Psychedelic medicines offer hope for veterans with depression, post-traumatic stress disorder, substance abuse disorders, and generalized anxiety. A new research study indicates that hope, by itself, is an important factor in the improvement of depression. The study by doctors at Stanford University showed that depressed people who believed they had received ketamine for their depression felt better and scored better on tests for depression. How are psychedelic medicines and hope related?
Lack of a Control in Prior Studies of Ketamine
Ketamine has been found to be effective in treating depression. However, one issue remained that bothered researchers. When someone takes ketamine they generally have a hallucinogenic or psychedelic experience. When they took a placebo it was clear to them that they were not getting ketamine. Over a period of time researchers at Stanford found depressed patients who needed surgery with anesthesia. They used ketamine as the anesthetic in some of the patients and another, non-psychedelic anesthetic in other patients. Thus, patients who received ketamine and those who did not did not know which treatment (or placebo) they received. Both patients and the researchers only found out which was given, treatment with ketamine or placebo, two weeks later after patients were interviewed and tested for depression.
Hope Treats Depression
The results of this study surprised the researchers. Patients in both the ketamine and placebo groups experienced substantial relief of depression. In both groups the degree of improvement was consistent with what is usually seen with ketamine treatment. Patients who improved had substantially less depression as measured by the Montgomery-Asberg depression rating scale within a day of their treatment and the improvement lasted throughout the two weeks until follow-up. The clinical improvements seen were from severe depression down to mild depression.
When patients were interviewed at follow-up, those who felt better believed that they had received ketamine even when they had not. It is unlikely that surgery itself caused improvements because prior studies have shown that having surgery either does not change depression or, often times, makes it worse. The researchers believe that expectations of getting better by getting an effective treatment for depression caused some of the folks who got the placebo to get better even when they did not receive ketamine.
Guessing Which Treatment Each Patient Received
At the very end of the study, the researchers asked their patients which treatment they thought they had received. Six out of ten guessed that they had received ketamine. What surprised researchers was that the guesses matched the improvement of their depression and not the treatment or placebo that they received. If a person felt better, less depressed, they tended to guess that they had received ketamine. If they did not experience much or any improvement they guessed that they had received the placebo.
Expecting the Best and Getting Better
The researchers referred to this finding as expectancy bias or hope. To a degree this makes some sense with depression because part of depression is the loss of hope or positive thoughts about life. Whatever instills positive thinking has the potential to improve depression. That having been said, what about the ability of psychedelic medicines to help rewire the brain, grow new neurons, and improve cross connections in the brain? To what degree are these important in treating conditions like depression. To what degree do physical things like this happen when a patient becomes hopeful for whatever reason?
What Combines Hope and Ketamine?
In their discussion of findings in this study the researchers noted that μ-opioid receptors in the brain, which process pain, may be affected by ketamine and by a hopeful attitude. This leads the researchers to believe that more research needs to be done in regard to hope, positive expectations, or the placebo effect. There is, they say, a physiological mechanism going on between one’s ears that makes a person with depression get better simply because they expect to!
One finding of this study is that you do not necessarily need to have a psychedelic experience with ketamine for you to get an improvement of depression because folks who got ketamine and got better never had a “trip.” It occurs to us that we see this sort of help with conditions like depression when we seek out veterans in need who are isolated, depressed, fighting PTSD, or have fallen into substance abuse. Having someone to talk to and a glimmer of hope in life can make all the difference in the world!