This was written a month after the treatment ended. I would love to hear how the author is doing now, because all of my research has conluded that this therapy -- while really powerful -- does not make a lasting and permanent change in your brain.
I would really like to give it a shot -- but for a couple thousand bucks for the initial series of treatments, I would hope that the change is more lasting.
It holds for a few months. During that time you can get your shit together. Try to figure out what is triggering the depression and try to change that thing. If you fail you can just do it again.
To be fair, I would much rather have a ket party once in a while than be on amohetamines (Adderall) for the rest of my life; which is an accepted treatment for certain disabilities.
The issue with saying this is we should probably have many words for different types of depression.
Probably not only split on this one variate (externally or internally triggered), but it means that certain types of depression are usually triggered externally and certain types not externally.
It's like saying that "in some cases, a broken leg is not triggered by some external influence". Sure, you could develop some bone density issue and break a leg when walking normally, so we tend to distinguish treatment of these cases--we may recommend a more permanent solution for someone who is prone to breaking their leg.
How can we even falsify your statement? To do so would require self-reports or some sort of real-time 24/7 measurement of the brain, the first doesn't really falsify anything, and the second is not very viable at the present.
Self-reports can easily lie. They also may simply not remember, or be in denial.
- It doesn't necessarily hold for a few months. For some people, it's not too much longer than an infusion session; for others, they might not even need the "booster" infusions some get.
- There's some patients for whom the "tolerance" for the antidepressant effect doesn't go away even after O(years) without taking it when it initially worked and then stopped, so you can't necessarily just do it again. (Source for this one is that it happened to me, and did not return while going as high a dose as the doctor was comfortable with.)
The author's active on instagram (linked from their medium profile), and has more recent writing there. From that, it sounds like they don't feel as if they've regressed.
For example, on Nov 27th, they wrote '[this year] I successfully treated depression with Ketamine'.
It's possible that they're not talking candidly on the shorter-form of an instagram post, but it's at least a sign that maybe it stuck, otherwise that phrasing would probably be a bit less positive.
The entire first section of the article is about how good the author was at pretending to be happy. Since projecting a happy image is also the main point of Instagram for most people, I'd be hesitant to assume everything is fine based on a few posts.
I did six infusions at 1.25mg/kg (because I have a high tolerance to.. Everything it seems?) and it lasted a few weeks~a month and a half. I did another batch of sessions 3 months later and the results were the same. I now take it as an intranasal spray at a much lower dose every other day. It makes me mentally exhausted for a few hours afterwards, but at least it provides me some ease on the mental burden I have. I've been in psychotherapy twice a week for nearly ten years, tried literally every drug aside from classic MAOIs and ECT. I've debated TMS/rTMS, but I'm concerned about the memory loss that I've read about and heard first hand accounts of from friends in similar situations.
Obviously everyone is different and YMMV, but for me- ketamine has been the only thing that made a real impact, bonus was the lack of nasty antidepressant side effects (I'm still taking an SSRI, SNRI, and a mood stabilizer and I hate them).
I'm hopeful that some of the new ketamine+___ compounds being created to extend the duration of the 'depression slightly lifted' feeling are successful and come to trial soon.
Have you tried or considered hallucinogens? I'm not suggesting that you do, just interested in your perspective considering how severe and long-lasting your depression seems to be.
I have, but I don't think I have the right mindset for tripping. Acid is totally out of the question for reasons related to an lsd abusing family member, but shrooms is still on the table
Combination of Wellbutrin & Dextromethorphan -- which is a dissociative with some side-effects similar to Ketamine. It's in trial for severe depression treatment. 15mg of DXM (which you can buy at any drug store) combined with 150mg Wellbutrin (which you can get your dr. to prescribe to you.) Could be worth a try...
I'm actually on wellbutrin, double that dose though, and have done dxm a few times. It's... Different. Very similar in dissociation, but ketamine dissociation for me I can actually go in with planned introspection in mind while I lose all sense of self and become one with whatever music I'm listening to, but dxm just makes me 'out of it', if that makes any sense.
Certainly, I'm well aware of DXM's side-effects (at 'recreational' doses). The point of the trial is to use very low doses of it though, on a regular basis.
It's funny though, if I were to compare recreational DXM to Ketamine I would describe them exactly opposite as you did.
> 15mg of DXM (which you can buy at any drug store) combined with 150mg Wellbutrin (which you can get your dr. to prescribe to you.) Could be worth a try...
Out of curiosity, where did you get these dosage numbers from?
The linked wiki page doesn't mention dosage and the source on wikipedia is paywalled.
I did a bunch of ketamine and mdma in the early 2000s. They’re miracle substances and they changed my life in positive ways that I can’t even begin to talk about, but they are not cures for depression. Eventually the effect wears off and all of the stuff that bothered you before will start bothering you again.
If you don’t figure out how to give your life meaning, the drugs aren’t going to do it for you. They’ll give you time and space to do it, but you really need to make the best of the opportunity while you have it.
This guy’s blog post sounds exactly like a hundred conversations I had with people I met at raves. We all knew that it was making our lives better, but most of us were broken people going into the scene and at best a lot of us were slightly less broken coming out of it.
Someone I’m sure is going to say that it’s a medicine and not a party drug now because a nurse is giving it and someone wrote a prescription, but it’s the same drug with the same effect. I’m not saying that to be judge-y. I think people should have a right to improve themselves or have fun anyway they want to without hurting any body. Just that if this thing cured depression, there would have been a whole lot of ravers that were permanently cured and I know from personal experience that it isn’t the case.
I’d really hate to see people try this thinking they’re going to be happy and be even worse off after the fog settles in again.
Yeah. I have a similar background to you with this stuff and the first major thing that popped into my head while reading this article was "not enough time has passed since you experienced this"
Your anecdata doesn’t match up with current ketamine research. The protocol for depression is really different than using it for a party drug. Same for mdma for things like ptsd- it’s paired with therapy that helps you work through things. You’re right that just taking drugs isn’t enough, but please don’t discount medical treatment that changes the lives of many people.
Rubbing ‘medical’ on something doesn’t magically change how it works. And it’s pretty much impossible to take mdma and not engage in talk therapy. I had conversations that went from favorite djs to the time they were raped in middle school with complete strangers. And then you go out and dance. I don’t think a hospital is going to improve the situation much. It’s just a loophole people have to go through to make it socially acceptable.
Certain placebos only work when administered by a doctor in a clinic (heard it on some podcast once). Seems like ketamine could have different effects in different environments.
Ketamine is probably the one drug where the environment doesn’t make a lick of difference because once you drop into the hole, you are on another planet. The outside world may as well not exist.
What? Talking about hard or traumatizing experiences is NOT the same as working through trauma with a trained therapist. It’s great, and it can be helpful, but just talking about something is the first step.
Also, I don’t why y’all are acting like folks who use things like mdma and ketamine in a medical/therapeutic context haven’t also used them recreationally. It’s different, because the environment, intention, and often the dosage are all different. You taking drugs at a party is not the same, and using absolutist language to say otherwise when there’s actual medical research that contradicts you is an odd choice.
> Also, I don’t why y’all are acting like folks who use things like mdma and ketamine in a medical/therapeutic context haven’t also used them recreationally.
I think questions like this are underappreciated.
I propose that the potential underlying mechanisms of why people behave the way they do are described here, at least in part:
I think it's useful to observe how people, particularly intelligent people, interact with these ideas, and the inherent uncertainty involved.
Are people curious about how nature plays out, or are they tied in some way to nature being a particular way? Are they willing to discuss these ideas, and defend their beliefs, or is there something subconsciously repulsive about certain beliefs that renders them unable to discuss it rationally, but instead forces them to revert to defensive techniques like appeal to authority or popular tribal axioms.
Do therapists actually contribute? I'm sceptical. For me, I got so much of the value from taking MDMA and just knowing my friends were around and actually loved me. Ended so much anxiety. Between Molly and Acid and these folks, I think I'm pretty much safe for the rest of my life.
My understanding is that the ketamine dosages used for treating depression are much, much lower than the dosages used recreationally. (I could be remembering wrong.)
Otherwise, the big advantage of getting a nurse to do it is that they are in a position to treat you if one of the rare but potentially fatal side effects pops up.
It matches up with the experience of anyone who has ever taken these drugs.
These drugs, taken with a good group of people, always lead to a therapy-like experience. And as GP comment said, they give you the ability to clearly identify what bothers you in life and what to do about it. The only difference between 'medical' sessions and 'recreational' ones is that you're talking to a therapist instead of friends. Having done both, friends are generally the better option.
Actually acting on that information to improve your life is a completely different task, and without taking that step, these drugs do nothing for mental health long term.
There is no difference between 'medicine' and 'drug' other than some regulatory body slapping a label on it. Especially the case with psychedelics where early pioneers performed and documented way more experimentation than FDA-approved research could ever hope to cover.
MDMA and LSD gives you a bit of a different perspective, K not so much. Once it wears off you stay with your insights but it can't really help you act upon them. I probably took this stuff with a bit of a more fun kind of group so there was not much of "someone raped me when i was 9" type of talk. Just the understanding that the mind can work in a different way to the normal and that you can feel and behave in a different way is the main insight, but from there you still have to do the tedious work of actually implement the changes to your life.
I've been taking intranasal racemic ketamine for a year. It's not a replacement for therapy - it's treatment for organic depression. As far as we can tell, the people like me who need ketamine don't have any effective alternatives, since their depression isn't simply exacerbated situational depression, but is driven by biologic processes, specifically involving inflammation. This isn't about drug induced insight - it's about brain chemistry.
There is absolutely difference between medical and recreational ketamine use, since the actual chemistry is unrelated - the high of the ketamine is not related to it's beneficial effect. Moreover, my ketamine use and schedule wouldn't make sense recreationally. The dose is just enough to be debilitating - the equivalent of 1/4-1/2 a line.
Ironically, due to the unfortunate nature of contemporary american society, regulatory capture has resulted in the FDA approved ketamine (s-ketamine aka esketamine) treatment being more inebriating and less effective antidepressant than recreationally consumed ketamine - which, being unpatentable is consequently unprofitable. A less inebriating, more effective antidepressant r-ketamine is 'in the wings', in order to let pharmaceutical companies milk as much money as they can from this otherwise cheap and effective drug. Hopefully psychiatrists will see through this, and start prescribing off-label ketamine once they have seen the effect that esketamine has on their treatment resistant patients.
Actually the problem is that doctors won't prescribe racemic ketamine - unless it's taken intravenously and consequently require medical supervision - which comes with medical malpractice insurance.
I would hazard that this is the main reason why most doctors are comfortable prescribing IV ketamine rather than intranasal or subcutaneous (both of which are currently prescribed self administration methods for depression). Otherwise the risk is all on them.
My intranasal (ie - same as esketamine) ketamine prescription is $70 every six weeks.
I've never heard of this before. What dose and what schedule is that dose on? Is it combined with any other treatments? How has it helped you? Do you have any sources describing this mode of treatment? Any evidence of said inflammation or its subsequent reduction after treatment?
Also, recreational use != party druggies. I put recreational in quotes because authorities etc. see no difference between self-medication and party time. Based on what you said, you could go get ketamine from a street dealer and continue the same dosage/schedule 'recreationally'.
I'm not saying all recreational drug use is theraputic. I'm saying the difference between 'street drug' and 'medicine' is decided mostly on politics and the profitability profile of the substance rather than its therapeutic efficacy. Also see: marijuana.
60mg every 3 days. I don't believe it's a common treatment modality - though my doctor has some other patients on it. The primary sensation I experience on an ongoing basis is the the elimination of the sensation of abstract physical pain that I experience with negative thoughts and mood. The process is not inherently anti-inflammatory: while high dose IV ketamine are used to treat inflammatory diseases, as I understand it, the dose I'm taking doesn't directly affect inflammation, but works by modulating glutamate signaling. The relationship between inflammation and mood isn't yet clear to science, but we know that it is likely involved in many cases of treatment resistant depression.
Third hand, I know of people who are taking black market ketamine to treat depression, though I don't know what schedule they are following. There's a definite 'cliff' at the third day, as the ketamine wears off.
60mg every 3 days. That's was the protocol I followed with auto-prescribed ketamine.
Then I wanted to try every NMDA antagonists existing other than ketamine, like memantine, used as alzheimer treatment, but also ephenidine, diphenidine, methoxphenidine and later MXPr, all present in research chemical scene.
Then I heard about dextromethorphan (DXM) on a drug forum about anecdotical experience on its potential as antidepressive and even read a scientific paper about it. It is used as composent in cough syrop worldwide and, according to country laws, available without legal restriction or not, mainly because it is reputed for its potential of abuse for its dissociative effect.
In Belgium, it is supposed to be unrestricted for possession and use and so I bought 100gr of it on Alibaba for 80€, transport comprised...
The molecule seemed promising because it could act as antidepressive in 2 complemental chimical processes, that you can fine tune with the ingestion of pink (or is it white ?) grapefruit and other citrus having the same chimical properties, leading to the greater degradation or not of DXM while digesting, the product of degradation also having anti-depressive properties on its own, but in a different way.
The package get unfortunatelly blocked at French custom border. Now it seems I'm blacklisted in european custom as most of my order from China is systematically blocked.
Long term use of ketamine can cause irreversible damage to the urinary tract. I'm not how well it's been studied, and I doubt it's known how much and use for how long causes this damage. It is best to be careful.
Any given document, or event in reality, can be read (interpreted) from a wide variety of perspectives, often with completely contradictory conclusions.
Individuals reading this article from a purely logical, scientific materialist perspective, may form drastically different conclusions than those reading from the wide variety of different possible perspectives. And that's fine, it is the nature of humanity. But it seems very plausible to me that an inability (or unwillingness) of people to interpret ideas from multiple perspectives, is not fine.
There are many problems in the world (yes, I know, this has always been the case...from a binary perspective, but that is only one perspective on it). The world is complex, and getting more complex. Perhaps the manner in which we currently evaluate the world lacks the dimensional complexity required to manage it in a reasonably optimum way?
If(!) this was the case, what might that look like? What would discussions about reality look like? Is it possible that we might be in a situation similar to this? How might we know?
What that I've written is offensive or incorrect downvoters? You have a sense of righteousness, but do you have any courage? How do you know your ideas are correct if you never put them to the test? Hiding in a mob seems like a waste of something precious.
I'm curious, how is your comment related to the article? Or in other words, don't you think your comment could be posted in any other entry and would be equally (ir)relevant? It's not that it's incorrect, more like it's kind of non-sequitur-ish, as if you omitted a part of it that connects the comment to what it's commenting on.
My comment could indeed be posted in many other threads and be relevant, but not equally relevant.
I felt this article did a well above-average job communicating details about what alternate states of consciousness are like, and how it can fundamentally change your thinking, in at least a semi-permanent manner. However, most of the comments on the article seem to be written very much from a scientific materialist perspectives, and are often utterly lacking in epistemic humility.
Take the very first sentence from the top voted comment in the thread:
>> I did a bunch of ketamine and mdma in the early 2000s. They’re miracle substances and they changed my life in positive ways that I can’t even begin to talk about, but they are not cures for depression. Eventually the effect wears off and all of the stuff that bothered you before will start bothering you again.
This is fairly representative of many comments. Some obvious questions:
- how does he know this to be true?
- it may be pedantically true that they aren't 100% cures on their own for every single person, but might they get us 75% or more of the way there for most people?
- it's true that the effect diminishes over time, but do you completely revert to the previous state? Can the improved state be maintained with ongoing usage (something which is rarely disputed for mainstream pharmaceuticals, but often seems to be considered unacceptable for psychedelics)
>> If you don’t figure out how to give your life meaning, the drugs aren’t going to do it for you.
This is another one of those comments that may be pedentically technically true, if read very generously, but also very misleading. Might the subconscious mind choose casual expressions like "do it for you" to maximize persuasion, while minimizing opportunity for criticism ("hey, I was speaking colloquially, man"). The next sentence appears to undo much of the harm, but what impression is left in the mind of an unknowing reader? Who knows. Does it matter? I think it probably does, and maybe a lot.
I would argue that result of this style of speaking is a kind of epistemological chaos - we are discussing substances that may finally offer at least a partial solutions for much of what ails the world, but the status quo aggregate opinion (~nothing particularly noteworthy to be seen here, just woo woo, move along citizen) in most threads like this seems completely incorrect to me. At least, there is a serious lack of epistemic humility - strong, conclusive opinions, on topics where the facts are currently unknown - literally. And no one can admit it (that such things are unknown). To me, this is a utterly surreal state of affairs, and it is incredibly frustrating to experience this, and then open the next thread on HN and hear people complaining about problem-of-the-day that could be fixed if group <x> would "just" stop being "stupid". The irony is bitter sweet.
>> Someone I’m sure is going to say that it’s a medicine and not a party drug now because a nurse is giving it and someone wrote a prescription, but it’s the same drug with the same effect.
Again, pedentically technically true as written (maybe, if read generously), but completely overlooks the essentially undisputed (among knowledgeable people) notion of the importance of set and setting. Ignorant and misleading comments like "not a party drug now because a nurse is giving it and someone wrote a prescription" getting heavily upvoted kind of disgusts me to be honest. I am of the opinion that that thinking like this, and the people that support it, are preventing the world from improving. And most likely, many of the people complaining about faults in the world are the very same people who refuse to consider alternative ways of thinking about issues, and downvote anyone who makes such a suggestion.
These substances, and articles like this, are finally giving us some n...
Trust me, without reading this last comment, I couldn't have known what you meant with the original comment. I tend to fall in the same trap, thinking that people understand what I have in mind with minimal explanation.
I wonder how often this is the case, where the shortcomings of language, the medium, and many other things, result in incorrect perceptions of disagreement, where none actually exists.
That's the kind of thing I wish people would be able to take away from essays like this.
>> ...and began to understand, on an emotional plane that overshoots the academic level at which I’d only previously understood this— that all that’s come today comes from all that’s come before, and as all things must pass, so must we always find ourselves fighting the same battles forever and ever, until the lesson is learned.
>> I emerged from that realization inspired, empowered and with a newfound sense of gravitas where rage and anger once resided. Where we are, now, as a human collective, is further along on the continuum of progress, yet no closer to achieving it. The moral arc of the universe is long, and bends toward justice, but that bend is fraught with fractious regressions, pauses, and misfires.
>> ...continuing for the next several paragraphs.
>> I began to confront things I felt I had forgotten. People I’d hurt. People I’d wronged. People who’d hurt me. People who’d wronged me. Traumas of every degree, gradient, and sub-genre stretching as far back as preschool. My brother who severed contact with me five years ago. Friends I’d let down. Bosses who’d fired me. Drugs I wished I’d never done. Drinks I wished I’d never drank. Decisions I made and regretted. Decisions I never made and regretted not making.
>> I was not scared — I gazed at them right in the eyes, and forgave them right in the moment. I forgave myself, too. “It’s okay,” I told them. “You are free.” And then they would leave, or I would leave. Determining who “leaves” during a ketamine trip is a bit like trying to choose which half of the car you want to drive while the other half is a boat. I rose in a grain elevator I didn’t willingly enter, and I escaped the minus-world as it crumbled and roared behind me. Safe.
And so on.
These sorts of sentiments seems potentially more productive than the "You're wrong, no you're wrong, and stupid..." mode that much of humanity seems stubbornly dedicated to currently, but then it doesn't seem clear to me that everyone experiences these things in the same way, and many seem(!) opposed to the very idea.
This place seems a little less infuriating taken into context, much in the "zen" spirit of the article that you quote.
Ten years ago I used to find tech news from other forums. The two more popular were Reddit and Slashdot. Both had unfortunate trends that made discusion tiresome to follow. Reddit had those pun threads in which everybody seemed to compete to be the funniest guy in the room while Slashdot was the church of the Free Software and Saint IGNUtius.
It was as if in any conversation that you tried to have, a bunch of laughing teenagers making jokes, or a bunch of quasi-religious zealots took over. Hacker News on the other hand was the forum for YC startup founders, with a practical approach to the same subjects, so it was a welcome change.
Ten years later it has been slowly degrading. It's full of self-serious young people that instead of making tons of jokes, frown upon any attempt of humour and, instead of the classic FSF zealotry, we have the usual offline causes, trying to shame everybody into thinking "the right way". If you take this place as some kind of contest to defend the best ideas, you're going to be sorely disappointed. Such place doesn't exist. It's enough that there's a place where interesting ideas are at least presented as articles and some comments.
About the drugs discusion, there has been a couple of topics here that may explain the caution some of us have. One was modafinil. A few years ago a bunch of articles were posted telling wonders about it. A guy said that he had learnt quantum physics in an infamous article, other guy that his procrastination problems had disappeared thanks to the drug.
You'll see that recent comments that appear in the search were starting to be negative. Modify the search to show last years results. There is none. That was a fad, people spent their money because what do you expect in a site like this where everybody wants to be more creative, smart and procrastinate less?
Similar things are being said now about hallucinogens. Most repeated line is that the experience is life changing. I dropped an acid more than 30 years ago. It was spectacular, but I wouldn't call it "life changing" and I haven't had the desire to repeat since. I don't feel like I have the right to recommend against it because "do as I say, not as I did" doesn't seem like honest advice. But I wouldn't tell anybody to do it, specially after I've seen three acquitances to lose their minds because they abused LSD.
Ketamine seems very promising. But it's illegal, unless you want to spend big dollars in it. The problem I see is: should we recommend a drug that will probably be acquired illegally and taken in unknown sets to a bunch of people that might be desperate to find something to cure chronic depression, burnout or blocking? I'm sure you understand what could go wrong. I know what I would do, but I know myself, I don't know what's in the minds of everybody reading HN, so I would be very catious to create false hopes and real risks.
1.85mg/kg injection IM once or twice a month in office, then 200mg sublingual or 80mg intranasal at home twice a week. Improvement has been steady for over a year.
I took twice, three times racemic pills and then a couple grams of esketamine in five or six sessions, everything illegal.
Racemic was funny. Esketamine is extra-weird, I felt the movie on tv was real and I was chatting with Antonio Banderas, an undercover CIA operative. Later my body felt as a paper balloon. No K-hole though.
A year later: I haven't smoke weed since. I just got uninterested. No more ketamine, but I'm considering buying again. For months after the binge, alcohol didn't get me drunk, that was weird. Anxiety, a little better. Block was no better.
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60 comments
[ 2.8 ms ] story [ 116 ms ] threadI would really like to give it a shot -- but for a couple thousand bucks for the initial series of treatments, I would hope that the change is more lasting.
The intersection between internal and external is not so clear.
What the ultimate cause is, who knows.
Is the idea of a ultimate cause is even a valid idea?
Personally I don't think so.
Probably not only split on this one variate (externally or internally triggered), but it means that certain types of depression are usually triggered externally and certain types not externally.
It's like saying that "in some cases, a broken leg is not triggered by some external influence". Sure, you could develop some bone density issue and break a leg when walking normally, so we tend to distinguish treatment of these cases--we may recommend a more permanent solution for someone who is prone to breaking their leg.
How can we even falsify your statement? To do so would require self-reports or some sort of real-time 24/7 measurement of the brain, the first doesn't really falsify anything, and the second is not very viable at the present.
Self-reports can easily lie. They also may simply not remember, or be in denial.
- It doesn't necessarily hold for a few months. For some people, it's not too much longer than an infusion session; for others, they might not even need the "booster" infusions some get.
- There's some patients for whom the "tolerance" for the antidepressant effect doesn't go away even after O(years) without taking it when it initially worked and then stopped, so you can't necessarily just do it again. (Source for this one is that it happened to me, and did not return while going as high a dose as the doctor was comfortable with.)
For example, on Nov 27th, they wrote '[this year] I successfully treated depression with Ketamine'.
It's possible that they're not talking candidly on the shorter-form of an instagram post, but it's at least a sign that maybe it stuck, otherwise that phrasing would probably be a bit less positive.
Obviously everyone is different and YMMV, but for me- ketamine has been the only thing that made a real impact, bonus was the lack of nasty antidepressant side effects (I'm still taking an SSRI, SNRI, and a mood stabilizer and I hate them).
I'm hopeful that some of the new ketamine+___ compounds being created to extend the duration of the 'depression slightly lifted' feeling are successful and come to trial soon.
Combination of Wellbutrin & Dextromethorphan -- which is a dissociative with some side-effects similar to Ketamine. It's in trial for severe depression treatment. 15mg of DXM (which you can buy at any drug store) combined with 150mg Wellbutrin (which you can get your dr. to prescribe to you.) Could be worth a try...
It's funny though, if I were to compare recreational DXM to Ketamine I would describe them exactly opposite as you did.
Out of curiosity, where did you get these dosage numbers from?
The linked wiki page doesn't mention dosage and the source on wikipedia is paywalled.
EDIT: looks like it's 60mg of DM, which seems rather high.
If you don’t figure out how to give your life meaning, the drugs aren’t going to do it for you. They’ll give you time and space to do it, but you really need to make the best of the opportunity while you have it.
This guy’s blog post sounds exactly like a hundred conversations I had with people I met at raves. We all knew that it was making our lives better, but most of us were broken people going into the scene and at best a lot of us were slightly less broken coming out of it.
Someone I’m sure is going to say that it’s a medicine and not a party drug now because a nurse is giving it and someone wrote a prescription, but it’s the same drug with the same effect. I’m not saying that to be judge-y. I think people should have a right to improve themselves or have fun anyway they want to without hurting any body. Just that if this thing cured depression, there would have been a whole lot of ravers that were permanently cured and I know from personal experience that it isn’t the case.
I’d really hate to see people try this thinking they’re going to be happy and be even worse off after the fog settles in again.
Also, I don’t why y’all are acting like folks who use things like mdma and ketamine in a medical/therapeutic context haven’t also used them recreationally. It’s different, because the environment, intention, and often the dosage are all different. You taking drugs at a party is not the same, and using absolutist language to say otherwise when there’s actual medical research that contradicts you is an odd choice.
I think questions like this are underappreciated.
I propose that the potential underlying mechanisms of why people behave the way they do are described here, at least in part:
https://en.m.wikipedia.org/wiki/Heuristic
https://en.wikipedia.org/wiki/Thinking,_Fast_and_Slow
I think it's useful to observe how people, particularly intelligent people, interact with these ideas, and the inherent uncertainty involved.
Are people curious about how nature plays out, or are they tied in some way to nature being a particular way? Are they willing to discuss these ideas, and defend their beliefs, or is there something subconsciously repulsive about certain beliefs that renders them unable to discuss it rationally, but instead forces them to revert to defensive techniques like appeal to authority or popular tribal axioms.
Is uncertainty acceptable?
Otherwise, the big advantage of getting a nurse to do it is that they are in a position to treat you if one of the rare but potentially fatal side effects pops up.
These drugs, taken with a good group of people, always lead to a therapy-like experience. And as GP comment said, they give you the ability to clearly identify what bothers you in life and what to do about it. The only difference between 'medical' sessions and 'recreational' ones is that you're talking to a therapist instead of friends. Having done both, friends are generally the better option.
Actually acting on that information to improve your life is a completely different task, and without taking that step, these drugs do nothing for mental health long term.
There is no difference between 'medicine' and 'drug' other than some regulatory body slapping a label on it. Especially the case with psychedelics where early pioneers performed and documented way more experimentation than FDA-approved research could ever hope to cover.
There is absolutely difference between medical and recreational ketamine use, since the actual chemistry is unrelated - the high of the ketamine is not related to it's beneficial effect. Moreover, my ketamine use and schedule wouldn't make sense recreationally. The dose is just enough to be debilitating - the equivalent of 1/4-1/2 a line.
Ironically, due to the unfortunate nature of contemporary american society, regulatory capture has resulted in the FDA approved ketamine (s-ketamine aka esketamine) treatment being more inebriating and less effective antidepressant than recreationally consumed ketamine - which, being unpatentable is consequently unprofitable. A less inebriating, more effective antidepressant r-ketamine is 'in the wings', in order to let pharmaceutical companies milk as much money as they can from this otherwise cheap and effective drug. Hopefully psychiatrists will see through this, and start prescribing off-label ketamine once they have seen the effect that esketamine has on their treatment resistant patients.
The problem is that insurance companies won't cover off-label drugs, and ketamine is too expensive for most people to pay for out of pocket.
I would hazard that this is the main reason why most doctors are comfortable prescribing IV ketamine rather than intranasal or subcutaneous (both of which are currently prescribed self administration methods for depression). Otherwise the risk is all on them.
My intranasal (ie - same as esketamine) ketamine prescription is $70 every six weeks.
Also, recreational use != party druggies. I put recreational in quotes because authorities etc. see no difference between self-medication and party time. Based on what you said, you could go get ketamine from a street dealer and continue the same dosage/schedule 'recreationally'.
I'm not saying all recreational drug use is theraputic. I'm saying the difference between 'street drug' and 'medicine' is decided mostly on politics and the profitability profile of the substance rather than its therapeutic efficacy. Also see: marijuana.
Third hand, I know of people who are taking black market ketamine to treat depression, though I don't know what schedule they are following. There's a definite 'cliff' at the third day, as the ketamine wears off.
Then I wanted to try every NMDA antagonists existing other than ketamine, like memantine, used as alzheimer treatment, but also ephenidine, diphenidine, methoxphenidine and later MXPr, all present in research chemical scene.
Then I heard about dextromethorphan (DXM) on a drug forum about anecdotical experience on its potential as antidepressive and even read a scientific paper about it. It is used as composent in cough syrop worldwide and, according to country laws, available without legal restriction or not, mainly because it is reputed for its potential of abuse for its dissociative effect.
In Belgium, it is supposed to be unrestricted for possession and use and so I bought 100gr of it on Alibaba for 80€, transport comprised...
The molecule seemed promising because it could act as antidepressive in 2 complemental chimical processes, that you can fine tune with the ingestion of pink (or is it white ?) grapefruit and other citrus having the same chimical properties, leading to the greater degradation or not of DXM while digesting, the product of degradation also having anti-depressive properties on its own, but in a different way.
The package get unfortunatelly blocked at French custom border. Now it seems I'm blacklisted in european custom as most of my order from China is systematically blocked.
Here are some ressources :
https://www.vice.com/en_us/article/9kzkje/dxm-cough-syrup-an...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398352/
https://sci-hub.tw/https://doi.org/10.1016/j.mehy.2011.02.00...
https://mhc.cpnp.org/doi/full/10.9740/mhc.2019.03.076
Edit : Typo and removed an irrelevant reference.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544340/
https://www.sciencedaily.com/releases/2016/03/160318090442.h...
https://www.nursingtimes.net/clinical-archive/medicine-manag...
Individuals reading this article from a purely logical, scientific materialist perspective, may form drastically different conclusions than those reading from the wide variety of different possible perspectives. And that's fine, it is the nature of humanity. But it seems very plausible to me that an inability (or unwillingness) of people to interpret ideas from multiple perspectives, is not fine.
There are many problems in the world (yes, I know, this has always been the case...from a binary perspective, but that is only one perspective on it). The world is complex, and getting more complex. Perhaps the manner in which we currently evaluate the world lacks the dimensional complexity required to manage it in a reasonably optimum way?
If(!) this was the case, what might that look like? What would discussions about reality look like? Is it possible that we might be in a situation similar to this? How might we know?
I felt this article did a well above-average job communicating details about what alternate states of consciousness are like, and how it can fundamentally change your thinking, in at least a semi-permanent manner. However, most of the comments on the article seem to be written very much from a scientific materialist perspectives, and are often utterly lacking in epistemic humility.
Take the very first sentence from the top voted comment in the thread:
>> I did a bunch of ketamine and mdma in the early 2000s. They’re miracle substances and they changed my life in positive ways that I can’t even begin to talk about, but they are not cures for depression. Eventually the effect wears off and all of the stuff that bothered you before will start bothering you again.
This is fairly representative of many comments. Some obvious questions:
- how does he know this to be true?
- it may be pedantically true that they aren't 100% cures on their own for every single person, but might they get us 75% or more of the way there for most people?
- it's true that the effect diminishes over time, but do you completely revert to the previous state? Can the improved state be maintained with ongoing usage (something which is rarely disputed for mainstream pharmaceuticals, but often seems to be considered unacceptable for psychedelics)
>> If you don’t figure out how to give your life meaning, the drugs aren’t going to do it for you.
This is another one of those comments that may be pedentically technically true, if read very generously, but also very misleading. Might the subconscious mind choose casual expressions like "do it for you" to maximize persuasion, while minimizing opportunity for criticism ("hey, I was speaking colloquially, man"). The next sentence appears to undo much of the harm, but what impression is left in the mind of an unknowing reader? Who knows. Does it matter? I think it probably does, and maybe a lot.
I would argue that result of this style of speaking is a kind of epistemological chaos - we are discussing substances that may finally offer at least a partial solutions for much of what ails the world, but the status quo aggregate opinion (~nothing particularly noteworthy to be seen here, just woo woo, move along citizen) in most threads like this seems completely incorrect to me. At least, there is a serious lack of epistemic humility - strong, conclusive opinions, on topics where the facts are currently unknown - literally. And no one can admit it (that such things are unknown). To me, this is a utterly surreal state of affairs, and it is incredibly frustrating to experience this, and then open the next thread on HN and hear people complaining about problem-of-the-day that could be fixed if group <x> would "just" stop being "stupid". The irony is bitter sweet.
>> Someone I’m sure is going to say that it’s a medicine and not a party drug now because a nurse is giving it and someone wrote a prescription, but it’s the same drug with the same effect.
Again, pedentically technically true as written (maybe, if read generously), but completely overlooks the essentially undisputed (among knowledgeable people) notion of the importance of set and setting. Ignorant and misleading comments like "not a party drug now because a nurse is giving it and someone wrote a prescription" getting heavily upvoted kind of disgusts me to be honest. I am of the opinion that that thinking like this, and the people that support it, are preventing the world from improving. And most likely, many of the people complaining about faults in the world are the very same people who refuse to consider alternative ways of thinking about issues, and downvote anyone who makes such a suggestion.
These substances, and articles like this, are finally giving us some n...
I wonder how often this is the case, where the shortcomings of language, the medium, and many other things, result in incorrect perceptions of disagreement, where none actually exists.
That's the kind of thing I wish people would be able to take away from essays like this.
>> ...and began to understand, on an emotional plane that overshoots the academic level at which I’d only previously understood this— that all that’s come today comes from all that’s come before, and as all things must pass, so must we always find ourselves fighting the same battles forever and ever, until the lesson is learned.
>> I emerged from that realization inspired, empowered and with a newfound sense of gravitas where rage and anger once resided. Where we are, now, as a human collective, is further along on the continuum of progress, yet no closer to achieving it. The moral arc of the universe is long, and bends toward justice, but that bend is fraught with fractious regressions, pauses, and misfires.
>> ...continuing for the next several paragraphs.
>> I began to confront things I felt I had forgotten. People I’d hurt. People I’d wronged. People who’d hurt me. People who’d wronged me. Traumas of every degree, gradient, and sub-genre stretching as far back as preschool. My brother who severed contact with me five years ago. Friends I’d let down. Bosses who’d fired me. Drugs I wished I’d never done. Drinks I wished I’d never drank. Decisions I made and regretted. Decisions I never made and regretted not making.
>> I was not scared — I gazed at them right in the eyes, and forgave them right in the moment. I forgave myself, too. “It’s okay,” I told them. “You are free.” And then they would leave, or I would leave. Determining who “leaves” during a ketamine trip is a bit like trying to choose which half of the car you want to drive while the other half is a boat. I rose in a grain elevator I didn’t willingly enter, and I escaped the minus-world as it crumbled and roared behind me. Safe.
And so on.
These sorts of sentiments seems potentially more productive than the "You're wrong, no you're wrong, and stupid..." mode that much of humanity seems stubbornly dedicated to currently, but then it doesn't seem clear to me that everyone experiences these things in the same way, and many seem(!) opposed to the very idea.
Ten years ago I used to find tech news from other forums. The two more popular were Reddit and Slashdot. Both had unfortunate trends that made discusion tiresome to follow. Reddit had those pun threads in which everybody seemed to compete to be the funniest guy in the room while Slashdot was the church of the Free Software and Saint IGNUtius.
It was as if in any conversation that you tried to have, a bunch of laughing teenagers making jokes, or a bunch of quasi-religious zealots took over. Hacker News on the other hand was the forum for YC startup founders, with a practical approach to the same subjects, so it was a welcome change.
Ten years later it has been slowly degrading. It's full of self-serious young people that instead of making tons of jokes, frown upon any attempt of humour and, instead of the classic FSF zealotry, we have the usual offline causes, trying to shame everybody into thinking "the right way". If you take this place as some kind of contest to defend the best ideas, you're going to be sorely disappointed. Such place doesn't exist. It's enough that there's a place where interesting ideas are at least presented as articles and some comments.
About the drugs discusion, there has been a couple of topics here that may explain the caution some of us have. One was modafinil. A few years ago a bunch of articles were posted telling wonders about it. A guy said that he had learnt quantum physics in an infamous article, other guy that his procrastination problems had disappeared thanks to the drug.
https://duckduckgo.com/?q=site%3Aycombinator.com+modafinil
You'll see that recent comments that appear in the search were starting to be negative. Modify the search to show last years results. There is none. That was a fad, people spent their money because what do you expect in a site like this where everybody wants to be more creative, smart and procrastinate less?
Similar things are being said now about hallucinogens. Most repeated line is that the experience is life changing. I dropped an acid more than 30 years ago. It was spectacular, but I wouldn't call it "life changing" and I haven't had the desire to repeat since. I don't feel like I have the right to recommend against it because "do as I say, not as I did" doesn't seem like honest advice. But I wouldn't tell anybody to do it, specially after I've seen three acquitances to lose their minds because they abused LSD.
Ketamine seems very promising. But it's illegal, unless you want to spend big dollars in it. The problem I see is: should we recommend a drug that will probably be acquired illegally and taken in unknown sets to a bunch of people that might be desperate to find something to cure chronic depression, burnout or blocking? I'm sure you understand what could go wrong. I know what I would do, but I know myself, I don't know what's in the minds of everybody reading HN, so I would be very catious to create false hopes and real risks.
Racemic was funny. Esketamine is extra-weird, I felt the movie on tv was real and I was chatting with Antonio Banderas, an undercover CIA operative. Later my body felt as a paper balloon. No K-hole though.
A year later: I haven't smoke weed since. I just got uninterested. No more ketamine, but I'm considering buying again. For months after the binge, alcohol didn't get me drunk, that was weird. Anxiety, a little better. Block was no better.
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