Does Anaesthesia Prove Ketamine Placebo?

Source: Astral Codex Ten
by Scott Alexander

“Ketamine is a dissociative drug — it produces weird drug effects like feelings of bodylessness and ego death. Recent research suggests it’s a powerful antidepressant. Usually we would try to run placebo-controlled trials. But it’s hard to run a placebo controlled trial of a dissociative. Either you feel bodylessness and ego death (in which case you know you’re getting the real drug) or you don’t (in which case you know you’re in the placebo group). Sometimes researchers try to use an ‘active placebo’ like midazolam — a drug that makes you feel weird and floaty. But weird and floaty feels different from bodyless and ego-dead. The authors of the recent study go further. They recruited depressed patients who were going into the hospital for routine surgery requiring anaesthesia. When they were anaesthesized, they gave them either ketamine or placebo. Then after they woke up, the researchers asked the patients how depressed they were.” (11/14/23)