John Oliver's Segment on Psychedelic Assisted Therapies

[DynamicDidactic]

First, it seems like someone on that staff loves mental health b/c they have done some, I would say, high-quality segments on the opioid crisis, rehab, and mental health. This was not my experience with this segment. I was wondering what others think about it.

My cursory review of the research indicates that a lot of this will not work better than placebo. The only exception is ketamine for treatment-resistant depression but there are still question marks about long-term efficacy (most studies are only looking at 1 month of treatment) and the general continued reliance on chemical treatment for something that is primarily caused by the environment. This segment, to me, provides an overly rosy perspective and is supporting another mental health fad.

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[R. Matey]

It would be a big step for JO to go against psychedelics as I suspect that such a position would alienate a large swath of his viewership.

 

[Fan_of_Meehl]

First, it seems like someone on that staff loves mental health b/c they have done some, I would say, high-quality segments on the opioid crisis, rehab, and mental health. This was not my experience with this segment. I was wondering what others think about it.

My cursory review of the research indicates that a lot of this will not work better than placebo. The only exception is ketamine for treatment-resistant depression but there are still question marks about long-term efficacy (most studies are only looking at 1 month of treatment) and the general continued reliance on chemical treatment for something that is primarily caused by the environment. This segment, to me, provides an overly rosy perspective and is supporting another mental health fad.

All I know is that I'm volunteering as a research participant...

 

[Ollie123]

I'm a bit more optimistic than you, but agree the segment went too far.

Its really too early to say much. Research is in its infancy since it was effectively not possible to do high-quality research for so long (and is still incredibly challenging). I don't rule out the possibility the experiences can be transformative, but that translating to clinically efficacious is a bigger question. As someone who has built his career off studying the role of environments in mental health, I also don't think its fair to say treatment-resistant depression is "caused by the environment" - nearly everything is a dynamic interplay between environment and our biology and I'm skeptical of anything that ascribes a dominant amount to one or the other. Chemicals could very well change our relationship to our environment (arguably the very mechanism-of-action posited by most psychedelic research), increase our willingness to modify our environment or any number of other mechanisms.

Full disclosure: My current R01 is specifically examining a combined pharmacological intervention that pairs a traditional medication targeting biological processes with one that may more directly target environmental/contextual influences on psychopathology (not psychedelics). We're very early stage (just pinning down neurobiological mechanisms) and I have mixed confidence it will lead anywhere but I did want to be transparent about my stake.

 

[DynamicDidactic]

It would be a big step for JO to go against psychedelics as I suspect that such a position would alienate a large swath of his viewership.

Going against and not doing a segment at all are two very different options.

 

[R. Matey]

Going against and not doing a segment at all are two very different options.

Very true, and honestly, I thought he took a middle path. I wholly expected the piece about how some conservative legislature somewhere is trying to block it for...reasons despite its so-called efficacy. On that point, I recall you and I agree as I have also been less than impressed with the research I've seen on this topic.

 

[AbnormalPsych]

The way the media, public at large, and my patients talk about these things has led me to invest some 'fun money' in these stocks. This is a fad that I believe will pick up steam in the next deacde the way our culture is evolving to look for quick, easy, trendy, external, and often chemical fixes to complex problems. I am not really up to speed on the literature specifics in this area outside some of the PTSD related stuff, but hey, the placebo effect is real, so I like to keep an open mind and optimism. I think if national policy opens the door here, regardless of the actual science, this will be a thing, for decades.

 

[cara susanna]

The literature that I've read on psychedelic-assisted therapy for PTSD is concerned about how the results of these therapies compare to the results of our "traditional" EBPs for PTSD. As you all know, they work very well so the question is, how much better does psychedelic-assisted therapy work and is it worth it?

Honestly, though, I have a few patients who haven't responded to our more conventional interventions and I've reached the point where if they find anything that helps, I will be thrilled.

 

[Fan_of_Meehl]

The literature that I've read on psychedelic-assisted therapy for PTSD is concerned about how the results of these therapies compare to the results of our "traditional" EBPs for PTSD. As you all know, they work very well so the question is, how much better does psychedelic-assisted therapy work and is it worth it?

Honestly, though, I have a few patients who haven't responded to our more conventional interventions and I've reached the point where if they find anything that helps, I will be thrilled.

True that. And I think there is a tendency for us to too often 'crystallize' in our thinking about a particular slate of 'indicated, evidence-based' treatments for a particular condition--especially those that were front and center during our training years. It's easy to forget that it is an ever-evolving process over time and, ultimately, an empirical question.

I'm really eager to see what the updated (from 2017) VA/DoD Guidelines for PTSD are gonna look like.

 

[smalltownpsych]

Sometimes drugs are good, sometimes they are bad. The patients who want to do them the most are often the ones who should do them the least. I have seen some benefit from ketamine assisted therapy and have recommended it. I also recently had a patient who did ketamine treatment and then committed suicide a few months later. I actually didn’t recommend the ketamine treatment because of his severe substance use disorder and he actually stopped seeing me shortly after receiving the treatment because he was “cured”.

 

[Ollie123]

Sometimes drugs are good, sometimes they are bad. The patients who want to do them the most are often the ones who should do them the least.

This is arguably the most reasonable and concise summary of the broader drug literature I have ever seen. Accurate. Includes caveats recognizing this is murky and there are no absolutes. I think it extends to traditional pharmacotherapeutics as well - people first in line for a pill to "fix" them rarely benefit extensively in my experience (I guess with the exception of psychosis).

I think there is something to this literature and I'm glad we are lifting political barriers to doing good science.

However, please note that "there is something to this literature" could mean anything from "Controlled administration of psilocybin is safe and highly efficacious" to "We uncovered a new brain mechanism involved in depression but holy @#$* bludgeoning it with psilocybin is akin to jamming your face in an electrical socket to get ECT. It might work, but there are much safer and more elegant ways."

 

[AbnormalPsych]

If the case study at hand right now is Aaron Rogers doing ayahuasca then wanting to play for the new york jets. Count me out.

/s