[PragmaticPulp]

> Ketamine is a life-saver and has been proven to relieve depression, regardless of the administration setting.

It’s really not uncommon for some trials to fail to differentiate from placebo when it comes to depression studies. That doesn’t make this study “rubbish”, it just shows that you need to examine the body of evidence rather than cherry-picking studies that appear to match the outcome you want while dismissing those that say the opposite.

Ketamine is a temporary boost for some people, but it has also been overhyped in recent years. The single biggest downside is that it’s not a long-term solution. The duration of the antidepressant effect is relatively short (days to weeks) and the antidepressant effect appears to diminish with repeated dosing.

It can be a great help for suicidal patients or for getting traditional treatment started, but it’s not a singular solution to depression for most people.

Ketamine prescribing also got out of control fast. I traveled to a city where Ketamine clinics were advertising on the radio and billboards and competing with coupons and discounts and exaggerated promises of efficacy. Reddit and other forums are also filling up with stories of people who think their ketamine “stopped working” because they weren’t properly informed that it was a temporary effect for most people that needed to be combined with traditional therapy. Way too many clinics and influencers looking to ride the hype train without honestly assessing the situation.

[hugatest]

> It’s really not uncommon for some trials to fail to differentiate from placebo when it comes to depression studies. That doesn’t make this study “rubbish”, it just shows that you need to examine the body of evidence rather than cherry-picking studies that appear to match the outcome you want while dismissing those that say the opposite.

But this study doesn't say the opposite. It fails to show an effect. That's different from proving the absence of an effect. Every Ph.D. student in an empirical field learns this in their first year. I'm surprised this study gets so much attention.

You can make a study verifying that a pound gold and a pound feathers accelerate downwards at the same speed in a vacuum, and perhaps you messed up the vacuum, so they actually fall with different speeds in your study. Doesn't prove gravity is messed up. You just failed to prove that it's not. Can have many reasons. Same with this study.

[DavidSJ]

But this study doesn't say the opposite. It fails to show an effect. That's different from proving the absence of an effect.

This was my first thought, jaded as I am from bad scientific reporting (such as the linked article) which doesn’t distinguish between these two cases, so I had a look at the actual study.

In this case, it looks like the 95% confidence interval just barely overlaps the null hypothesis, however the mean effect favors placebo:

The mixed-effects model showed no evidence of effect of group assignment on post-infusion MADRS scores at 1 to 3 days post-infusion (-5.82, 95% CI -13.3 to 1.64, p=0.13).

(See also figure 2, which clarifies the direction of effect.)

So, potential methodological issues aside, I’d actually consider this evidence against a strong benefit relative to placebo, and possibly very weak evidence of harm.

[Rookie42]

I couldnt disagree more with your second paragraph.

I have a partner who has been prescribed Ketamine for the last 3 years. I firmly believe that the drugs ability to rebuild neural pathways and thus work around / resolve damage to be the only reason why partner is still alive today, and is now ready to return to work after so many years and such a brutal road.

In Australia, being prescribed Ketamine is very difficult, and thus very uncommon. While I do not believe it should be opened up to everyone, my experience over the last few years makes me a massive fan of the drug for specific situations.

[cypherpunks01]

Agreed on all points.

Doing studies isn't bad in itself, of course they will produce conflicting outcomes and need to be studied as a large body of evidence.

Yes, it cannot be used as a long-term solution. It's more of a fast-acting effect and has been over-hyped beyond its capabilities.

My immediate reaction was just that their conclusion ("has no short-term effect on the severity of depression symptoms" and what the co-author said in the linked article) is not reasonable to draw based on the study they designed, because they failed to consider whether the therapy needed a conscious patient or not.

[35997279]

> It can be a great help for suicidal patients or for getting traditional treatment started, but it’s not a singular solution to depression for most people.

Is there any singular solution to depression for most people?