Psychedelic enthusiasts can be even worse in this regard. When someone does have a bad trip, they tend to reach for every possible excuse to avoid blaming the drug. This ranges from criticizing their "set and setting" to blaming "triggering an underlying mental health issue". The latter is particularly concerning in the context of treating mental health issues, because by definition everyone in that category has some level of underlying mental health issues.
Research is particularly difficult in this area because the study volunteers are self-selecting for psychedelic research. Basically, anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out. This creates a huge risk of placebo effect when your patients are arriving with huge enthusiasm and preconceived notions of efficacy. Combine that with the weirdness of a psychedelic trip and it's a recipe for a sort of super-placebo.
However, that's doubly interesting in that maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo. Put someone through a weird, confusing psychedelic experience and tell them that it their life will be radically different afterward and maybe they'll believe it so much that it becomes their new reality. Weirdly enough, we have the opposite problem with SSRIs right now because so many patients will start googling side effects and become convinced that they're not going to work before they even take the first dose.
It's an interesting area of research, but I think right now there's too much crossover between the research and the pop-culture phenomenon of "psychedelics cure everything". It's also strange that so few people are questioning why all of the previous psychedelic users didn't notice that the drugs were treating depression. In fact, the common wisdom among psychedelic enthusiasts years ago was that psychedelics were to be avoided if someone was not in a good mental state, largely due to all of the negative reactions they noticed. It seems that telling someone "this will cure your depression" provides a different set and setting than just giving them the psychedelics without context.
Listen, your comments on all these threads make it clear you’re seriously pessimistic about psychedelic medicine, and that’s perfectly ok.
What bothers me is the incessant pushing of this agenda:
> anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out
> maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo
This amounts to uninformed armchair dismissal that is inconsistent with a growing body of scientific evidence, and easily refuted by a cursory survey of recent literature and clinical trial results.
Surely you’re familiar with double blind randomized placebo controlled studies? I’ve linked you to recent ones in other comments.
These methods aren’t perfect and your concerns certainly have merit in general - I just don’t understand why you continue to make these broad and suggestive claims without any supporting evidence.
I am curious: is it actually possible, even in principle, to have a blind placebo controlled psychedelics study?
How can you not be aware of whether you have consumed a psychedelic substance or a sugar pill, assuming we are not discussing something like micro-dosing?
It’s a valid concern and many folks have raised it here on threads concerning this topic.
The short answer is yes: beyond mannitol, niacin, and even bespoke substances designed to mimic the organoleptic properties of ayahuasca have been used effectively as placebos.
At modest dosages (above the threshold of perception but within the therapeutic window) the side effects can be surprisingly similar in the general population, and thus difficult to distinguish for the average joe.
Of course studies vary widely in quality and rigor, so one must critique experimental design on a case by case basis.
> Psychedelic enthusiasts can be even worse in this regard.
Oh yes, I've had a run in with a "psychedelic enthusiast", and this is so accurate. It was my girlfriend during my late 20s, a woman who was 12 years older, very into psychedelics, and pretty obnoxious about how beneficial they were. Of course, at the time I ate it up because I was kinda lost in life, and let her overcome my better judgement with her guru bullshit.
I'd previously only ever used marijuana, and had mostly negative experiences resulting in anxiety, so had mostly sworn off the idea of trying psychedelics until she came into my life. Long story short, I tried mushrooms once with her, fun for a bit, but then led into a crazy making spiral leading me to be convinced I'd never be the same.
I guess I was a glutton for punishment back then, because I also tried LSD with her twice, and it had pretty similar results. In fact the second trip shook me up in such a bad way that I think it took nearly a year to get the negative bits still remaining out of my head.
Of course her reaction after all this was that I was being too resistant and that I simply needed to have a "corrective experience". Fuck that! She seriously couldn't comprehend the fact that everyone reacts to psychedelics differently and that they might be quite dangerous for some people. Which seemed kinda crazy because she was actually highly intelligent, but possibly too arrogant to look outside her world. I seriously could have ended up in an institution if I had stayed with that woman (can you tell I'm venting a tad :) ).
I've later come to learn that I have a genetic mutation that reduces my ability to degrade dopamine in the prefrontal cortex by 75% (COMT met/met), leading to much higher baseline dopamine levels. After learning about this, it makes a ton of sense why I have such bad experiences with dopaminergic drugs like caffeine and Adderall (euphoria followed hours later by intense anxiety). Now I don't know how LSD and mushrooms impact the domaine system, but it does make me wonder if this genetic SNP, partially explains my propensity to anxiety/psychosis on these drugs. High baseline dopamine leads to hyperfocus, which is great for coding or other technical work, but terrible when you're stuck in a spiral of thinking you're going crazy and will never be the same.
Research is particularly difficult in this area because the study volunteers are self-selecting for psychedelic research. Basically, anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out. This creates a huge risk of placebo effect when your patients are arriving with huge enthusiasm and preconceived notions of efficacy. Combine that with the weirdness of a psychedelic trip and it's a recipe for a sort of super-placebo.
However, that's doubly interesting in that maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo. Put someone through a weird, confusing psychedelic experience and tell them that it their life will be radically different afterward and maybe they'll believe it so much that it becomes their new reality. Weirdly enough, we have the opposite problem with SSRIs right now because so many patients will start googling side effects and become convinced that they're not going to work before they even take the first dose.
It's an interesting area of research, but I think right now there's too much crossover between the research and the pop-culture phenomenon of "psychedelics cure everything". It's also strange that so few people are questioning why all of the previous psychedelic users didn't notice that the drugs were treating depression. In fact, the common wisdom among psychedelic enthusiasts years ago was that psychedelics were to be avoided if someone was not in a good mental state, largely due to all of the negative reactions they noticed. It seems that telling someone "this will cure your depression" provides a different set and setting than just giving them the psychedelics without context.