorous scientific research based on experimental results, including the X-ray crystallography of Rosalind Franklin.
Your examples are exceptions and are certainly not a justification. Drugs are destroying lives of a lot of people who otherwise could have good lifes.
I agree as someone who was previously excited about the idea. Although to be honest, I think people overstate the changes. They did not last. Lots of salesmen in this industry like any other.
Reprogramming? Not at all, at least not with intense mushroom experience alone and laying with closed eyes, never did ayahuasca. But understanding way way more about myself, overall brain structure, and ie where religions come from? And by far the most intense and out-of-reality/body/senses experience I could ever go through?
Definitely, those few experiences will be with me till my last breath.
Definitely, those few experiences will be with me till my last breath.
You can't pop a trip, go to a music festival and except a new mindset. You can however use these tools to deeply connect with yourself and this is where life altering experiences happen.
100%. Ask any one of these people to quantify how their view on reality changed and it'll be vague transcendentalist talking points and hand waving around things like something something spiritualism, something something deeper connection with nature, something something cosmic holographic kaleidoscopic reality.
On par with new age crystal healing and chakra points.
On par with new age crystal healing and chakra points.
There are plenty of people who talk about how psychedelics helped them integrate and move past traumatic experiences, kick addictions, and come to terms with difficult truths like the mortality of themselves or their loved ones. The transcendental and indescribable is part of the experience for sure, but there's plenty of evidence for psychedelic experiences creating concrete, durable, quantifiable changes in worldview and behavior. MAPS (https://maps.org) has done fantastic work to compile literature reviews for the scientific studies that demonstrate these outcomes.
I'm not saying that psychedelics are for everyone, or that anyone should take them on a whim and without preparation. However, it's just incorrect to equate their ability to change people's lives for the better to crystal healing or similar.
I'm not saying that psychedelics are for everyone, or that anyone should take them on a whim and without preparation. However, it's just incorrect to equate their ability to change people's lives for the better to crystal healing or similar.
I'm an extreme materialist, I don't believe in gods or spirits or anything of the sort. I don't even believe in the magic some people call "free will".
I first tried LSD about 10 years ago and have taken various forms of psychedelics once or twice a year since. Some of them were, without a doubt, the most profound experiences of my life. You're right about the vague transcendentalist nonsense. The problem is there are no words to describe it adequately.
Despite only having pleasant experiences myself, I would never encourage any friend or stranger to try them. That is something only they can decide with their own research and risk appetite. There are absolutely serious potential consequences.
I think the worst consequence for me is that I have started to like weird music like psytrance even when sober.
I first tried LSD about 10 years ago and have taken various forms of psychedelics once or twice a year since. Some of them were, without a doubt, the most profound experiences of my life. You're right about the vague transcendentalist nonsense. The problem is there are no words to describe it adequately.
Despite only having pleasant experiences myself, I would never encourage any friend or stranger to try them. That is something only they can decide with their own research and risk appetite. There are absolutely serious potential consequences.
I think the worst consequence for me is that I have started to like weird music like psytrance even when sober.
As a materialist, do you believe in laws of physics?
I believe they're our current best approximation to how the universe behaves based on our empirical observations.
But that the universe behaves according to some laws?
I don't know.
The universe does not know or care about our laws and they are incomplete.
For example, we have no idea how consciousness works, so at this point we stop at "I don't know", rather than inventing explanations.
I don't know if consciousness is computable -- I suspect it isn't.
If it is not computable then we cannot come up with laws to explain it.
Or maybe the whole universe is computable but its kolmogorov complexity is larger than its information capacity.
The universe does not know or care about our laws and they are incomplete.
For example, we have no idea how consciousness works, so at this point we stop at "I don't know", rather than inventing explanations.
I don't know if consciousness is computable -- I suspect it isn't.
If it is not computable then we cannot come up with laws to explain it.
Or maybe the whole universe is computable but its kolmogorov complexity is larger than its information capacity.
I believe we know, based on any definition of knowing - I.e. assuming we can know anything at all, and realizing that any definitions of knowing are all circular to an extent, that the electron follows some laws.
I agree that the universe doesn't care how we approximate these laws, but only that they clearly exist.
If these laws exist, they are certainly not material, unless you redefine material, and that is why I am no longer a materialist :)
I agree that the universe doesn't care how we approximate these laws, but only that they clearly exist.
If these laws exist, they are certainly not material, unless you redefine material, and that is why I am no longer a materialist :)
You're technically correct (the best kind of correct)!
However, I don't think any materialist would deny laws of physics exist. We might say that how materials interact with each other is an intrinsic property of material itself, just as an electron behaves as though it has a certain mass.
What definition of material would you use that separates it from its laws?
However, I don't think any materialist would deny laws of physics exist. We might say that how materials interact with each other is an intrinsic property of material itself, just as an electron behaves as though it has a certain mass.
What definition of material would you use that separates it from its laws?
How does one quantify a conversation with a transdimensional being?
Just because a subjective experience is ineffable and difficult to describe adequately doesn't mean it's nonsense. It's convenient to lump those things all together, but it's not accurate.
After all, asking someone what it was like to stand at the top of a mountain they'd just climbed, admiring the view, you're likely to get similar "hand-waving" answers about connection to something bigger than them, but you probably wouldn't argue that climbing a mountain and taking in the view is a worthless experience that amounts to nonsense.
After all, asking someone what it was like to stand at the top of a mountain they'd just climbed, admiring the view, you're likely to get similar "hand-waving" answers about connection to something bigger than them, but you probably wouldn't argue that climbing a mountain and taking in the view is a worthless experience that amounts to nonsense.
They say such things of travel too. “It will forever change how you see the world, international travel.”
I hope it's overstated cause damn do I not really feel like traveling. It's just a lot of work.
I'll probably travel a little within the US but in the space of therapy stuff, I'd much rather accept that I'm simply not a travel person, than actually bother traveling.
I'll probably travel a little within the US but in the space of therapy stuff, I'd much rather accept that I'm simply not a travel person, than actually bother traveling.
No one wants to talk about all the downsides of trips that include leaving the house.. It's almost like a sizable portion of GDP has been taken over by an industry of vultures that need to fight any cleaner, safer more environmental alternative that might be successful by word of mouth alone.
It’s less that you upgrade your firmware, but rather that some thoughts that never occurred to you are thought in such a setting. Having felt connected to nature, or even a specific tree, changes how you view trees and life in general. There are many other ways to gain such insights, like travelling or reading; any insight that resonates with you will »change your view on reality«.
> I often hear stuff like “and then my whole view on reality changed”. Unless there’s an easy way to upload the previous “factory image” so to speak, it feels pretty risky to experiment with that.
Some people say if you keep up to date on global news, the opposite may be even more true.
Some people say if you keep up to date on global news, the opposite may be even more true.
It is risky, but life comes with risks. And not facing risks can be risky, too. You might waste your life in boredom, instead of taking off.
You also might "crap on the roof with your ass on the ground" to (miss)quote Castaneda.
You also might "crap on the roof with your ass on the ground" to (miss)quote Castaneda.
N of one but my friend (who always saw the world as very black and white) killed herself not long after doing Ayahuasca. I’m pretty sure it contributed to her death, she became an extreme fantasist about judgement and god, not a formalised religion but a personified fantasy with crazed rules and vengeances. It was not good.
I'm sorry for your loss. I'm not a medical practitioner but it sounds like the experience triggered a psychotic "break" in your friend? It's a sad but real possibility with psychedelics that more people should be aware of.
Devasting when such events occur. This can also occur from doing meditation for some, I'm not sure if anyone has measured whether there is any set means to determine individual level of risk and whether any particular mental conditioning/ study would mitigate that risk. Certainly awareness is important.
The problem is that even among large socially connected groups who are into psychedelics, the event of someone having a psychotic break is often rare to none.
Whereas in other groups a cascade effect sometimes happens and many people in such groups can experience mental health issues, and trauma.
There's that common call to examine "set and setting" but it's often a crap-shoot, due to the chaotic number of variables.
Whereas in other groups a cascade effect sometimes happens and many people in such groups can experience mental health issues, and trauma.
There's that common call to examine "set and setting" but it's often a crap-shoot, due to the chaotic number of variables.
Also not medical but I experienced similar and it sounds like psychosis to me. Personally I had manic episode triggered by taking several doses of acid spread over a week or so preceded by shroom doses spread over prior weeks. This culminated in several nights of insomnia, paranoia and then psychosis - the religious stuff is relatable. I had intense apocalyptic beliefs and “visions” - sort of closed eye waking dream more so then an open eye hallucination. The black and white thing also highly relatable and I think it is splitting (https://en.wikipedia.org/wiki/Splitting_(psychology)) - again not an expert.
Her suicide is very sad but I can relate. Rest in peace.
Personally it took me at least a month to feel functional again and then probably a year to start feeling better. Prior to that I struggled immensely with depression most of my life and abusing substances was my attempt to pull out of it, so to bottom out intensely like that feels extremely hopeless.
Once again giant disclaimer that I’m not authority, but I learned more about how psychedelics work from neuroscientists who research them and it was very illuminating. They are extremely potent in regards to neuroplasticity which seems like why they can be heaven or hell (https://en.wikipedia.org/wiki/Psychoplastogen). My best take away from the scientists was to space trips out by several months similar to what you should do for MDMA. Frequently redosing keeps your brain activity from stabilizing. That’s not their advice or strong statements (they were avoiding advice-giving entirely), of course, just what I took away.
Years later and I have done a lot introspection and learning and I have taken psychedelics again. I can identify my own anxiety, paranoia, or bad patterned thoughts creeping up and talk myself back. I don’t attribute that traumatic experience or drug use in general to improving my circumstance and I sure as hell don’t recommend it but it does seem like my life going to total shit was a step I needed to take to get it back together. Therapy would’ve been easier.
Her suicide is very sad but I can relate. Rest in peace.
Personally it took me at least a month to feel functional again and then probably a year to start feeling better. Prior to that I struggled immensely with depression most of my life and abusing substances was my attempt to pull out of it, so to bottom out intensely like that feels extremely hopeless.
Once again giant disclaimer that I’m not authority, but I learned more about how psychedelics work from neuroscientists who research them and it was very illuminating. They are extremely potent in regards to neuroplasticity which seems like why they can be heaven or hell (https://en.wikipedia.org/wiki/Psychoplastogen). My best take away from the scientists was to space trips out by several months similar to what you should do for MDMA. Frequently redosing keeps your brain activity from stabilizing. That’s not their advice or strong statements (they were avoiding advice-giving entirely), of course, just what I took away.
Years later and I have done a lot introspection and learning and I have taken psychedelics again. I can identify my own anxiety, paranoia, or bad patterned thoughts creeping up and talk myself back. I don’t attribute that traumatic experience or drug use in general to improving my circumstance and I sure as hell don’t recommend it but it does seem like my life going to total shit was a step I needed to take to get it back together. Therapy would’ve been easier.
> so to bottom out intensely like that feels extremely hopeless.
Had a similar experience to you but took it in a different way. Came down out of the craziness and realized "hey, I'm still here, shit could be a lot worse"
But I don't get why you still came back to them after having a negative reaction. Seems like a good sign to stop
Had a similar experience to you but took it in a different way. Came down out of the craziness and realized "hey, I'm still here, shit could be a lot worse"
But I don't get why you still came back to them after having a negative reaction. Seems like a good sign to stop
How do you know she wouldn't have killed herself without having tried Ayahuasca?
It’s funny, this is the sort of harshness and absolute certainty Jen would have come out with. Nothing is certain but my opinion given the outcome is that it definitely did not help.
Psychedelics are extremely strong experience, ayahuasca is supposed to be the strongest. If you have anything broken in your personality, it will come up. Thats why at least initially it should be screened and if OK handled by professionals who can lead, guide or stop the experience if needed.
I've seen lifelong schizophrenia triggered by nothing more than a bit of binge drinking. For some people it takes trauma to trigger bad things, some drugs, some have luck and manage to go through life with such a thing without ever experiencing it. Powerful tool, nothing more, nothing less.
I've seen lifelong schizophrenia triggered by nothing more than a bit of binge drinking. For some people it takes trauma to trigger bad things, some drugs, some have luck and manage to go through life with such a thing without ever experiencing it. Powerful tool, nothing more, nothing less.
If you shake up a box of poorly packed stemware, you’re going to get some breakage.
It's an objective comment on your subjective opinion of an N=1 result. You are free to share your opinion (and I may even be inclined to agree with you) but it holds no scientific value.
Sorry for your loss.
Sorry for your loss.
N=1 is perfectly relevant to an individual occurrence when the N and the event in question are one and the same. If I kill myself with a hammer n=1 hammers were fatal to use in my case. I don’t see anyone asserting that this means that broadly ayahuasca is dangerous or claiming scientific relevancy.
Interesting that OCD is the winning disorder, with zero negative responders.
Recalling my mushroom days.... Okay, I think I get it. Psychedelic experience is, in part, about embracing the beautiful chaos of the universe. Surrendering to the charms of free-flowing wild information at scale so huge there's no chance of imposing your own orderly corrections - as you might in normal every day life via OCD. That's my armchair take anyway.
Recalling my mushroom days.... Okay, I think I get it. Psychedelic experience is, in part, about embracing the beautiful chaos of the universe. Surrendering to the charms of free-flowing wild information at scale so huge there's no chance of imposing your own orderly corrections - as you might in normal every day life via OCD. That's my armchair take anyway.
Psychiatric history | Negative responders (%) | Non-responders (%) | Positive responders (%)
OCD | 0.0 | 25.0 | 75.0The n=16 is ridiculously low, though. Psychotic disorder, with 25%/25%/50%... n=4. The only number from Table 2 that makes sense is the aggregate. Even "history" vs "no-history" the differences are not that big, and slightly suggest that having a history of psychiatric illness has better outcome.
Yes true, I left out n=16 for my casual observation.
It's a murky subject due to the traditional way being far removed from clinical environments. Anything artificial like therapy props would stand out under the influence of psychedelics, but I guess they've thought of that. Good luck to them.
It's a murky subject due to the traditional way being far removed from clinical environments. Anything artificial like therapy props would stand out under the influence of psychedelics, but I guess they've thought of that. Good luck to them.
My subjective take is the opposite - psychedelics make you see order (patterns) emerge out of seeming chaos pretty much everywhere you look.
Yeh the infinite latticework does reveal a kind of order, I know what you mean. Perhaps it calms the OCD person seeing all those patterns.
Although while under the influence of psychedelics you're unlikely to arrange your sock drawer with compulsive order. You're more likely to free the socks from captivity.
Although while under the influence of psychedelics you're unlikely to arrange your sock drawer with compulsive order. You're more likely to free the socks from captivity.
I am nearly 70 years old.
I have been taking psychedelics for 50 over years. I am retired psychotherapist and I do not have a predisposition to mental ill health. I was also a substance misuse worker and methadone dispenser for over 10 years. I gave up smoking hash when I was 40 years old.
I did notice that with the introduction of skunk and the increase of up to 20% more Tetrahydrocannabinol (THC), there were more and more people being sectioned under the mental health act with psychosis. Whereas prior to skunk when people generally smoked good old fashioned, Moroccan, Lebanese and Afghani hashish it was a rarity.
I know a range of people of different ages who partake in psychedelic use and have no trouble, like me, in holding down a professional job role and engaging fully in life.
As with all drugs there is a risk, however, the risks with Psyceedelics are very low in comparison with other drugs.
We must not use individual cases to determine the safety of any drug.
Here in the UK the media went wild over reports that a 18 year old girl (Leah Betts) had died from taking MDMA. Very rarely are the true facts given; The coroner said that "water intoxication", and not an allergic reaction to the drug, was the cause of death.
I have a great deal of respect for Professor David Nutt who is an English neuropsychopharmacologist specialising in the research of drugs that affect the brain and conditions such as addiction. His recommendations to the government to reclassify drugs were rejected and he was sacked.
heroin is top of the list - alcohol is 5th on the list - LSD is 14th on the list - Ecstacy is 18th on the list
I have been taking psychedelics for 50 over years. I am retired psychotherapist and I do not have a predisposition to mental ill health. I was also a substance misuse worker and methadone dispenser for over 10 years. I gave up smoking hash when I was 40 years old.
I did notice that with the introduction of skunk and the increase of up to 20% more Tetrahydrocannabinol (THC), there were more and more people being sectioned under the mental health act with psychosis. Whereas prior to skunk when people generally smoked good old fashioned, Moroccan, Lebanese and Afghani hashish it was a rarity.
I know a range of people of different ages who partake in psychedelic use and have no trouble, like me, in holding down a professional job role and engaging fully in life.
As with all drugs there is a risk, however, the risks with Psyceedelics are very low in comparison with other drugs.
We must not use individual cases to determine the safety of any drug.
Here in the UK the media went wild over reports that a 18 year old girl (Leah Betts) had died from taking MDMA. Very rarely are the true facts given; The coroner said that "water intoxication", and not an allergic reaction to the drug, was the cause of death.
I have a great deal of respect for Professor David Nutt who is an English neuropsychopharmacologist specialising in the research of drugs that affect the brain and conditions such as addiction. His recommendations to the government to reclassify drugs were rejected and he was sacked.
heroin is top of the list - alcohol is 5th on the list - LSD is 14th on the list - Ecstacy is 18th on the list
> heroin is top of the list
Can you please share the list? Went through the article hoping to find one but either I am blind or its not there.
As for rest of the comment - thank you for your work and balanced insight. All this could have been researched to death (and optimal solutions be picked up based on results with regard to population health) if this stuff wasn't illegal for so long and governments acknowledged that people can actually get (a bit) high, since they can already ie drink themselves to death.
Can you please share the list? Went through the article hoping to find one but either I am blind or its not there.
As for rest of the comment - thank you for your work and balanced insight. All this could have been researched to death (and optimal solutions be picked up based on results with regard to population health) if this stuff wasn't illegal for so long and governments acknowledged that people can actually get (a bit) high, since they can already ie drink themselves to death.
Nutt’s Wikipedia entry has pictures and sources: https://en.wikipedia.org/wiki/David_Nutt
He’s been working in the field for quite a while, and many of the drug harmfulness diagrams that pop up every now and then are from one of his papers.
He’s been working in the field for quite a while, and many of the drug harmfulness diagrams that pop up every now and then are from one of his papers.
given your long experience with psychedelics and profession, I am curious.
Do you feel a "hero's" dose is necessary, or do you see benefit in micro dosing psychedelics. Or any dose in between for that matter.
Do you feel a "hero's" dose is necessary, or do you see benefit in micro dosing psychedelics. Or any dose in between for that matter.
eimrine(3)
> We find that 16% of the cohort falls into the “negative responder” subset.
“they should have known they had a family history of schizophrenia before using it!”
every dismissive psychedelic user that brags about increased empathy in the next breath
but in all seriousness, yes I would like to see more studies so we can at least have side effects printed on the side of the package, so the right people can take informed risks
“they should have known they had a family history of schizophrenia before using it!”
every dismissive psychedelic user that brags about increased empathy in the next breath
but in all seriousness, yes I would like to see more studies so we can at least have side effects printed on the side of the package, so the right people can take informed risks
Unironirally this. Whenever taking drugs of any kind, but especially with one's that meddle with your reality. There is no excuse for not doing your research. Your consciousness is all you have
Thing is research has been extremely hindered in the last ~100 years. At least they are trying to do their research instead of going blindly "psychedelics bad, make you jump from roofs and stare at the sun. Take this thingy-zepam for years instead, known to turn you into a zombie, increase the risk of suicide, create dependency and tolerance, and have withdrawal".
This makes sense because people that have used psychedelics sharing their positive experiences are the bad guys and people that have used psychedelics sharing their negative experiences are the good guys
using anyone as a source for side effects is a dumb standard and we should reach parity with how other drugs are studied
just like this study is trying to chisel at
while psychedelic communities are uniquely dismissive
just like this study is trying to chisel at
while psychedelic communities are uniquely dismissive
Exactly! People that say that they’ve benefited from psychedelics are uniquely dismissive and people that say that those people form a uniquely dismissive community that should be distrusted are not uniquely dismissive
interesting commenting strategy, its as if its supposed to spark introspection by strawmanning absolutes that nobody said to discredit their position, while feigning agreement with them
oddly consistent in your other recent posts
dang, is this substantive to you?
oddly consistent in your other recent posts
dang, is this substantive to you?
At least there's one thing everyone can agree on: what seems to be true is true.
so 84% had a positive response?
No.. 16% had a negative response, 28% had ~no response, and 55% had a positive response. I think people would be much more hesitant to try psychedelics for their mental issues if you told them it was a coin toss whether it would help or not -- and was an unlucky game of Russian Roulette from making their mental problems worse.
People take prescribed drugs for less than a 25% chance that it helps and a Russian roulette of side effects. Does sexual dysfunction improve depression?
I, for one, would like the same standard applied to psychedelics, instead of worrying about whether bad results lead to its continued prohibition
It seems that right now people are too worried about a bad result messing up their ability to talk casually about their trips
I just want side effects to be based on less conjecture
science lets its beliefs die, faithful die with their beliefs
right now, psychonauts seem to be in the latter group and its not helping the science form at all
It seems that right now people are too worried about a bad result messing up their ability to talk casually about their trips
I just want side effects to be based on less conjecture
science lets its beliefs die, faithful die with their beliefs
right now, psychonauts seem to be in the latter group and its not helping the science form at all
84% positive and 16% worsened mental health is not the same thing as 84% and the rest neutral or mild side effects.
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Psychedelics are a force to be reckoned with. Plus people are conflating clinical trials with taking unknown substances, in unknown amounts without considering the proper set and setting.
Controlling for the substance and amount as well as having a professional, caring guide to help the patient through the experience will be a FAR different experience than eating a fist-full of shrooms at a party some stranger gave you while under the influence of other things...
Controlling for the substance and amount as well as having a professional, caring guide to help the patient through the experience will be a FAR different experience than eating a fist-full of shrooms at a party some stranger gave you while under the influence of other things...
I’m also worried about all the self-medication, where people treat serious issues without supervision. But I also want to highlight that there is a place for recreational, responsible, and safe drug use; there is a _lot_ between between clinical/therapeutic settings and random recklessness.
This really just feels like fearmongering because this is a threat to big pharma. I mean, several commonly prescribed antidepressants have black box warnings about increased risk of suicide. When they trialed Prozac on people with no history of mental illness, someone committed suicide out of the blue. Fairly certain someone could cobble together a much more compelling meta analysis about even worse adverse effects of psych meds on similar populations, but due to NAMI and big pharma I think there's pressure not to draw those lines too clearly.
I think there's a clear bias in cases of big pharma approved meds to jump to "Oh, it wasn't the medication, the condition just worsened" and with psychedelics/weed to jump to "The substance use is causing this". Even when there is proof of RX medication worsening mental health conditions, it's common to have these relationships straight up denied by the prescribing doctor.
This isn't to say that there isn't a similar relationship in psychedelics, but it feels really disingenuous to me to be mentioning this outside of the wider context of psychiatric meds which somehow get a free pass for causing a much wider and dangerous range of side effects. If psychedelics cause less harm than commonly prescribed drugs in the same population, isn't that a good thing? We should understand these harms, but the bias of Big Pharma needs to be taken out of the picture.
I think there's a clear bias in cases of big pharma approved meds to jump to "Oh, it wasn't the medication, the condition just worsened" and with psychedelics/weed to jump to "The substance use is causing this". Even when there is proof of RX medication worsening mental health conditions, it's common to have these relationships straight up denied by the prescribing doctor.
This isn't to say that there isn't a similar relationship in psychedelics, but it feels really disingenuous to me to be mentioning this outside of the wider context of psychiatric meds which somehow get a free pass for causing a much wider and dangerous range of side effects. If psychedelics cause less harm than commonly prescribed drugs in the same population, isn't that a good thing? We should understand these harms, but the bias of Big Pharma needs to be taken out of the picture.
> When they trialed Prozac on people with no history of mental illness, someone committed suicide out of the blue.
I hadn't heard about this before, and while I'm sure it is possible for any drug that messes with brain chemicals to cause someone to decide to kill themselves, I've always been told & read a different explanation for the suicide warning that comes with most (or all?) antidepressants:
Which is that a depressed person while at their lowest might think about suicide but not have the energy or willpower to do anything, but if they start taking a drug that partially fixes it, so they start having energy again, but doesn't fix their root problems so they still think that suicide would be preferable to life, and suddenly have energy to make that happen.
Which is also the reason that modern guidance is for antidepressants to be co-prescribed with talk therapy, to try to use drugs to let the person be able to work on their issues, rather than just hoping the drug can fix all issues.
I hadn't heard about this before, and while I'm sure it is possible for any drug that messes with brain chemicals to cause someone to decide to kill themselves, I've always been told & read a different explanation for the suicide warning that comes with most (or all?) antidepressants:
Which is that a depressed person while at their lowest might think about suicide but not have the energy or willpower to do anything, but if they start taking a drug that partially fixes it, so they start having energy again, but doesn't fix their root problems so they still think that suicide would be preferable to life, and suddenly have energy to make that happen.
Which is also the reason that modern guidance is for antidepressants to be co-prescribed with talk therapy, to try to use drugs to let the person be able to work on their issues, rather than just hoping the drug can fix all issues.
That may be a factor, but it is likely more complex than just that.
SSRIs can cause some individuals to become disinhibited, impulsive. It is a particularly common symptom in children and adolescents (which is why many paediatricians and child psychiatrists hesitate to prescribe them), but more rarely can happen in adults too. Probably some people have a genetic susceptibility to it. It isn’t purely about ameliorating depression, since the same side effect has been observed in non-depressed children administered SSRIs (which aren’t solely used to treat depression, sometimes they are used to treat anxiety too, plus some children can end up being prescribed them when they have neither, due to misprescribing or off-label use.)
Disinhibition and increased impulsivity can increase the risks of suicidality/homicidality/etc
SSRIs can cause some individuals to become disinhibited, impulsive. It is a particularly common symptom in children and adolescents (which is why many paediatricians and child psychiatrists hesitate to prescribe them), but more rarely can happen in adults too. Probably some people have a genetic susceptibility to it. It isn’t purely about ameliorating depression, since the same side effect has been observed in non-depressed children administered SSRIs (which aren’t solely used to treat depression, sometimes they are used to treat anxiety too, plus some children can end up being prescribed them when they have neither, due to misprescribing or off-label use.)
Disinhibition and increased impulsivity can increase the risks of suicidality/homicidality/etc
I honestly wonder if it isn't less rare in adults or if adults just are more likely to fall through the cracks and to have whatever underlying disorder blamed on the behavior. Children are a more vulnerable group who has a parent who is witness to the obvious behavior changes and can staunchly advocate for their child. Many adults starting SSRIs are isolated, don't have great support networks or friends looking out for them and are meeting with their doctors for the first time. For all the doctors know, behavioral issues were underlying, things just got worse, etc.
Anecdotal, but I've never once met a doctor who adequately described the risks of an SSRI to me as a patient, and even some who have pushed back when I've told them of my own dangerous reactions and other risk factors the drugs have. They really should, as should the risks of new psychedelic based drugs hitting the market. I don't have a problem with the study that's posted. What I do have a problem with is that I feel as if this information is going to be disproportionately used to deny access to RX psychedelics, when existing RXs with similar or worse risk factors aren't discussed in this manner at all.
Anecdotal, but I've never once met a doctor who adequately described the risks of an SSRI to me as a patient, and even some who have pushed back when I've told them of my own dangerous reactions and other risk factors the drugs have. They really should, as should the risks of new psychedelic based drugs hitting the market. I don't have a problem with the study that's posted. What I do have a problem with is that I feel as if this information is going to be disproportionately used to deny access to RX psychedelics, when existing RXs with similar or worse risk factors aren't discussed in this manner at all.
> Anecdotal, but I've never once met a doctor who adequately described the risks of an SSRI to me as a patient,
I've tried SSRIs several times, more than one (and an SNRI and MAOI too). They never did anything for me other than cause unpleasant side effects.
The best cure for depression I've ever found is Vyvanse/lisdexamfetamine. Is that because I was never actually depressed and my real problem all along was ADHD? Maybe... but, on the other hand, I'm pretty sure sometimes my depression has been an independent problem from my ADHD and sometimes a much bigger one. The fact is, psychostimulants have an antidepressant effect, and are sometimes even prescribed off-label to non-ADHD patients in order to treat depression (generally only for "treatment-resistant depression", i.e. "we've tried all the antidepressants and none of them work"). I think it could possibly benefit more people with depression (at least they should try it), but psychiatrists are discouraged from prescribing it for them (here in Australia, psychiatrists actually need per-patient government approval to legally prescribe stimulants off-label). In practice, it is easier to convince a psychiatrist that you have ADHD, than it is to convince a psychiatrist to prescribe you stimulants for something other than ADHD.
I've tried SSRIs several times, more than one (and an SNRI and MAOI too). They never did anything for me other than cause unpleasant side effects.
The best cure for depression I've ever found is Vyvanse/lisdexamfetamine. Is that because I was never actually depressed and my real problem all along was ADHD? Maybe... but, on the other hand, I'm pretty sure sometimes my depression has been an independent problem from my ADHD and sometimes a much bigger one. The fact is, psychostimulants have an antidepressant effect, and are sometimes even prescribed off-label to non-ADHD patients in order to treat depression (generally only for "treatment-resistant depression", i.e. "we've tried all the antidepressants and none of them work"). I think it could possibly benefit more people with depression (at least they should try it), but psychiatrists are discouraged from prescribing it for them (here in Australia, psychiatrists actually need per-patient government approval to legally prescribe stimulants off-label). In practice, it is easier to convince a psychiatrist that you have ADHD, than it is to convince a psychiatrist to prescribe you stimulants for something other than ADHD.
I can understand why you would have that reasoning, but SSRIs are commonly prescribed off label to populations for non-mental health related reasons, for example ED or urinary incontinence, and in these populations the relationship holds, leading to some governments and regulatory bodies to recommend or warn against use for these conditions.
"Although duloxetine reduced the symptoms of stress urinary incontinence and improved women’s quality of life, the harms related to suicidality and violence were 4 to 5 times more common with duloxetine than with a placebo, a meta analysis using patient level data by researchers from the Nordic Cochrane Centre showed." https://www.bmj.com/content/355/bmj.i6103
"Although duloxetine reduced the symptoms of stress urinary incontinence and improved women’s quality of life, the harms related to suicidality and violence were 4 to 5 times more common with duloxetine than with a placebo, a meta analysis using patient level data by researchers from the Nordic Cochrane Centre showed." https://www.bmj.com/content/355/bmj.i6103
Wow, TIL, thanks!
Any idea if the logic I wrote about is also true? Or is it the same as how many doctors will talk about SSRIs working because depressed people "have too little serotonin", a myth that remains commonly believed despite research not backing it up?
Any idea if the logic I wrote about is also true? Or is it the same as how many doctors will talk about SSRIs working because depressed people "have too little serotonin", a myth that remains commonly believed despite research not backing it up?
It is possible multiple processes are at work-it is possible that SSRIs increase violence risks independently of their antidepressant effect, and simultaneously their antidepressant effect also increases it. The two explanations aren’t necessarily mutually exclusive
Sure, but if that's what's going on, it should be researched further and taken seriously during prescribing. 100% guarantee that when psychedelics hit the market, doctors will fall prey to overstating the harms from studies like this while turning a blind eye to the wealth of evidence of greater likelihood of harms in prescriptions they churn out without blinking an eye.
I'm not anti medication, and I'm not saying that there are cases where the benefit doesn't outweigh the harm, but I do think the potential harms of each medication should be thoroughly investigated equally. Large companies with the ability to withhold damaging trials, sway the public opinion, and have a giant PR team and legal team at their disposal shouldn't be impacting our understanding of the real risks and science.
I'm not anti medication, and I'm not saying that there are cases where the benefit doesn't outweigh the harm, but I do think the potential harms of each medication should be thoroughly investigated equally. Large companies with the ability to withhold damaging trials, sway the public opinion, and have a giant PR team and legal team at their disposal shouldn't be impacting our understanding of the real risks and science.
> Sure, but if that's what's going on, it should be researched further and taken seriously during prescribing.
Well I mean, it is, at least to some extent. The FDA has officially put a "black box" warning on antidepressants that they can increase the risk of suicide, especially in the young, and so have its counterpart agencies in several other countries. All doctors know about it – whether they all take that risk seriously enough is a matter of opinion, some are much more hesitant about prescribing them than others are. And it remains an active area of research.
> 100% guarantee that when psychedelics hit the market,
Here in Australia, they only let psychiatrists prescribe them (started in July last year for psilocybin and MDMA), and only for individually approved psychiatrists who have completed a training programme in psychedelic treatment. This is similar to our existing restrictions on prescribing psychostimulants–which most Australian states only permit psychiatrists and paediatricians to prescribe absent special approval–albeit even stricter. They'll likely relax the rules over time, but very unlikely non-psychiatrists will ever be legally allowed to prescribe them (outside of exceptional circumstances).
From what I understand, the approach in the US is different, as far as the DEA is concerned, theoretically, any doctor can get a DEA number which lets them prescribe any Schedule II/III/IV controlled substance. However, in practice, there are a number of drugs which very few US doctors would dare write a script for, even though by the letter of the law they are allowed to do it, because they don't want the "extra attention" the DEA will give them if they do – methamphetamine is a good example. (Technically, any Australian doctor can legally write a script for methamphetamine, but it is almost impossible to fill, because unlike the US, it isn't approved for sale in Australia–not because it is a controlled substance, rather because it lacks our equivalent of FDA-approval–the only way to actually fill the script would be to get a government permit to import it for an individual patient, and there is zero chance they'd approve such a permit unless the prescriber was a senior psychiatrist.)
Well I mean, it is, at least to some extent. The FDA has officially put a "black box" warning on antidepressants that they can increase the risk of suicide, especially in the young, and so have its counterpart agencies in several other countries. All doctors know about it – whether they all take that risk seriously enough is a matter of opinion, some are much more hesitant about prescribing them than others are. And it remains an active area of research.
> 100% guarantee that when psychedelics hit the market,
Here in Australia, they only let psychiatrists prescribe them (started in July last year for psilocybin and MDMA), and only for individually approved psychiatrists who have completed a training programme in psychedelic treatment. This is similar to our existing restrictions on prescribing psychostimulants–which most Australian states only permit psychiatrists and paediatricians to prescribe absent special approval–albeit even stricter. They'll likely relax the rules over time, but very unlikely non-psychiatrists will ever be legally allowed to prescribe them (outside of exceptional circumstances).
From what I understand, the approach in the US is different, as far as the DEA is concerned, theoretically, any doctor can get a DEA number which lets them prescribe any Schedule II/III/IV controlled substance. However, in practice, there are a number of drugs which very few US doctors would dare write a script for, even though by the letter of the law they are allowed to do it, because they don't want the "extra attention" the DEA will give them if they do – methamphetamine is a good example. (Technically, any Australian doctor can legally write a script for methamphetamine, but it is almost impossible to fill, because unlike the US, it isn't approved for sale in Australia–not because it is a controlled substance, rather because it lacks our equivalent of FDA-approval–the only way to actually fill the script would be to get a government permit to import it for an individual patient, and there is zero chance they'd approve such a permit unless the prescriber was a senior psychiatrist.)
Seems like a pretty good system as letting doctors prescribe “psychedelics” can mean everything under the Sun.
Also the training and approval is paramount, they are doctors not magicians and many don’t even have a good understanding of nutrition let alone this type of drugs.
Also the training and approval is paramount, they are doctors not magicians and many don’t even have a good understanding of nutrition let alone this type of drugs.
No problem, I like to spread awareness of this stuff! BTW here are a few more RCTs about the relationship https://www.madinamerica.com/2021/03/antidepressants-still-l...
Honestly it's hard to say and I'm not even sure if you'd be able to study this empirically in this population. I do think that's why doctors fall prey to this bias, and especially so in a stigmatized population. "Ah, they were likely to have these symptoms anyway". It would be interesting to do a wider study, but there already was a history of these companies withholding damaging trials and results so I doubt it would be done, especially given that suicides have occurred in these trials.
I really do believe that these classes of medications are treated differently due to the great power the industry has on this issue. If you look up the background of NAMI it's quite suspect and reminds me about how doctors were getting textbooks that were written by the opioid prescribing company. NAMI goes on to inform public opinion and then this stuff becomes "fact". I'm glad the "too little serotonin" thing is being examined but it was crazy to see how many weirdly defensive memos and articles there were out when it first came out. I see I'm getting downvotes on my original comment but I do think it's extremely important to examine these intuitions and where they came from, because as we've seen some of this stuff has been based on profits/trial P-hacking/junk science.
Honestly it's hard to say and I'm not even sure if you'd be able to study this empirically in this population. I do think that's why doctors fall prey to this bias, and especially so in a stigmatized population. "Ah, they were likely to have these symptoms anyway". It would be interesting to do a wider study, but there already was a history of these companies withholding damaging trials and results so I doubt it would be done, especially given that suicides have occurred in these trials.
I really do believe that these classes of medications are treated differently due to the great power the industry has on this issue. If you look up the background of NAMI it's quite suspect and reminds me about how doctors were getting textbooks that were written by the opioid prescribing company. NAMI goes on to inform public opinion and then this stuff becomes "fact". I'm glad the "too little serotonin" thing is being examined but it was crazy to see how many weirdly defensive memos and articles there were out when it first came out. I see I'm getting downvotes on my original comment but I do think it's extremely important to examine these intuitions and where they came from, because as we've seen some of this stuff has been based on profits/trial P-hacking/junk science.
SSRIs are never used for ED. If anything they may cause it. They are sometimes used to treat premature ejaculation though because they tend to cause genital numbing or anorgasmia.
I always thought the “war on drugs” was a big pharma turf war.
Nearly every school shooter was on an antidepressant, but somehow that never makes headlines.
Nearly every school shooter was on an antidepressant, but somehow that never makes headlines.
In US, the original war on drugs was racial in nature (targeting blacks and Mexicans specifically).
The particularly heavy-handed enforcement from 1970s onwards that spawned the term itself broadened into a war against the social and cultural opposition to the status quo - still partly racial in nature as various black civil rights and black power movements were a significant part of that, but also targeting anti-war protesters, "pinkos" etc.
The particularly heavy-handed enforcement from 1970s onwards that spawned the term itself broadened into a war against the social and cultural opposition to the status quo - still partly racial in nature as various black civil rights and black power movements were a significant part of that, but also targeting anti-war protesters, "pinkos" etc.
The tale of Qin Shi Huang
We infer that the presence of a personality disorder may represent an elevated risk for psychedelic use and hypothesize that the importance of psychological support and good therapeutic alliance may be increased in this population.
Feels like another publish or perish paper.
Feels like another publish or perish paper.
You know when you see HN discussion on some subjects where you have significant background and it's hyper cringe? Psychology/neurology is one of those areas where the community's commentary is almost always extremely...factually challenged. Be very careful making health decisions based off of HN comments. Lots of people with strong agendas and weak subject matter knowledge. Also, be careful not to over-estimate your ability to interpret random study results. It's kinda like trying to get a project to build you downloaded from sourceforge.
I've found this to be generally true. Engineers are passionate and intelligent people, but frequently make the mistake of thinking this means they are experts in everything.
Reminds me of this article by Dan Luu: https://danluu.com/cocktail-ideas/
> A line I often hear from programmers is that programming is like "having to build a plane while it's flying", implicitly making the case that programming is harder than designing and building a plane since people who design and build planes can do so before the plane is flying1. But, of course, someone who designs airplanes could just as easily say "gosh, my job would be very easy if I could build planes with 4 9s of uptime and my plane were allowed to crash and kill all of the passengers for 1 minute every week".
We tend to think that some problems are only as complex as our understanding of them.
> A line I often hear from programmers is that programming is like "having to build a plane while it's flying", implicitly making the case that programming is harder than designing and building a plane since people who design and build planes can do so before the plane is flying1. But, of course, someone who designs airplanes could just as easily say "gosh, my job would be very easy if I could build planes with 4 9s of uptime and my plane were allowed to crash and kill all of the passengers for 1 minute every week".
We tend to think that some problems are only as complex as our understanding of them.
> but frequently make the mistake of thinking this means they are experts in everything.
That condition has a name, and it is "Engineer's Disease" or "Engineer's Syndrome."
That condition has a name, and it is "Engineer's Disease" or "Engineer's Syndrome."
which tbh isn't fair to the doctors and lawyer who also suffer from the disease
> which tbh isn't fair to the doctors and lawyer who also suffer from the disease
Even if that's the case, I think framing it as "Engineer's Disease" is pretty critical for HN, which at times can become a literal orgy of it.
Also, SV culture amplifies Engineer's Disease into a destructive force only rivaled by its counterpart in finance. Doctors and lawyers who suffer from something similar are far more limited in their effects.
Even if that's the case, I think framing it as "Engineer's Disease" is pretty critical for HN, which at times can become a literal orgy of it.
Also, SV culture amplifies Engineer's Disease into a destructive force only rivaled by its counterpart in finance. Doctors and lawyers who suffer from something similar are far more limited in their effects.
Doctors and lawyers can become programmers far more easily than programmers can become doctors and lawyers though, so though the SV amplification is real, doctors and lawyers can also wreak havoc outside their discipline.
> Doctors and lawyers can become programmers far more easily than programmers can become doctors and lawyers though, so though the SV amplification is real, doctors and lawyers can also wreak havoc outside their discipline.
I think that's kind of missing the point. Also, I don't think many doctors are making the switch to engineering. Why would they? There are probably far more engineers becoming doctors than vice versa (though the total numbers in both directions are likely small).
The specific problem with Engineer's disease, is that engineers have the job of building things for others, and thus have the opportunity to force their half-baked ideas onto them. SV has amplified that and turned it into a monster, by elevating things like "disruption" into something like a moral imperative.
The counterpart in finance and the closely related managerialism rival it because those jobs involve control of others.
Doctors though? If they get arrogant about some other field, they usually just end up hurting themselves or a few others (like they learn to sail, get in over their heads, and sink their ship in a storm). They don't have a mechanism to do more damage.
I think that's kind of missing the point. Also, I don't think many doctors are making the switch to engineering. Why would they? There are probably far more engineers becoming doctors than vice versa (though the total numbers in both directions are likely small).
The specific problem with Engineer's disease, is that engineers have the job of building things for others, and thus have the opportunity to force their half-baked ideas onto them. SV has amplified that and turned it into a monster, by elevating things like "disruption" into something like a moral imperative.
The counterpart in finance and the closely related managerialism rival it because those jobs involve control of others.
Doctors though? If they get arrogant about some other field, they usually just end up hurting themselves or a few others (like they learn to sail, get in over their heads, and sink their ship in a storm). They don't have a mechanism to do more damage.
Midwitism and lack of culture
Dentist's curse.
What's going to happen if we don't listen to your red-lettered life advice? Are we going to spontaneously combust?
Shrug...probably...
Your entire comment is about HN, not the article. Do you have anything substantial or interesting to say about the study?
It's a valid comment, you don't need to be offended.
I'm not offended. I'm curious if this person actually has an interesting angle on the article or is just grinding an axe.
It's also against HN guidelines to comment about the site itself instead of something substantial that promotes discussion.
It's also against HN guidelines to comment about the site itself instead of something substantial that promotes discussion.
This argument is moot as we know jackshit about halucinogenics and research isn't very rampant in this area. And what we have is weak bs like this. So both sides are lacking I would say.
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That said, I think it's a refreshing perspective, and it seems like a good idea to look at effect heterogeneity in psychedelics use. Thinks like bayesian trees (BART) can help identify subgroups that react differently to stimuli along specific characteristics.