[omginternets]

A while back I posted a moderately popular comment, which I think is equally relevant here.

https://news.ycombinator.com/item?id=37949336

Beyond the importance of controlling the placebo effect, I am worried that a lot of the drug-depression research is overlooking an important possibility: that the thing about ketamine/psilocybin/etc that is helping with depression is not some latent property of the molecule, but rather the actual transcendent experience of the trip. In other words, the trip is the point, not the mechanistic neuro-tinkering [0]. Importantly, this tracks with what we know about the protective effects of things like religiosity against depression. As such, the qualitative experience of the drug might not be something we can (or should) do away with. I would even go as far as suggesting that an absence of transcendence in one's life is precisely what causes a large segment of people to become depressed in the first place, and that perhaps drugs are helpful only insofar as they produce a transcendent experience. This isn't to say we can't take a scientific approach to treating depression, but that has to be balanced with something profoundly metaphysical: the actual qualia of life experience. Wellness isn't the absence of disease; it's the presence of thriving, and that includes within it a component of things like hope, inspiration, and elevation above the ordinary. We used to have various ceremonies designed to turn us towards the numinous, but we've pretty systematically dismantled those in favor of a grounded hyper-rationality [1]. As a scientist, I can't really object to rationality on its own, but it may be worth considering non-rational, transcendent experience as a fundamental psychological need. [0] If you're a materialist, you might object that neurological machinery is not differentiable from qualia. Fair enough! I even agree! My point is simply that medicine needs to consider qualia as a major parameter in the treatment of depression. Fixing depression is not like fixing a car. [1] I suspect most people here are familiar with Nietzsche's "God is dead quote". Many people in my entourage are floored to discover that he correctly predicted the dramatic increase in anxiety, depression, neuroticism and nihilism that is present in modern life.

[panagathon]

Your intuitions are on the mark.

https://link.springer.com/article/10.1007/s00213-017-4771-x

This study finds that:

> No patients sought conventional antidepressant treatment within 5 weeks of psilocybin. Reductions in depressive symptoms at 5 weeks were predicted by the quality of the acute psychedelic experience.

I think there's another out there with similar findings, that the stronger the mystical-type experience induced, the stronger the impact on the pathology. I haven't been able to dig it up though.

[monktastic1]

A lovely take. For years now, JHU has been emphasizing that the benefits of psilocybin are strongly correlated with whether one has a "mystical-type experience." My own explorations (long ago) strongly bore this out.

[silverquiet]

I’ve had many treatments for depression throughout my life, to include trans cranial magnetic stimulation, which I think is considered a rather modern second or third line type intervention.

Ultimately none of it has mattered much. I went through the “Death of God” thing at about seven years old and also acquired a condition that causes me chronic pain to this day around then. It seems rather natural that that could cause someone to be sad.

I suppose at the end of the day, you can’t escape modern life and you can’t create a god where none exists, so we try drugs and other tweaks to the brain because it’s what we have.

[dbspin]

My experience is oddly similar. But I do question whether existential anxiety about the existence of a deity at age seven, is more of a symptom of trauma than a cause. In my case I grew up in a dismally religious family, in an alienated place, at a time when the disconnect between my families belief and the implicit beliefs of modernity were in stark contrast. It was fairly inevitable that the contradictions would become absurd. I don't see that revellation as responsible for my dark worldview though. That's likely more mundane toxic family, learned helplessness, chronic health related stuff.

[silverquiet]

I’d say my religious upbringing was a positive experience actually, to the point that today I wish I was able to believe in it. My brushes with evangelical Christianity however are what initially caused me to question the whole thing - it’s hard to believe that they believe in what they say when their actions are so in contradiction with the words in their religious texts. That this was so apparent to a seven-year-old me is quite an indictment and I think explains a lot of the recent secularization of the US.

I do have a possible surgery that may relieve the pain at some point and I think that that hope may be about the closest thing I have to religion these days.

[joquarky]

Alan Watts reopened my interest in the metaphysical while deconstructing western mythology. Check out some of his lectures if you're interested in exploring the potential for reviving some of those positive experiences.

[bitcoin_anon]

I mildly disagree with this on the basis that I’ve experienced lasting antidepressant effects from psychedelics at sub-transcendent doses.

[omginternets]

Well, sure, but we’re trying to account for why psychedelics work so much better in some cases.

[tootie]

Transcendence is 100% a chemical process. So is all cognition and perception.

[monktastic1]

Your objection is addressed in the comment. See "If you're a materialist, you might object..."

[dbspin]

That's the wrong level of description. It adds little to the argument about whether neurochemistry or perception underly the efficacy of psychedelic treatments. As a counterpoint - human cognition and perception only exist in contexts beyond the brain - a perceived world, brain development through perceptual stimulation, language acquisition etc. Brain in a vat does nothing.

[omginternets]

Missing the point completely …

The issue is that not all chemical processes produce transcendence.