From the description you’ve given, which doesn’t give much to go on, it sounds like you have some, but not all, of the same problems I do (in my case stress-related anxiety and clinical depression, compounding mild comorbid Asperger’s and dyspraxia).
What I’d recommend in this case is that you access cognitive behavioural therapy. It’s the only psychiatric intervention that has been actually shown to have any long-term effects (short of dumping people full of antipsychotic drugs, which have far too many bad side-effects for me to ever recommend them). It’s also very close to applied rationality, so it might fit your worldview and be more acceptable to you than other treatments would. From my own personal experience with it, it’s not a panacea, but it is useful.
If you’re in the US and poor, and thus can’t access medical help, I would suggest learning some of the techniques from Zen Buddhism. I don’t have much experience of this myself, but several friends who I trust have told me that the meditation techniques in Zen are very similar to a less-formalised version of CBT, and in some cases have helped them more. The podcasts at zencast.org have been very helpful to several people I know with problems like that.
Also, I am NOT a doctor and this is NOT meant to be medical advice that you should take without consulting one, and I am NOT accepting liability for anything you do, but I have seen suggestions that taking large doses of niacin—large enough to cause flushing—can help get rid of mild paranoia, anxiety and depression. My own experiences tend to bear this out, but it could well be a placebo effect.
And finally, this is DEFINITELY NOT IN ANY WAY A RECOMMENDATION, but there are several studies that suggest that the prescription-only drug ketamine, which is not licensed for this purpose, can provide long-term relief from depression and can also aid cognitive functioning. If you have a doctor who is willing to prescribe off-label, it may be worth discussing that with her, although it is very unlikely you’d get the prescription as ketamine is widely used as a recreational drug. I have no experience of it myself, unlike the other things I’ve mentioned here, so can’t speak directly for its efficacy.
While this post is appreciated, this feels more like tactical advice than strategic. You’re ultimately correct—the tactical details theoretically are between me and my psychiatrist or therapist (although you’re also tactically correct in that I am in the US and poor, and hence have no psychiatrist or therapist).
But the question I’m trying to pose to the group is tailored more to the specific strengths of this group—which are less about “how do I be less crazy?” and more about “how should people who are crazy adjust the processes described on this site, so that they can attempt to work them around their crazy?”
… do you understand the distinction? Put this more metaphorically, we get that the hardware’s toast, we’ve got a field repair ticket submitted, but in the meantime can we please get a software patch? Because this is kinda mission-critical.
Ketamine’s main advantage is that it’s fast. As in, minutes to hours to kick in, rather than weeks to months. But it doesn’t look more helpful than ordinary antidepressants.
I saw a study recently saying that it actually helped rebuild synaptic connections that are destroyed by depression. Afraid I don’t have a cite for it. As for ordinary antidepressants, they seem at best to have placebo effects and at worst to actually be harmful, as far as I can tell, though it’s not something I’ve looked into a great deal.
Ordinary antidepressants are no better than placebo in mild depression but incredibly useful in severe cases. I suspect that their overall effect is underestimated because they can be anywhere from extremely helpful to extremely harmful, so studies that look only at averages miss that.
I suspect that their overall effect is underestimated because they [have high variance]
Averaging is the right thing to do. High variance with zero mean really has zero mean.
If the drug is used differently in the field than in the studies, the studies may be misleading. In particular, if the patient tries several drugs, looking for one with positive effect, high variance of the individual drugs yields an overall positive outcome (if the drugs are not correlated). Some people claim that antidepressants are used this way, but others claim that they are used blindly.
Yes, the effect is usually stable for the same person on the same drug, so it’s standard procedure to try a lot of antidepressants until one helps. Who claims that it’s not? I’ve never heard of that, and it just sounds completely weird that a doctor wouldn’t adjust treatment depending on results.
That’s why averages aren’t enough data. High-variance meds are better as long as the worst case is rarely lethal, since bad effects are felt only for as long as it takes to notice and switch whereas good ones are forever.
Ketamine’s is good because it helps rebuild synaptic connections?
A drug is good when it helps people to achieve the results they want to achieve.
If a study doesn’t tell you that the drug helps people get better results but insteadly tells you that
the drug does something good “in the brain”, be wary.
When people say that ordinary antidepressants aren’t much better than placebo’s they aren’t saying that ordinary antidepressants don’t have an effect. They do stuff in the brain that you can measure.
The problem is that they still only better the state of depression by 1.8 points on a 50 point scale (Kirsch et al 2008)
Separately, other studies have shown that it works as an antidepressant. My follow-up comment was pointing out that it also works in a way that should be expected to have a longer-term effect than other antidepressants. It hasn’t been studied much for that use, though, so we don’t know for sure, but repairing damage as opposed to the symptoms of the damage seems like a promising result.
For any given antidepressant there are a few studies that show that they work. Even for homeopathy there are studies that it works.
You said that it’s off-label to use the drug as antidepressant. That probably means that the FDA thinks that the studies that exist don’t provide enough evidence for it being a good antidepressant.
It hasn’t been studied much for that use, though, so we don’t know for sure, but repairing damage as opposed to the symptoms of the damage seems like a promising result.
How do you know that rebuilding the specific synaptic connections they studied isn’t treating symptoms but causes?
Different people are depressed for different reasons. People who get serious head insuries are more likely to develop depression. If you have a way to address the causes of depression within one person, you don’t necessarily have a way to address it for the next person.
“How do you know that rebuilding the specific synaptic connections they studied isn’t treating symptoms but causes?”
I don’t know that, which is why I suggested discussing it with a qualified medical practitioner, rather than, for example, just buying some from an illegal dealer, and said it was definitely not a recommendation, capitalising those words. The little I know about the subject suggests it might be a promising line of enquiry, but I am not making any claims about its efficacy.
I don’t know that, which is why I suggested discussing it with a qualified medical practitioner, rather than, for example, just buying some from an illegal dealer, and said it was definitely not a recommendation, capitalising those words.
Lesswrong isn’t a place where you would tell someone directly: “Go buy illegal drugs.” It’s a public forum in which you participate with your real name.
Saying “this is not a recommendation” is likely be read be some adventurous people as: “I don’t want to held accountable in any way for the recommendation I’m making, but in case you are interested...”
I can certainly see that, but I would also hope that if someone is, as the OP claims to be, wanting to be truly rational, possibly the very first point in a list of ‘how to be rational’ rules would be “Don’t buy illegal brain-altering chemicals based solely on a remark made by a total stranger on the internet.”
Were someone to not be following that rule already, I suspect any other advice any of us could give them would be useless.
(Incidentally, I’m not one of the people who downvoted that comment. It seems reasonable to at least raise the issue.)
The existence of gwern, of Crazy Meds, and of the subset of the trans community unable to get treatment through official channels suggests that this rule isn’t actually all that good.
“Drug restored damaged synaptic connections” → “Drug is good” is a quite seductive argument that bears the danger of being accepted by smart people. The person might focus his fact check whether the claim about restoring damaged synaptic connections is true.
Given the failure of antidepressants in which companies invested a lot of money, it’s rational to choose the prior “a new antidepressent isn’t likely to create big positive effects” when evaluating a new candidate. Picking the right reference class is valuable.
According to Wikipedia there are small studies that seem to show a short-term antidepressant effect, but their size and methodological quality appears to be insufficient to consider them conclusive evidence. There seems to be nothing on long-term effects.
the FDA thinks that the studies that exist don’t provide enough evidence for it being a good antidepressant
I was going to say the FDA is a bunch of cowardly windbags who won’t approve anything that looks remotely scary or new, but turns out I can’t find a neutral source on that, just libertarian journals and lizard-conspiracy guy.
As handoflixue said, potential for recreational use. (This even scares them about freaking bupropion, which doesn’t actually have any.) Long-term effects not well known, because horses rarely take the Beck depression inventory. Just plain bizarre effects given current model—depression does not normally goes away in an hour, and if it goes away in less than a week you panic, lock the patient up, and watch for signs of mania.
Cannabis is a Schedule I (1) drug, the most severe rank a drug can have. Requirements for Schedule I:
1 - The drug or other substance has a high potential for abuse. 2 - The drug or other substance has no currently accepted medical use in treatment in the United States. 3 - There is a lack of accepted safety for use of the drug or other substance under medical supervision.
There have been some theories about a “war against recreational drugs”, and proponents of this theory suggest that drugs with strong recreational properties may meet with excessive bureaucratic regulation.
Further theories along the same vein suggest the ocean may in fact be slightly damp, and that Hand Of Lixue may be prone to the occasional understatement.
″ That probably means that the FDA thinks that the studies that exist don’t provide enough evidence for it being a good antidepressant.”
The previous comment of mine was an example of a controversial move by the FDA, which illustrates that they may have reasons to deny approval to certain drugs deemed to have excessive “recreational” potential. I’m hoping you can see why this is relevant to a conversation about why the FDA might opt not to approve a drug.…
Why do you focus on the FDA? Almost all countries have drug regulation agencies, and various of them approve cannabis or cannabinoids for therapeutic uses, but, as far as I know, none of them approves ketamine for use as an antidepressant.
Because the thread was about the FDA. I have no clue whether the claim about ketamine is valid or not, but I do strongly suspect that “The FDA has not approved this” is not relevant (since they have a clear motive to oppose the substance even if it is an antidepressant.)
If no place else has approved it, then that is much more useful evidence against ketamine, and I’m glad to encounter such :)
Replies to EvelynM would seem to belong as, well, replies to the comment which is authored by EvelynM.
There is an annoying aspect of the recently added karma penalty “feature” that doesn’t allow you to reply if you don’t have enough karma to pay the penalty, which I don’t have.
File your complaints to the geniuses who thought this was a good idea.
Downvoted for diagnosing someone over the internet.
The OP himself stated that he is probably insane. It seems to me that if you suspect that you have mental health issues, seeking help from a mental health professionals is the best thing to do.
Cognitive behavioral therapy seems to have the best evidence of success, at least for some disorders.
From the description you’ve given, which doesn’t give much to go on, it sounds like you have some, but not all, of the same problems I do (in my case stress-related anxiety and clinical depression, compounding mild comorbid Asperger’s and dyspraxia).
What I’d recommend in this case is that you access cognitive behavioural therapy. It’s the only psychiatric intervention that has been actually shown to have any long-term effects (short of dumping people full of antipsychotic drugs, which have far too many bad side-effects for me to ever recommend them). It’s also very close to applied rationality, so it might fit your worldview and be more acceptable to you than other treatments would. From my own personal experience with it, it’s not a panacea, but it is useful.
If you’re in the US and poor, and thus can’t access medical help, I would suggest learning some of the techniques from Zen Buddhism. I don’t have much experience of this myself, but several friends who I trust have told me that the meditation techniques in Zen are very similar to a less-formalised version of CBT, and in some cases have helped them more. The podcasts at zencast.org have been very helpful to several people I know with problems like that.
Also, I am NOT a doctor and this is NOT meant to be medical advice that you should take without consulting one, and I am NOT accepting liability for anything you do, but I have seen suggestions that taking large doses of niacin—large enough to cause flushing—can help get rid of mild paranoia, anxiety and depression. My own experiences tend to bear this out, but it could well be a placebo effect.
And finally, this is DEFINITELY NOT IN ANY WAY A RECOMMENDATION, but there are several studies that suggest that the prescription-only drug ketamine, which is not licensed for this purpose, can provide long-term relief from depression and can also aid cognitive functioning. If you have a doctor who is willing to prescribe off-label, it may be worth discussing that with her, although it is very unlikely you’d get the prescription as ketamine is widely used as a recreational drug. I have no experience of it myself, unlike the other things I’ve mentioned here, so can’t speak directly for its efficacy.
While this post is appreciated, this feels more like tactical advice than strategic. You’re ultimately correct—the tactical details theoretically are between me and my psychiatrist or therapist (although you’re also tactically correct in that I am in the US and poor, and hence have no psychiatrist or therapist).
But the question I’m trying to pose to the group is tailored more to the specific strengths of this group—which are less about “how do I be less crazy?” and more about “how should people who are crazy adjust the processes described on this site, so that they can attempt to work them around their crazy?”
… do you understand the distinction? Put this more metaphorically, we get that the hardware’s toast, we’ve got a field repair ticket submitted, but in the meantime can we please get a software patch? Because this is kinda mission-critical.
And the patch that appears to work is CBT. CBT in my experience is applied rationality for people with problems in their brains...
Ketamine’s main advantage is that it’s fast. As in, minutes to hours to kick in, rather than weeks to months. But it doesn’t look more helpful than ordinary antidepressants.
I saw a study recently saying that it actually helped rebuild synaptic connections that are destroyed by depression. Afraid I don’t have a cite for it. As for ordinary antidepressants, they seem at best to have placebo effects and at worst to actually be harmful, as far as I can tell, though it’s not something I’ve looked into a great deal.
Ordinary antidepressants are no better than placebo in mild depression but incredibly useful in severe cases. I suspect that their overall effect is underestimated because they can be anywhere from extremely helpful to extremely harmful, so studies that look only at averages miss that.
Averaging is the right thing to do. High variance with zero mean really has zero mean.
If the drug is used differently in the field than in the studies, the studies may be misleading. In particular, if the patient tries several drugs, looking for one with positive effect, high variance of the individual drugs yields an overall positive outcome (if the drugs are not correlated). Some people claim that antidepressants are used this way, but others claim that they are used blindly.
Yes, the effect is usually stable for the same person on the same drug, so it’s standard procedure to try a lot of antidepressants until one helps. Who claims that it’s not? I’ve never heard of that, and it just sounds completely weird that a doctor wouldn’t adjust treatment depending on results.
That’s why averages aren’t enough data. High-variance meds are better as long as the worst case is rarely lethal, since bad effects are felt only for as long as it takes to notice and switch whereas good ones are forever.
Ketamine’s is good because it helps rebuild synaptic connections? A drug is good when it helps people to achieve the results they want to achieve.
If a study doesn’t tell you that the drug helps people get better results but insteadly tells you that the drug does something good “in the brain”, be wary.
When people say that ordinary antidepressants aren’t much better than placebo’s they aren’t saying that ordinary antidepressants don’t have an effect. They do stuff in the brain that you can measure. The problem is that they still only better the state of depression by 1.8 points on a 50 point scale (Kirsch et al 2008)
Separately, other studies have shown that it works as an antidepressant. My follow-up comment was pointing out that it also works in a way that should be expected to have a longer-term effect than other antidepressants. It hasn’t been studied much for that use, though, so we don’t know for sure, but repairing damage as opposed to the symptoms of the damage seems like a promising result.
For any given antidepressant there are a few studies that show that they work. Even for homeopathy there are studies that it works.
You said that it’s off-label to use the drug as antidepressant. That probably means that the FDA thinks that the studies that exist don’t provide enough evidence for it being a good antidepressant.
How do you know that rebuilding the specific synaptic connections they studied isn’t treating symptoms but causes?
Different people are depressed for different reasons. People who get serious head insuries are more likely to develop depression. If you have a way to address the causes of depression within one person, you don’t necessarily have a way to address it for the next person.
“How do you know that rebuilding the specific synaptic connections they studied isn’t treating symptoms but causes?”
I don’t know that, which is why I suggested discussing it with a qualified medical practitioner, rather than, for example, just buying some from an illegal dealer, and said it was definitely not a recommendation, capitalising those words. The little I know about the subject suggests it might be a promising line of enquiry, but I am not making any claims about its efficacy.
Lesswrong isn’t a place where you would tell someone directly: “Go buy illegal drugs.” It’s a public forum in which you participate with your real name. Saying “this is not a recommendation” is likely be read be some adventurous people as: “I don’t want to held accountable in any way for the recommendation I’m making, but in case you are interested...”
I can certainly see that, but I would also hope that if someone is, as the OP claims to be, wanting to be truly rational, possibly the very first point in a list of ‘how to be rational’ rules would be “Don’t buy illegal brain-altering chemicals based solely on a remark made by a total stranger on the internet.”
Were someone to not be following that rule already, I suspect any other advice any of us could give them would be useless.
(Incidentally, I’m not one of the people who downvoted that comment. It seems reasonable to at least raise the issue.)
The existence of gwern, of Crazy Meds, and of the subset of the trans community unable to get treatment through official channels suggests that this rule isn’t actually all that good.
I don’t know about that. After all it seems like they are the kind of person to take the advice of strangers on the internet...
“Drug restored damaged synaptic connections” → “Drug is good” is a quite seductive argument that bears the danger of being accepted by smart people. The person might focus his fact check whether the claim about restoring damaged synaptic connections is true.
Given the failure of antidepressants in which companies invested a lot of money, it’s rational to choose the prior “a new antidepressent isn’t likely to create big positive effects” when evaluating a new candidate. Picking the right reference class is valuable.
According to Wikipedia there are small studies that seem to show a short-term antidepressant effect, but their size and methodological quality appears to be insufficient to consider them conclusive evidence. There seems to be nothing on long-term effects.
I was going to say the FDA is a bunch of cowardly windbags who won’t approve anything that looks remotely scary or new, but turns out I can’t find a neutral source on that, just libertarian journals and lizard-conspiracy guy.
In what way is Ketamine more scary and new than the antidepressant that the FDA approved?
As handoflixue said, potential for recreational use. (This even scares them about freaking bupropion, which doesn’t actually have any.) Long-term effects not well known, because horses rarely take the Beck depression inventory. Just plain bizarre effects given current model—depression does not normally goes away in an hour, and if it goes away in less than a week you panic, lock the patient up, and watch for signs of mania.
Cannabis is a Schedule I (1) drug, the most severe rank a drug can have. Requirements for Schedule I:
1 - The drug or other substance has a high potential for abuse. 2 - The drug or other substance has no currently accepted medical use in treatment in the United States. 3 - There is a lack of accepted safety for use of the drug or other substance under medical supervision.
There have been some theories about a “war against recreational drugs”, and proponents of this theory suggest that drugs with strong recreational properties may meet with excessive bureaucratic regulation.
Further theories along the same vein suggest the ocean may in fact be slightly damp, and that Hand Of Lixue may be prone to the occasional understatement.
Cannabis is schedule I, ketamine isn’t. I therefore don’t see the point of bringing up cannabis.
The previous comment of mine was an example of a controversial move by the FDA, which illustrates that they may have reasons to deny approval to certain drugs deemed to have excessive “recreational” potential. I’m hoping you can see why this is relevant to a conversation about why the FDA might opt not to approve a drug.…
Why do you focus on the FDA? Almost all countries have drug regulation agencies, and various of them approve cannabis or cannabinoids for therapeutic uses, but, as far as I know, none of them approves ketamine for use as an antidepressant.
Because the thread was about the FDA. I have no clue whether the claim about ketamine is valid or not, but I do strongly suspect that “The FDA has not approved this” is not relevant (since they have a clear motive to oppose the substance even if it is an antidepressant.)
If no place else has approved it, then that is much more useful evidence against ketamine, and I’m glad to encounter such :)
(Reply to wedrifid)
There is an annoying aspect of the recently added karma penalty “feature” that doesn’t allow you to reply if you don’t have enough karma to pay the penalty, which I don’t have.
File your complaints to the geniuses who thought this was a good idea.
Downvoted for diagnosing someone over the internet.
I didn’t diagnose anyone. I said it sounds like the OP has some of the same problems I do.
(Reply to EvelynM)
The OP himself stated that he is probably insane. It seems to me that if you suspect that you have mental health issues, seeking help from a mental health professionals is the best thing to do.
Cognitive behavioral therapy seems to have the best evidence of success, at least for some disorders.
Replies to EvelynM would seem to belong as, well, replies to the comment which is authored by EvelynM.