
Ketamine 'exciting' depression therapy - piokuc
http://www.bbc.co.uk/news/health-26647738
======
JPKab
While I was in university, I suffered (not knowingly at the time) from pretty
bad depression. I basically was extremely self-destructive, and at 19 was
experimenting with various drugs. My roommate's girlfriend stole a half used
bottle of ketamine from a veterinary clinic she worked at. They dried the
liquid into powder form in the microwave, and we all used it by snorting it.
(as I said, I was hell bent on self destruction)

Obviously, whatever dose we obtained would be far, far beyond a clinical
amount. I immediately sank into what is called a "k-hole" and had what is
often described as an "out of body" sensation. I was 5 years old again,
walking along the beach in winter, looking through my father's binoculars at
the humpback whales. A feeling of peace and calm came to me, and some amount
of time later (perhaps an hour) I awoke from the "k-hole."

The sense of peace I felt remained. I wasn't intoxicated, nor did I feel any
other effects. I just felt like I had before my girlfriend had died two years
before.

That was the last time I touched a drug other than alcohol or marijuana.

~~~
Blahah
To my knowledge I never suffered from depression. When I was a teenager I also
experimented with various drugs. At age around 17 me and some friends took a
lot of ketamine at a friend's house one night. We went out for a walk at at
some point I started k-holing. We were walking along a train line at the time.
I collapsed on the line and watched myself lying there. My friends hadn't
noticed me fall, they'd carried on. Then I calmly watched myself get hit by a
train. I watched my bloody corpse lying there for quite a while.

I came back to my senses lying by the rails in a puddle of my own vomit. I
hadn't really been hit by the train, although I had watched it, seen my body
crumble and split.

I spent the next several hours vomiting and feeling atrocious. Ever since
then, I occasionally see the image of my own dead body again. That was the
last time I touched ketamine, though I carried on experimenting with
everything else until my early 20s.

Not to detract from your experience, but ketamine _can_ be a disgusting,
dangerous drug, and taking it at home is not a sensible approach to
depression, drug addiction, or anything.

~~~
Zak
_Not to detract from your experience, but ketamine can be a disgusting,
dangerous drug, and taking it at home is not a sensible approach to
depression, drug addiction, or anything._

This is a very black and white statement. Most people probably shouldn't treat
serious illnesses by self-medicating with powerful drugs, especially those
obtained illegally where the purity of the drug might be questionable.

On the other hand, someone with crippling depression who has sought treatment
from medical professionals to no avail and is on the verge of suicide has few
options and not much to lose. Trying ketamine might well be a reasonable
option for such a person - more reasonable than suicide, anyway.

~~~
cal2
I don't dispute that ketamine may perhaps have some clinical relevance for
humans, but unfortunately it wreaks too much havoc on the kidneys for me to
consider it as a viable option for treatment of depression.

~~~
draakon
Those points seemed already covered in the article, but somehow it must have
been unclear.

First of all, it's unlikely to ever have ketamine as a first-line treatment
for a depression. Probably more somewhere near electroconvulsive therapy. ECT
also has adverse effects which can't be considered as minor (e.g. severe
memory loss). However, at the same time it's recognized as a life-saver for
certain population of patients.

As I have understood from this research and previous ones, it's hoped that the
effect of ketamine would be long-lasting: at least up to months. Not so-called
daily anti-depressant pill. The adverse effects of ECT would also be more
severe if it would be administered on a daily basis. As it was mentioned, some
patients relapsed within days, some were free from depression for up to three
months.

According to animal research[1], it's prolonged not acute ketamine use that
has shown signs of renal and bladder damage. In a review of ketamine-induced
vesicopathy[2] it's also noted that 'Very little is known regarding the
pathogenesis of its effects on the urinary tract.' I'm not claiming that it
doesn't cause any damage, but that it needs more research and currently
there's no indication of "renal havoc" after few doses.

In light of this, I can't even imagine how someone could call possibility of
using ketamine for treatment of depression not viable. However, it may be
because I know how disabling severe or even moderate depression is and how
much damage it causes to person's life.

Each person reacts very differently to anti-depressants and there's large
amount of people with treatment resistant depression. It's not like there's
silver bullet and because of that we need as many as possible different
treatment methods. Depression is life-threatening condition and thus all of
those methods can't (and don't need to) be 100% safe. A lot of approved drugs
have serious side-effects. Basically it's all about assessing the benefit:risk
ratio of a drug. It's not rational to cross any treatment out, just because it
may have side-effects. Especially if there's not reasonable amount research
done - like with ketamine.

When we have more data, then it may show that certain population would need
additional doses of ketamine after 1-3 months and the damage to organs is
minor or non-existent in such case. Or it may show something else. It's just
unthinkable to call it as "not viable" option, yet.

[1] Yeung, LY, Rudd JA, Lam WP, Mak YT, Yew DT. (2009) Mice are prone to
kidney pathology after prolonged ketamine addiction. Toxicol Lett. 2009 Dec
15;191(2-3):275-8. doi: 10.1016/j.toxlet.2009.09.006. Epub 2009 Sep 17.

[2] Middela, S., Pearce, I. (2010) Ketamine-induced vesicopathy: a literature
review. Int J Clin Pract. 2011 Jan;65(1):27-30. doi:
10.1111/j.1742-1241.2010.02502.x.

------
funkjunky
I was a ketamine user for over a decade. It really did work wonders for
clinical depression, even brought me right out of suicidal hysteria and
despair within moments, but it comes with severe drawbacks. It can ruin your
bladder. It will sap the b vitamins out of your system, and could cause nerve
damage. More importantly, it is VERY addictive psychologically. I'm not saying
to stay away, but to be careful and disciplined.

Thoughts on the research: to the extent that the mind is already chemical in
nature, yes depression can be a chemical issue. However, I think they are
looking at it all wrong. I believe the reason ketamine (and nitrous oxide,
they may soon find out) are so effective at attacking depression is because
they are disassociative in nature. Looking at it as simply a chemical problem
erroneously reduces what is likely a complex issue in a complex organ. What
ketamine and other disassociatives do is they "loosen" one's attachment and
identification with various parts of their cognitive minds, allowing thoughts
and feelings to exist in their own space without having such a strong hold on
a person's conscious self, or seat of awareness, or whatever. Its basically
like induced meditation, and from my experience with both disassociatives and
years of meditation, I will tell you that they are VERY similar and the
ancient traditions of buddhism and yoga got the nature of the mind and
depression more right than any of the shit I learned in university or this
kind of research. Meditation WORKS, it just takes practice and discipline.
Like brushing teeth, but for the mind. If you dont do it, you will get plaque
and your mind will rot. A drug may help pull a person out of the depression
temporarily, which is definitely useful in times when a person can't break out
of the loop and is immobilized with despair, but to reduce the whole thing
down to this chemical or that chemical will only continue to find chemical
solutions, which are never ideal.

~~~
sizzle
very insightful post, thanks for sharing your thoughts. I think I'll give
meditation a go

~~~
funkjunky
The best piece of advice I can give you is to do whatever you can to make, and
keep, it as a daily habit. It is far better to do 5-10 minutes every morning
than half an hour once a week. If you want any good resources, I've got a
great list of books to choose from, but whatever method you just make sure you
stick to it regularly. Think of it like brushing your teeth, brushing 3 times
as long every 3 days doesn't work as well as brushing a shorter amount of time
every day.

~~~
sizzle
thanks for the advice. I'd appreciate a couple links to recommended books, as
would other people here reading this. My techniques are very basic and
uninspired currently, so I'd like to change that. Take care!

------
lutusp
Two quotes from the article:

1\. "Eight showed improvements in reported levels of depression, with four of
them improving so much they were no longer classed as depressed. Some
responded within six hours of the first infusion of ketamine."

2\. "Lead researcher Dr Rupert McShane said: 'It really is dramatic for some
people, it's the sort of thing really that _makes it worth doing psychiatry_ ,
it's a really wonderful thing to see.'" [emphasis added]

Wait ... what? Saying, "Take this pill and you'll feel better" isn't how
psychiatry is (or was) defined. That isn't psychiatry, it's pharmacology.

Also, none of the treatments, the old ones like talk therapy, or the new ones
including drugs and/or deep-brain stimulation, suggest or identify a cause for
depression. So far we've only been treating the symptoms of a disease whose
cause we don't know.

I long for the good old days, the days of science, when we identified the
cause of a disease, then designed a cure based on our understanding of its
cause.

This isn't a cure, it's a symptomatic treatment, and to remain effective it
would have to continue forever, reliant on a drug whose mechanism is as
unknown as the thing being treated, just as with ADHD and PTSD. I'm sure Big
Pharma is very upset that another perpetual market for drugs is opening up.

~~~
jonahx
The "good old days" of psychiatry were a far cry from "the days of science."

~~~
lutusp
Yes -- as true now as it was then. But moving away from talk therapy toward
symptomatic drug treatment moves neither toward nor away from science.

Also, by "the good old days" I was referring to the medical practice of first
identifying a disease's cause, then designing a cure. Most mental illnesses
don't have this property, which open them up to exploitation by Big Pharma.

~~~
psloth
Of course scientists are trying to identify the underlying causes of mental
illnesses. They're even making a lot of progress, but the brain is just
unbelievably complex.

In the meantime, treatments are found by trial and error. Testing whether a
drug treats a disease's symptoms can be scientific even if you don't know how
the drug actually works.

------
llamataboot
Many people at bluelight.ru have blogged extensively about their experiences
using ketamine to treat bipolar depression and major depression. The general
consensus seems to be that using doses low enough to not feel any effect with
very frequent dosing (every hour or so over the course of a few days) seems to
have the strongest effects. I have tried both this route and the more
traditional k-hole route to self-treat treatment resistant depression but
haven't noticed much of an effect with either route in the long term. In the
short term, I rather enjoy the psychedelic experience of ketamine trips. It is
a rather "more-ish" drug though, because it is both short-lasting and hits
dopamine so I urge people to experiment responsibility (ie; lay out the
ketamine you are going to do, put the rest away, and don't touch it no matter
how much you think one more line will be useful/fun)

------
fun2have
The test was only done on 28 people and only 8 showed some improvements. The
Improvements where self reported. What I wonder is the statistical error on
such a small study. From this small study they are generalising to say that it
is "exciting" and "dramatic"!

~~~
natdempk
Usually a small study like this is done as a test of safety and potential
benefit as a precursor to a larger more comprehensive study. I think its
exciting and dramatic that there were enough initial positive results to move
on to a better study.

------
jasonkolb
"It shows that depression is something chemical, that it can be reversed with
chemicals, it dispenses for once and for all that you can just pull your socks
up."

This is entirely an assumption, and shows nothing conclusively. Just as an
experience can trigger a depression (see @JPKab) an experience can cause it to
end. There's no reason to look at a human being as a walking slab of meat for
the sake of analysis.

This says nothing about "chemicals", and I'll bet you can find many of the
same benefits are attained by people who are able to achieve similar
experiences using meditation or other techniques.

~~~
Jtsummers
Per the linked article, the particular test subjects had longterm depression
and had undergone numerous, unsuccessful, treatments in the past. And, while
that quote seems a bit too absolute in stating that "depression is something
chemical". They probably should have said something like: depression can be
caused by something chemical. And you are correct that for many, maybe even
most, people it's probably not chemical in origin, that doesn't mean that it's
_never_ chemical.

------
kh_hk
Mhmm.. funny the article mentions it's an illegal party drug but not that is
widely used in veterinary anesthesia.

~~~
jrabone
You mean, apart from the bit at the end which says:

    
    
      The Home Office is reclassifying ketamine in the UK to be a class B drug, although it is already used in medicine for the treatment of back pain and as an anaesthetic.

~~~
jawr
I think it's also used on infants as well as it is does not effect the
respiratory system.

------
tibbon
I've had friends experiment with this, and they've reported good effects from
taking small doses to help with depression. In small amounts, it isn't as
scary of a drug as most people make it sound like. In small doses, its kinda
like being tipsy (acts on similar receptors to alcohol), and if you know what
you're doing there isn't much of a chance of 'accidentally' going into a
K-hole, as its roughly a magnitude of difference between what you need to take
for basic effects and a K-hole.

------
throwaway8484
Several years ago and for a period of around 5 months I took Ketamine
recreationally.

I was taking it nearly everyday and besides the effect of the drug itself, the
resulting lifting of depression was very strong. It got to a point where I had
feelings of intense love for people and my interactions became very
emotionally charged in a positive way.

I also noticed that I had higher levels of clarity and my writing and thinking
became clearer. The only explanation I've found is that ketamine reduces the
level of kynurenic acid in the brain, something that I've found to have higher
levels of.

As I started taking it less depression would start to kick back in 5-7 days. A
relatively small dosage (not enough to get back in to a k-hole) would get rid
of the depression almost instantly.

But there was a critical downside. After a while I noticed that my ability to
do technical work diminished greatly. It made me stupider in many ways. I felt
like I did not have access to the portion of my brain in which I could code.
On the flipside it seemed to make me smarter socially, or at least give the
impression as the increased verbal clarity and feelings of connection to
people.

From looking around at other users at the time, I would say the effects of
increased clarity were not commonly reported, and the anti-depression effect
wasn't really talked about much, yet people got quite addicted to it.

At the end of around 5 months, I stopped taking it completely. I couldn't do
it and hold down a technical job.

~~~
RankingMember
I'm curious: what kind of test did you undergo that let you see how much
kynurenic acid you have in your brain?

------
Reallynow
A few points:

This is not just getting high. The antidepressant effects far outlast the
brief trippy effects, which is an important reason why science is interested.

Although this is a small sample, this is not the first study of this
antidepressant effect, which had been studied since at least 2000 (citation at
end). I'd guess this study is probably getting extra attention from the BBC
because of it's from a British group of researchers.

This area of research is important both because it's a new mechanism of
antidepressant (opening doors to other drugs and a better understanding of
depression) and it is faster acting than other antidepressants, which improve
mood slowly over weeks. For the suicidal, this wait can be a lifetime.

There's currently a super interesting (to some of us) question about how
important the acute trippy effects are to the sustained antidepressant
effects. Is this something where we can engineer out the psychedelic
components or are these somehow part of the antidepressant mechanism? See for
example this paywalled paper from Zatare's group, which correlates what they
call 'dissociative' effects with the antidepressant effect
[http://www.sciencedirect.com/science/article/pii/S0165032714...](http://www.sciencedirect.com/science/article/pii/S016503271400055X)

(An early paper on the phenomenon is Berman RM, et al. Antidepressant effects
of ketamine in depressed patients. Biol Psychiatry. 2000;47(4):351–354.
Paywalled
[http://www.biologicalpsychiatryjournal.com/article/S0006-322...](http://www.biologicalpsychiatryjournal.com/article/S0006-3223\(99\)00230-9/abstract)
)

------
netcan
Lately, I seem to be hearing a lot about drugs of the "psychedelic" variety
being used to treat thugs like depression. psilocybin, DMT, MDMA, Ketamine.
The thing that jumps out at me is that they sound like / claim to be
treatments in the way that antibiotics are rather than in the way painkillers
are. IE, you go through treatment and get "cured."

Please correct me if I am wrong but as I understand it most medical treatments
for mental illness is of the painkiller variety. It relieves symptoms while
taken consistently and patients either stay medicated indefinitely or the
illness runs its course while the effects are mitigated by the drug.

Are there any established treatments that we understand well of the
antibiotics variety? Mental illnesses that are cured by a course of treatment
rather than and indefinitely ongoing one.

~~~
nemo1618
Psychedelics are certainly not drugs in the antibiotic sense; they don't seek
out depression-causing neurons and cure them or anything remotely like that.

Rather, psychedelic drugs offer a means for the user to "get out of their
head" for a bit. In the right set and setting, the experience offers an
opportunity for intense introspection. “Psychedelics probably work in
addiction by making the brain function more chaotically for a period — a bit
like shaking up a snow globe — weakening reinforced brain connections and
dynamics.” It is the experience, not the drug, which causes a fundamental
shift in attitude/mindset/worldview, and that is what "cures" the illness.

------
te_platt
Very interesting. There have also been recent studies on the effects of
anesthesia (Isoflurane in particular) on depression. See:

[http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjourna...](http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0069809)

I thought the ketamine therapy was especially interesting in that it had good
effect with relatively low doses. In the Isoflurane study they would put
patients completely under (asleep? What is the technical term for being
unconscious under anesthesia?) for about 15 minutes. Makes me wonder about the
relation between sleep problems and depression.

~~~
noir_lord
> Makes me wonder about the relation between sleep problems and depression.

There is fairly strong evidence that sleep deprivation can trigger or
exasperate depression [1].

As someone who has had chronic cyclical insomnia since my teens (17 years) in
my case it has a massive effect.

When I'm coming out of an insomnia phase the first couple of days where I get
a proper nights sleep I feel like I'm on drugs, it's a feeling of well-being
and euphoria that is hard to describe, I have limitless energy and I'm
enthusiastic about all the things I love to do.

When I'm in the middle of the no-sleep cycle, I struggle to do even basic
tasks and anything requiring complete focus is basically ruled out, the world
is a grey dreary place, summoning the energy to do anything is a major
challenge.

I manage my insomnia without drugs (the problem with sleeping pills in my
experience is that while they do make you sleep it's not a high quality sleep
and that combined with the lag from the pills means I don't feel any better
with them than without) by impeccable sleep hygiene, diet and exercise and the
knowledge that eventually the cycle will end.

[1]
[http://www.ncbi.nlm.nih.gov/books/NBK19961/](http://www.ncbi.nlm.nih.gov/books/NBK19961/)

~~~
lutusp
> There is fairly strong evidence that sleep deprivation can trigger or
> exasperate [sic] depression ...

This is one I'm seeing more and more often. The word you were after is
"exacerbate". It's my hope that _exasperate_ and _exacerbate_ won't suffer the
same fate as _literally_ and _figuratively_ , which now mean the same thing:

[http://www.merriam-webster.com/dictionary/literally](http://www.merriam-
webster.com/dictionary/literally)

~~~
noir_lord
Your pointing out a trivial error that didn't significantly impact the
intelligibility of my comment adds absolutely nothing to the conversation
except demonstrating that you have superior English skills to mine (which I
suspect was entirely the point).

In addition if we are going to be rigourously accurate I will point out that
merriam-webster also has exasperate down as "to make more grievous" as an
obsolete meaning and since you seem to be concerned about changing the meaning
of words over time we should perhaps allow the obsolete usage here.

~~~
benched
Aw. And to think, you could have just thanked him!

~~~
noir_lord
As a rule I don't thank pedants I just avoid them.

------
zxexz
I wonder what the effects of other arylcyclohexylamine compounds have on
depression. There is plenty of anecdotal evidence on Bluelight.ru and
Erowid.org suggesting that other chemicals of this class can have a positive
impact on depression. Of course, there are plenty reports of addiction and
negative behavior (mostly with PCP). I know that many people report the legal
analogue Methoxetamine (legal in the US; Ketamine is schedule III and the
federal analogue act only applies to schedules I and II) has potent
antidepressant effects.

------
justinpaulson
This is very interesting for the use of ketamine. My wife is currently
undergoing a ketamine infusion for RSD/CRPS. RSD/CRPS is a crippling pain
disorder, and ketamine infusions are so far the only thing that has given her
any relief. Hopefully things like this will help to get ketamine treatments
covered by insurance, because it is insane that they are not covered for those
suffering RSD/CRPS.

------
tokenadult
Treatment of depression has improved enormously over the last four decades.
It's a tough treatment and research problem because depression isn't just one
disease at the biological level.

Quoting the full study abstract will probably be helpful to the discussion
here.

"Background: Ketamine has a rapid antidepressant effect in treatment-resistant
depression (TRD). The effects on cognitive function of multiple ketamine
infusions and of concurrent antidepressant medication on response rate and
duration are not known. Method: Twenty-eight patients with uni- or bipolar TRD
were treated over three weeks with either three or six ketamine infusions (0.5
mg/kg over 40 minutes) in the recovery room of a routine ECT clinic. Post-
treatment memory assessments were conducted on day 21 (4–7 days after the
final infusion). Patients were followed up for six months where possible, with
severity of depression and side effects monitored throughout. Results: Eight
(29%) patients responded of whom four remitted. Only three (11%) patients had
responded within six hours after a single infusion, but in all responders, the
response had developed before the third infusion. The duration of response
from the final infusion was variable (median 70, range 25–168 days).
Discontinuations included two (7%) because of acute adverse reactions during
the infusion and five (18%) because of failure to benefit and increasing
anxiety. Ketamine was not associated with memory impairment. The ECT clinic
was rated suitable by patients and offered appropriate levels of monitoring.
Conclusion: This small, open label naturalistic study shows that up to six low
dose ketamine infusions can safely be given within an existing NHS clinical
structure to patients who continue their antidepressants. The response rate
was comparable to that found in RCTs of single doses of ketamine in
antidepressant-free patients but took slightly longer to develop."

The free full text of the article reporting this preliminary finding can be
found online.[1] (Hat tip to the participant here who first found the abstract
link, which leads to the full-text link.)

Depression is maddeningly difficult to treat because it is quite clear on
multiple grounds that not everyone with signs of depression (extremely
persistent low mood contrary to the patient's life circumstances) has the same
underlying physical or psychological cause of depression. The human mood
regulatory system is a SYSTEM, and as such it can be perturbed by a number of
biochemical stressors internal to the patient, and also by a number of
outside-the-patient environmental stressors (including sleep disturbance,
already mentioned in this thread, and the use or abuse of various druggs). Not
all patients have the same biological substrate to their depression, so not
all patients will respond to the same treatment. To date, the most effective
treatment for depression is a both-and of prescribed medication and
professionally supervised talk therapy, and there is an active research
program on identifying which patients respond to which medicines and to which
kinds of talk therapy.[2]

In any research program on treatment of human subjects, the studies have to
start with small numbers of subjects to verify safety of the treatment, and
then gradually increase the number of subjects and add in double-blind
protocols to verify both safety and effectiveness. (The study reported here is
"open label," not double-blind.) New treatments are usually tested first on
patients who don't respond to current treatments, as in the research reported
here. It will be a long time before we know how helpful ketamine is compared
to other treatments for depression, but that will be an ongoing program of
research, and so far it looks somewhat promising.

[1]
[http://jop.sagepub.com/content/early/2014/03/17/026988111452...](http://jop.sagepub.com/content/early/2014/03/17/0269881114527361.full.pdf+html)

[2]
[http://www.annualreviews.org/doi/abs/10.1146/annurev.psych.1...](http://www.annualreviews.org/doi/abs/10.1146/annurev.psych.121208.131653?prevSearch=depression&searchHistoryKey=)

------
dfc
I am not sure why they linked to sagepub but not the actual article. The full
text journal article is available:
[http://jop.sagepub.com/content/early/2014/03/17/026988111452...](http://jop.sagepub.com/content/early/2014/03/17/0269881114527361.abstract)

~~~
davidgerard
It was a lot of work to get BBC to link even that much. I would suggest a
polite note thanking them for the link, and suggesting how to make it even
more helpful :-)

------
davidgerard
THE WHITE ROOM, Trancentral, Thursday (NTNME) — The illegal party drug
ketamine is an “exciting” and “dramatic” new treatment for depression, say
doctors who waited about two decades too long before conducting the first
trials in the UK.

The single small study has attracted due caution from evidence-based medicine
experts, since 80% of single studies turn out to be in error. However, middle-
aged doctors and researchers who feel they didn’t get out enough in their
youth are clamouring to do multiple large-scale replications of the study,
probably this weekend.

The findings open up whole new avenues of research. “It’s the sort of thing
really that makes it worth doing psychiatry,” said lead researcher Dr Rupert
McShane, or, as he now calls himself, DJ Rupe McK-Hole. “Can we get back into
trials on LSD yet? I understand there’s also considerable clinical
possibilities for the therapeutic qualities of sequences of repetitive beats,
MDMA and the possibility of shagging cute raver chicks like the ones I
remember.”

The duration of the effect is still a problem. “We’ll have to make sure we
repeat the trials next weekend and the weekend after as well. For science and
verifiability.”

------
orf
I remember reading about this in a New scientist issue over 8 years ago. It's
a shame that it's taken this long for newsworthy studies to be done on it.

------
0800899g
ketamine

------
cLeEOGPw
> Some patients who have faced incurable depression for decades have had
> symptoms disappear within hours of taking low doses of the drug.

So in other words they are getting high.

~~~
sivetic
Yes, they are getting "high". I'm not sure what your point is however.

I've never understood the stigma associated with all mind-altering drugs,
regardless the relative 'safety' of certain drugs in comparison to legal, and
far more dangerous alternatives (nicotine and alcohol).

~~~
lutusp
> I've never understood the stigma associated with all mind-altering drugs ...

One objection that comes immediately to mind is that it may divert from a
search for the actual cause of depression. Remember that this treatment, like
all depression treatments, is symptomatic. It doesn't either identify or treat
the underlying condition, only its symptoms.

~~~
dragonwriter
> One objection that comes immediately to mind is that it may divert from a
> search for the actual cause of depression.

That's an insane objection, because understanding of how different depressions
(depression isn't one thing, its just a set of symptoms) respond to different
treatments is one method of determining the causes.

Linking observed symptoms to environmental factors (both those that precede
the symptoms, those that occur with the symptoms, and those that cause changes
to the symptoms) is a fairly essential part of the normal scientific method of
determining the mechanism behind the symptoms.

That it also helps people in the here and now is a not insignificant side
benefit, of course.

~~~
lutusp
>> One objection that comes immediately to mind is that it may divert from a
search for the actual cause of depression.

> That's an insane objection ...

Actually, it's called "science". Science isn't about descriptions, it's about
explanations. If we knew why ketamine worked, we would have finally crossed
the threshold of science.

Without science, we will continue to see one "breakthrough" after another,
each lasting a few months, to eventually be discarded as its questionable
statistical basis comes to light.

> Linking observed symptoms to environmental factors (both those that precede
> the symptoms, those that occur with the symptoms, and those that cause
> changes to the symptoms) is a fairly essential part of the normal scientific
> method of determining the mechanism behind the symptoms.

That can only be a preliminary to science. Science is not about "links", it is
about testable, falsifiable _explanations_ for those links. Without an effort
to explain "links", any correlation becomes science. But that's not how
science works.

> That it also helps people in the here and now is a not insignificant side
> benefit, of course.

But that has no value at all, in fact it's an obstacle to understanding. And
it explains the many drugs presently available that are either known to be
ineffective or that have adverse effects -- all of them gained a foothold by a
study like this one, a questionable study, over-reliant on self-reporting.

~~~
the_other
> Actually, it's called "science". Science isn't about descriptions, it's
> about explanations. If we knew why ketamine worked, we would have finally
> crossed the threshold of science.

Actually, science is mostly observation and description. Sometimes the
descriptions can lead to theories, but only after peer-majority agrees the
theory adequately describes enough observed cases to be trusted for
prediction. Most of the seemingly immutable parts of science are in fact
maths.

And maths is mostly description of observation...

~~~
lutusp
> Actually, science is mostly observation and description.

That's not science, that is a preliminary to science. If this were not so,
astrologers -- who do lots of observing and describing -- would be scientists.

~~~
aninhumer
If you think observation is "preliminary" to science, then you fundamentally
misunderstand the scientific method.

The reason Astrologers are not scientists is not that they don't try to work
out why the positions of planets might affect the future.

The reason they are not scientists is that they don't _observe_ the world to
see if they actually do.

------
veganarchocap
Well, on a drug where you've forgotten the difference between up and down and
are now convinced you're able to walk through solid objects, I'm pretty sure
you'd forget about being depressed...

~~~
jsn
I don't know why you are being downvoted. My understanding is that yes, that's
more or less how it works. Speaking from experience, whatever it is you are
obsessing about, a ketamine trip makes you forget about it for about an hour.
I think the main feeling you get when coming down from the trip is that you
were just shown a world where your obsession doesn't make any sense, and it's
a very good time to question your obsessions.

~~~
gwern
> I don't know why you are being downvoted.

He's being downvoted for making a moronic criticism: what the person feels
under the influence of ketamine is obviously irrelevant, of no value for
treating depression, this would be just as obvious to the researchers as to
him, and so they couldn't possibly have meant that, and indeed, the _second
sentence_ of the article says benefits last well beyond the immediate
influence.

~~~
veganarchocap
You're an idiot, I wasn't making a moronic criticism, I happen to be 100%
anti-drug prohibition, but yet again on Hacker News, I've been massively down-
voted and insulted for making a joke.

