I agree it is interesting that ketamine seems to work very quickly for some people. Re: your placebo comment, I also agree it's hard to separate it out.
One of the tricky things with the placebo effect is that there are really multiple distinct types of placebo effect; on the one hand, you have objective measurable biological changes that placebos can trigger, but on the other hand placebos can also affect peoples' subjective perceptions of the symptoms they're experiencing.
In the case of depression though, the subjective perception of misery is the core problem we're trying to fix. Hence why treatments that have no biological effect (like, e.g., therapy) are still considered valid approaches. So, then the question is, does it matter whether ketamine is just a placebo? Maybe all antidepressants are placebos, in which case the important thing is to find the safest, most effective, fastest-acting placebo we can.
Really though I do kind of think peoples' subjective experiences matters in a more concrete way than folks give credit for. Even though it's not directly modifying your brain chemistry, I wouldn't call therapy a placebo, for example. Maybe sometimes medications help people because beliefs like "someone is trying to help me" or "I've found an explanation for why I feel bad and there's a treatment for it" actually help people break out of their self-destructive patterns, regardless of the actual efficacy of the meds. It's more questionable though whether those beliefs actually help with long-term root-cause fixes though, or if they just trap people in a local maxima.
I agree it is interesting that ketamine seems to work very quickly for some people. Re: your placebo comment, I also agree it's hard to separate it out.
One of the tricky things with the placebo effect is that there are really multiple distinct types of placebo effect; on the one hand, you have objective measurable biological changes that placebos can trigger, but on the other hand placebos can also affect peoples' subjective perceptions of the symptoms they're experiencing.
In the case of depression though, the subjective perception of misery is the core problem we're trying to fix. Hence why treatments that have no biological effect (like, e.g., therapy) are still considered valid approaches. So, then the question is, does it matter whether ketamine is just a placebo? Maybe all antidepressants are placebos, in which case the important thing is to find the safest, most effective, fastest-acting placebo we can.
Really though I do kind of think peoples' subjective experiences matters in a more concrete way than folks give credit for. Even though it's not directly modifying your brain chemistry, I wouldn't call therapy a placebo, for example. Maybe sometimes medications help people because beliefs like "someone is trying to help me" or "I've found an explanation for why I feel bad and there's a treatment for it" actually help people break out of their self-destructive patterns, regardless of the actual efficacy of the meds. It's more questionable though whether those beliefs actually help with long-term root-cause fixes though, or if they just trap people in a local maxima.