The problem with psychoactive drugs, as I understand it, is not the lack of positive results. There are plenty of well recognized cases.
There is a long way to go toward solid research on this topic. The studies that exist have small sample sizes and usually very limited monitoring periods after the dose, which makes them extremely prone to placebo effects. There’s no real blinding in a study with powerful psychedelics, so long-term comparisons against active comparators (therapy, other antidepressants) are needed.
There is a lot of reporting that would make the studies seem like slam-dunk, case closed results, but every study I’ve read so far has felt very weak compared to traditional antidepressant studies. That’s expected for early stage research, but it’s going to take a lot more to quantify the treatment effects.
The problem is the the unpredictability, because there are plenty of catastrophic results too, and we don't really know why.
The studies go to great lengths to have controlled circumstances like therapists monitoring and guiding the situation for hours, including integration sessions afterward in a lot of the studies.
This helps control the situation for those studies, but it’s hard to translate that to real world practices. If the current proliferation of poorly-run ketamine clinics by cash grabbing providers is a clue, it would be really hard to ensure the level of trained therapist oversight that happens in these studies if this every becomes mainstream.
There’s also the big problem of occasional majorly negative outcomes, as you noted. There are a lot of reports around the internet of even seasoned psychonauts who eventually had a trip that left them depressed or dissociated for months. For the longest time these anecdotes were dismissed as having triggered an underlying mental health disorder as a way to avoid blaming the drug. The advice was always that people with mental health problems shouldn’t take the drugs. Well now that we’re talking about using these as antidepressants (maybe) then it would be exclusively people with severe mental health conditions taking them.
I don’t think it would take very many severely negative public cases to shut it down or at least severely restrict it.
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There is a long way to go toward solid research on this topic. The studies that exist have small sample sizes and usually very limited monitoring periods after the dose, which makes them extremely prone to placebo effects. There’s no real blinding in a study with powerful psychedelics, so long-term comparisons against active comparators (therapy, other antidepressants) are needed.
There is a lot of reporting that would make the studies seem like slam-dunk, case closed results, but every study I’ve read so far has felt very weak compared to traditional antidepressant studies. That’s expected for early stage research, but it’s going to take a lot more to quantify the treatment effects.
The studies go to great lengths to have controlled circumstances like therapists monitoring and guiding the situation for hours, including integration sessions afterward in a lot of the studies.
This helps control the situation for those studies, but it’s hard to translate that to real world practices. If the current proliferation of poorly-run ketamine clinics by cash grabbing providers is a clue, it would be really hard to ensure the level of trained therapist oversight that happens in these studies if this every becomes mainstream.
There’s also the big problem of occasional majorly negative outcomes, as you noted. There are a lot of reports around the internet of even seasoned psychonauts who eventually had a trip that left them depressed or dissociated for months. For the longest time these anecdotes were dismissed as having triggered an underlying mental health disorder as a way to avoid blaming the drug. The advice was always that people with mental health problems shouldn’t take the drugs. Well now that we’re talking about using these as antidepressants (maybe) then it would be exclusively people with severe mental health conditions taking them.
I don’t think it would take very many severely negative public cases to shut it down or at least severely restrict it.