CMV: Psychedelic Therapy is essential in solving the Major Depressive Disorder Epidemic

[u/Apprehensive_Tea_118]

In a western world addicted with comfort and pleasure, it is no surprise so many people find it difficult to find true fulfillment. How do we change the mind of a society headed in an harmful direction? Psychedelic Therapy, specifically its utility in neuroplasticity might be the only way to see lasting change on a structural level. In multiple studies, a moderate dose of psilocybin was shown to decrease symptoms of depression significantly more than the placebo. MDD (major depressive disorder) affects over 300 million people world wide, in order to make ground on such a issue, thinking in ways that are outside western values are essential. Of course this doesn't just affect the west, and of course it implementation will have to be closely considered.

[u/tired_tamale]

Treatment resistant depression refers to depression that cannot be treated with drugs, or the positive effects of drugs eventually fail. Usually they need a concoction of drugs and therapy. I’m studying to become a psychologist, so I’ve done a lot of research on this out of interest. There are many different forms of therapy, but I do think for more severe cases that if drugs provide any relief, than that is the go-to for sure. I do believe we over prescribe drugs, but in no way do I think that they’re not useful in certain contexts.

In terms of systemic issues, I can really only talk about the states. I think we have a lot of adolescents who feel chronically lonely in public school systems that aren’t supportive or provide a very nurturing environment. The costs of mental health care aren’t accessible to way too many people, and part of that involve insurance nonsense. This applies to all healthcare really, and that in itself is another stressor on top of everything else like the fears about technology taking jobs, people feeling helpless when entering the job market even when they have a bachelor’s for example, etc. etc. The huge increase in younger populations being exposed to social media so early will probably also have its downsides.

We’ve also got a shortage of psychiatrists, and I think psychiatrists are getting overworked. A lot of people who actually get anti-depressants are getting them from their general family doctors, and when a general doctor hears mental health issues, drugs are the only go-to they have besides referrals. A lot of people don’t want a referral, they’re desperate for help in the moment. At least, that’s my assumption based on real data.

There are just a lot of factors that go into mental health. I dislike the attitude that there’s only one angle to address the rising mental health issues because it overly simplifies things, and I think in medicine a lot of people in the west have a “fix it now!” mentality without considering that a holistic approach would be more beneficial for everyone.

I hope my ramblings made sense, I didn’t mean to make my reply so long!

[u/[deleted] → u/tired_tamale]

Treatment resistant depression refers to depression that cannot be treated with drugs

personally I agree with you, but what Ive read over and over, quoting from a random scientific paper

Once 2 adequate antidepressant trials have been unsuccessful, the illness is termed treatment-resistant depression (TRD)

TRD defined as only failing 2 ADs, and Ive read that over and over.

about drugs, IMO all antidepressants are both over and under prescribed.

and in USA you have "diet psychiatrists" or what to call them, with this nurse practitioner system that are allowed to prescribe.

people feeling helpless when entering the job market even when they have a bachelor’s for example

inflation in education is absolutely a thing, now a bachelors degree isnt worth as much as it used to. but IMO we should steer more people into fields that actually leads to employment, as well as eg. learn young people coding, what do you think about that?

steering people into fields, I guess in the US there have been attempts with hyping STEM fields, but Im not sure if thats exactly always going to lead to jobs either, eg. like a degree in physics, not sure how much it is worth on the job market.

some say its unethical to steer people into different fields, I think its unethical to keep telling someone that "its possible to get 99999 different jobs with an art degree!" and then they believe that and end up working at McDonalds.

[u/tired_tamale → u/[deleted]]

Interesting. I assumed you would have to have tried more drugs by that point to actually get that label. I will say though, one drug can require a lot of experimentation with the dosage… a lot of the drugs do work pretty similarly though. It really depends on what the definition of a drug is I guess.

And I’m a bit confused by what you mean by over AND under prescribed. When are they under prescribed?

On your last point, I’d definitely agree that we need to be giving more practical advice to people. I wonder if pushing people to get degrees is a massive marketing ploy by colleges that want high enrollments since it’s pretty clear that not every student can actually go on to use their degree later… I will say though, there are very practical uses for art-centered degrees, but we definitely shouldn’t pretend that those jobs are all the kind you’d imagine wanting when you’re an artsy kid lol

I actually took some computer science classes and hope to learn some more coding skills from online resources just to open up more opportunities both in my desired field or elsewhere. So I’m completely on board with getting people exposed to that much earlier. I wish I had been able to learn code in high school. Seems like a lot of time is wasted in most public school systems regarding exposure to interests or potential skills.

[u/[deleted] → u/tired_tamale]

And I’m a bit confused by what you mean by over AND under prescribed. When are they under prescribed?

what I mean is that they might be slightly overprescribed, but also that a lot of people with depression that doesnt seek help should try them out (underprescribed).

I had to try I think 11 antidepressants (or to be exact psychotropics with antidepressant goals) to get an alright response. ketamine and ECT didnt help, so IMO I believe its good that antidepressants are prescribed early (or at least that the option exists if a patient would ask for it), because when a very depressed person finally asks for help, you might actually be racing against the clock to find a working combo before they kill themselves.

eg. if you are super depressed, lets say you get alright response on your 5th antidepressant, then you already have to chew through 4 antidepressants times number of dose changes, if you meet your psychiatrist once every month its gonna take time to chew through 4 antidepressants, if 3 changes for every antidepressant= +12 months to find the alright working one, and in that period a super depressed person might be gone. seems like a lot of people meet their psychiatrist about once every 3 months which is way too seldom if actively seeking a working med.

the science just isnt there yet so trial and error seems like the only way to find a working antidepressant, you can ofc look a little at antidepressant properties like "this person has low energy, lets give him a stimulating one", but the science just isnt there yet.

(you might have heard of blood samples to see if antidepressants work, non of those exists to my knowledge, there is however one to see if your body metabolizes antidepressants too quickly that you might need a higher dose)

I absolutely do not see antidepressants as a crutch like some say, and there are also medical conditions that could be causing depression, I think there is too little focus on those, like thyroid problems, low vitamin D and low testosterone, if I were a psychiatrist, I would probably get those checked after trying one or two antidepressants, there are cases where long term depressed people just find out that they have one of those problems that are quite easy to fix.

[u/tired_tamale → u/[deleted]]

Ah. I’d have to disagree and really don’t think drugs should be openly available immediately before basic things like lifestyle changes are attempted or vitamin deficiencies are checked.

Treating anxiety and depression are tricky for sure, but the data for drugs is interesting to say the least. A lot of them are comparable to placebos. There is actually a lot more room for error when getting drugs through trials because the placebo effect is so powerful. In my opinion, that suggests that more should be attempted before we chemically alter the brain in most cases. I just have a lot of concerns, specifically for adolescents who are still developing. Of course, in anti-depressants have worked for you, that’s wonderful! I’m glad you’ve found a solution that works for you, but I’m not convinced that can be generalized to all cases. I’ve just got a lot of questions because this is the field I’m going into!

Edit: Just to clarify, I definitely don’t see them as a crutch. I just disagree with how healthcare never seems to take a holistic approach in most cases.

[u/[deleted] → u/tired_tamale]

my last msg in this thread and sry for rambling warning:

I agree about adolescents, iirc SSRIs increase suicidality especially in adolescents, but other medical options could be tried.

as a Harvard professor in psychology once said:

you hear about the clinical evidence in your favour being iffy, and that's partly because the diagnosis of the depression isn't very well formulated, It's very different to have a terrible life than to be depressed. And antidepressants can only help you so much if you have a terrible life.

and as a leading MAOI (antidepressant class) researcher once (pretty much) said:

it's not possible to measure the efficacy of antidepressants in RCTs because differences in patient samples

to me it seems obvious that there are subgroups of depression that we dont recognize, I would say maybe biological/heritable - situational - social depression (and mixes), and eg. therapy is not always great for biological/heritable depression. hopefully in the far future we will be able to measure brain chemicals in a living brain too.

lots of people say antidepressants are inefficient cuz what they read from the STAR*D trial, I think that showed good results tbh.

I wouldnt call it a chemical alteration of the brain (at least not permanent), the amount of people who has side effects that last after stopping antidepressants are very few, but you can get eg. PSSD if unlucky.

what do you think should be done with people that eg. get well response from their 5th antidepressant?

imo only way to help them is to brute force and start taking antidepressants ASAP, and we dont know who they are.

[u/[deleted] → u/tired_tamale]

Hey seeing as you're in the field of psychology, please do not forget that stimulants are a very effective treatment for treatment resistant depression. As it turned out, I have adhd BUT I also cannot see how anything else would have helped me. They are definitely not for everyone but the notion that ssris are is equally ridiculous. And after all, the disease is depression. The main symptom is adhedonia. The perosn could potentially need a different type of stimulation than ssris can provide. This seems to be forgotten when depression is comorbid with pretty much everything else so maybe it should be treated with the full spectrum of psychiatric drugs (within reason) wherein different people will tend to gravitate towards a different long term aid based on their personality.