A common example would be ADHD stimulants, where the early stimulating and mood-boosting effects disappear over time while the concentration-enhancing effects mostly remain. This leads a lot of patients to assume the medication isn’t working because it doesn’t feel like those first few doses, which can lead to discontinuation or abuse.
Ketamine has a similar story arc. The antidepressant effect doesn’t require full blown dissociation, but so many headlines and fame-seeking authors have hyped it as “psychedelic medicine” that some patients assume it isn’t working until they disassociate/hallucinate. This can create a sort of nocebo effect where patients may actually be improving but they think they’re not because they didn’t have the wild hallucinations they read about in some exaggerated internet article.
I think a possible reason why medical research prefers a pill that works forever for continued use is that if you buy something cheap twice in your life and it fixes whatever needs fixing the pharma industry can't make money off of you the same way they can put you on antidepressants for life. I'm not in the medical field so I'm just speaking out of my ass based on personal anecdotes though.
Perhaps if you are looking for something profound or want a change of mindset, psychedelics might be able to help you reach it - similar to how shamans used psychedelics to talk to their gods or whatever - but if you're just looking to have fun that's what you'll get
Anyway if you take drugs to party and then go to a party, you'll party. If you take drugs and do therapy you'll do therapy. If you take drugs just to see what happens and you're open to whatever happens, things will happen. Maybe you'll just have an oddly memorable time and you ponder what it means, slowly altering how you think about other things for the rest of your life.
Drug discovery is difficult enough that the pharma companies don't have the ability to make a meaningful choice between fix-once-and-you're-set-for-life versus manage-symptoms-forever.
How do you test a medication that only needs to be taken once or twice? This is very challenging to study scientifically.
Psychedelics bridge the gap between medication and therapy. A trip is not guaranteed to be therapeutic, but a trip with proper guidance it's more likely to be.
How can we know which aspects of that guidance are useful, and which are superfluous?
It's going to take a lot of work to get to the level of certainty that our medical system expects for medication.
Most vaccines you only take once, you can still test if they work or not. Same with poison antidotes and things like that. Like I said, I'm not a doctor, but the fact that it's only once doesn't seem like the problem.
How do you measure depression? How do you know what changed it, or how much?
How are you quantifying "frequently"? Does that necessarily mean that the recreational effects cannot themselves be therapeutic?
After some time, the novelty of the experience wears off, and you start to get more familiar with the limitations of medication. That's disappointing. Disappointment feels bad. Again, this is not caused by the drug itself, but by the surrounding experience.
ADHD itself is riddled with secondary experiences: they make up the name itself! People with ADHD do not struggle to pay attention, we struggle to direct it. Hypoactivity is a reaction to living without enough simulation. Neither is a direct symptom of the disorder, but they are ubiquitous enough to
People who live with undiagnosed/untreated ADHD are likely to end up with a lot of trauma. That trauma is unaffected by medication.
So if you start taking ADHD medication, you need to know what it does and doesn't help with. Medication can't make up the entirety of treatment, just like cognitive behavioral therapy can't replace medication.
I'm not sure, isn't that kind of what's being shown by this study? Or like, is there levels of disassociation that you're distinguishing between? Are you able to enumerate those levels for those of us who are unfamiliar with disassociation?
"Future studies of novel antidepressants with acute psychoactive effects should make stronger efforts to mask treatment assignment to minimize the effects of subject-expectancy bias."
Instead of pondering if their method is at fault for their negative result, the conclusion is to double down and working even harder at masking the effects.
That line just says people should do better at this in future to get more accurate results. It's not a statement about the ultimate form the treatment should take.
I believe benzodiazepines have also been tried as an active placebo but I don't remember what the results were.
No idea about deliriants like atropine/scopolamine, but in low doses, they were traditionally used to spice up beer (hence Pilsen named for Bilsenkraut, black henbane), so I could imagine short antidepressant effect there too.
It does, and this observation led to the development of dedicated antidepressant drugs. There are several such cases where interesting side effects turned out to open a world of possibilities, including an anti-TB drug that also led to antidepressants, and of course Viagra.
"find something that has a similar trip but does nothing" is actually equivalent to the original problem.
But it's also doubling down on the assumption that the subjective effects aren't the source of the benefit.
'Schenberg points out that people often report dreamlike and visual, auditory, and affective experiences under anesthesia. “Maybe people who had dreamlike experiences during the anesthesia had more improvement than the people who didn’t,” he says.'
So maybe the trip does indeed help, but evidently it is not necessary to be able to remember if you had one to get the reported benefits.