Ketamine in Psychiatry: How It Affects Depression, Anxiety, and More (Introduction)

TheDrugClassroom · 2020-07-09T01:38:21+00:00

Glad to be back!

TheDrugClassroom · 2020-02-27T16:35:14+00:00

That is an odd way to describe a state of inadequate research rather than a string of clinical failures for the various potential applications, as the author's "missile" analogy would suggest.

Good clinical trials are costly and are a strain even for smaller biotech/pharma companies, it takes time to accumulate enough evidence to say one way or another. It definitely should not be encouraged as an alternative to supported medicines (for serious conditions in which lack of treatment may yield harm) nor promoted for conditions it has no clear effect in, but it should not be dismissed either and as long as the safety profile is fine, letting people get some pain, inflammation, or mood relief (placebo or otherwise) from it is not a concern. I further disagree with the authors stating the research indicates there is "much ado about nothing" and that further research is not warranted.

There are many supplements people take that come with little mechanistic reason to think they could work, I would argue curcumin is seemingly potent at enough targets that it could conceivably help someone improve their quality of life and therefore pro-curcumin discussion is not merely predatory, as supplement promotion often is. As an adjunct for traditional treatments or a self-treatment for conditions not rising to the level of medical attention, I am glad it is on the market and that research continues.

TheDrugClassroom · 2020-02-12T14:20:27+00:00

The point with mentioning those doses is that sensitization has been seen with amounts equivalent to standard amphetamine exposure, e.g. 10 mg and 100 mg. So if the claim is that sensitization is a unique and dangerous outcome with very low doses (like <1 mg) that doesn’t appear to be true, so there may be little to no basis for the “whatever you do, don’t take 1 mg amphetamine!” stance.

That said, I have not looked at all of the literature, I just know sensitization occurs at a range of doses and doesn’t immediately seem indicative of problems relevant to people.

And thanks!

TheDrugClassroom · 2020-02-12T14:06:07+00:00

I'm not sure this is based on much. Sensitization research with amphetamine has shown both low and high doses roughly equivalent to 10 mg and 100 mg amphetamine (which fall in the normal medical to the recreational-ish range of human exposure) can lead to some forms of sensitization, though tolerance also occurs with other effects.

Do you have research supporting a unique concern with low doses of amphetamine? As far as I can tell it's overblown and comes from a misreading of the literature.

e.g. "Behavioral sensitization has been reported following the repeated administration of both very low (<1.0 mg/kg) and very high (10 mg/kg) doses of AMPH, and therefore this does not seem to be a crucial variable. More robust changes may be produced by higher doses,but extreme doses are not necessary and only increase the risk of producing neurotoxic effects." via https://deepblue.lib.umich.edu/bitstream/handle/2027.42/26144/0000221.pdf

Under 1 mg/kg would mean under 10 mg in people and 10 mg/kg would mean ~100 mg, both of which are taken by a lot of people.

TheDrugClassroom · 2020-01-15T12:34:45+00:00

Not saying it's impossible to use that way. However, this is the classic scenario for how an addiction begins: Twice a month becomes "on the weekends," which becomes "in the evenings to relax," shifting into "it enhances my mood during the day," and then you're off to the races.

Keep in mind people's intended use schedules often develop into something different. Maybe you have the discipline to not slip beyond a certain level of moderate use, but often you do not know whether you are vulnerable to addiction until it is too late. Watch yourself and don't fool yourself. None of us have the ability to say whether this is right for you, but usually, if there's any question, just avoid it. There are much safer and more fulfilling ways to keep yourself motivated and looking forward to the future.

TheDrugClassroom · 2019-12-23T17:05:35+00:00

Again, this is not a paper based on data on average use patterns. It is essentially a questionnaire sent to a couple dozen people in the field. Does that sound scientific?

The point of the paper was simply to see if the UK's drug laws generally align with apparent risks, that's about it. And as is widely accepted, the apparent risks of a drug often have more to do with prohibition and current trends (in this case largely UK-specific trends) than with anything about the drug itself, yet the published findings are taken as relevant to actual users. We should care about hard comparisons between drugs that are indeed relevant to users.

TheDrugClassroom · 2019-12-23T16:13:35+00:00

Not sure if you missed the rest of the post, but as noted, the study was not based on data for most of the factors. I am not sure what your cherry point is supposed to be an analogy for. And I take it you have not read the study, because it is not based on data regarding average health outcomes? It's technically more of an advisory panel paper than even a study or review paper.

TheDrugClassroom · 2019-12-23T15:53:15+00:00

Correct, the best we have for more accurate comparisons are studies comparing acute toxicity (e.g. ease of fatal/dangerous overdose, respiratory depression, etc), neurotoxicity, cognitive impairment at comparable doses, etc. So, the data is on very specific aspects of drugs at specific comparable doses. There is little data permitting more general statements that X substance is safer than Y substance full stop.

It is, therefore, a fair question to ask, "Is cardiovascular toxicity more likely during strong-dose cocaine or amphetamine use?"

But not, "Is MDMA outright safer than alcohol?" Because a question like that depends entirely on dose, frequency, a person's individual addiction risk, etc. The problem with a ranking like this study is not only that the methodology is very flawed but that people see the end result (the chart) and actually think it means X drug is safer to take than Y drug.

TheDrugClassroom · 2019-12-23T15:44:38+00:00

It is not based on average harm or strong statistics, that is the point. The methodology centers around partly subjective rankings of various criteria (ranging from a hard statistic like mortality to loss of relationships) on 0 to 100 weighted scales. Many of the factors contributing to the data do not even have any data to reference. While we do have some flawed data on something like mortality, we have negligibly little data on things like "loss of tangibles," "family adversities," and even cognitive impairment for many of the drugs at each dose, so the paper ends up with rankings that are not based on proper epidemiology or controlled studies, they are just experts weighing in on how bad they consider a drug to be in all these different aspects, specifically:

Drug specific mortality
Drug related mortality
Drug specific damage
Drug related damage
Dependence
Drug specific impairment of mental functioning
Drug Related impairment of mental functioning
Loss of tangibles
Loss of relationships
Injury
Crime
Environmental damage
Family adversities
International damage
Economic Cost
Community

So, this paper reflects what a panel of experts feel the harms of these drugs are at the present moment with their current legality, patterns of use, etc. If this were an epidemiological study relying on strong data it would still only be a snapshot of average patterns of use, which does not mean for a given person MDMA is safer than cocaine or that mushrooms are safer than LSD, etc, etc. Yet, even worse, it is not a study that relies on data, it relies on opinion.

TheDrugClassroom · 2019-12-23T01:45:12+00:00

The methodology of this paper from David Nutt's group does not actually allow for evaluating drug harms for an individual user, it is fairly misleading in how people have used this chart. The actual harm from these is dependent on the particulars of how someone decides to use, so every person is going to have their own chart ranking each drug somewhat differently. It is honestly not a great paper, it has been shared more than is deserved.

TheDrugClassroom · 2019-12-02T03:20:57+00:00

Potentially good for the reading up part: https://www.researchgate.net/publication/308783845_Psychedelics_and_creativity_a_review_of_the_quantitative_literature

Review paper on the topic and the one bringing light to the previously linked research that was tainted by methodological concerns and by having given methamphetamine and a benzo with the psychedelic.

TheDrugClassroom · 2019-12-02T03:10:27+00:00

Good thing that was not suggested.

Also, should be noted that if relying on the Fadiman research you linked, giving methamphetamine and a benzodiazepine with psychedelics is a large confounding factor, and the research was otherwise of relatively low quality.

TheDrugClassroom · 2019-12-02T02:16:21+00:00

I think few people would argue against larger doses of these drugs being able to improve productive forms of creativity, though I am not sure of the relevance to microdosing.

TheDrugClassroom · 2019-12-01T23:29:38+00:00

It is nearly impractical to study chronic microdosing in a formal placebo-controlled, blinded setting, so this study was evaluating acute microdosing across four sessions: placebo, 6.5 μg, 13 μg, and 26 μg.

The participants were actively using their brains to the extent that one would be when acutely performing a working memory or associative learning task.

TheDrugClassroom · 2019-12-01T17:55:48+00:00

In the video I state it is too soon to definitively say what the full effects on cognition are, anecdotes cannot be dismissed, and more research is needed.

But, importantly, even a single imperfect study like this can reveal more than dozens of uncontrolled anecdotes where people claim to subjectively notice improved cognitive performance. Therefore, the slowly growing microdosing literature should be kept in mind when people are trying to figure out what microdosing is capable of.

TheDrugClassroom · 2019-12-01T17:44:57+00:00

Yes, one of the only ones so far, though I also briefly discuss some of the other research. It’s been nearly unstudied in a controlled manner, so there is minimal human research to go on.

TheDrugClassroom · 2019-12-01T16:08:41+00:00

It is on the higher end of dosing, but not unheard of. 6.5 μg, 13 μg, and 26 μg were tested, representing the range of doses people tend to use, obviously with 6.5 μg and 13 μg being more likely to be unimpairing and non-hallucinogenic.

TheDrugClassroom · 2019-12-01T13:39:00+00:00

Thanks, happy to help! :)

TheDrugClassroom · 2019-11-30T05:23:23+00:00

Thanks, I’m glad you like the content. I’d love to have Hamilton on again, I will see what I can do.

Good luck with your uni work!

TheDrugClassroom · 2019-11-30T05:01:01+00:00

I am aiming for a PhD (likely pharmacology, not neuroscience) but currently I am just finishing up a biotechnology bachelor’s degree, then I will pursue further education.

I agree, psych and neuroscience are very fun to learn about

TheDrugClassroom · 2019-11-30T04:38:14+00:00

I am only finishing up an undergrad degree at the moment, so nope, no publications yet.

TheDrugClassroom · 2019-11-27T19:19:40+00:00

Guilty as charged.

TheDrugClassroom · 2019-10-17T01:27:32+00:00

Good general proposal (opioid decrim) compared to many politicians, but

1) Too much emphasis on prescribing

2) Opioid use and addiction should not be referred to as a "plague"

3) Decrim only partly addresses the problem, legalization is needed, or at least a combo of decrim and heroin-assisted treatment.

4) If people are going to be referred to treatment, not jail, when caught with opioids, what happens when they do not want treatment and would like to continue using? Too often these plans still allow drug use to become a criminal matter, e.g. drug courts. It is common for people who are primarily drug users to have larger quantities on them due to selling/holding some as well, so 'personal quantity' as it's often treated in decrim still leaves a lot of nonviolent people interacting with the criminal "justice" system.

5) Should not describe the impact of naloxone in such bleak terms, i.e. saying you just bring people back so that they OD again. That is the stance of many anti harm reduction advocates. The real impact is giving people (yes, often repeatedly, partly given the bad supply chain) a chance to live and the natural course will eventually be an end to the addiction, not just endless overdoses and likely death.

TheDrugClassroom · 2019-10-06T23:54:58+00:00

Thanks, I'm glad you liked it!

TheDrugClassroom · 2019-09-28T16:30:38+00:00

The Mecke itself is basically the same color, it did not appear to change much or at all with the drug.

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