Why Antidepressants Need Set And Setting: Lessons From Psychedelics (Kozak & Miller, 2024)

Описание: I. Overview I: Set & Setting -- Not Just for Psychedelic Therapy
"Set and setting" are concepts usually reserved for psychedelic therapy.
New research suggests they are just as critical for standard psychiatry.
SSRIs & psychedelics share a common mechanism: Neuroplasticity.
Neuroplasticity: Brain's ability to adapt structurally & functionally.
This can explain the improtance of environment in psychedelic outcomes
(The brain responds to its environment).
Psychedelic Assisted Therapies enhance the brain's ability to respond.
This enhances the role enviornment can play on outcome and wellbeing.

II. Overview II: The "Undirected Susceptibility to Change" Theory
Posits SSRIs open a critical window of plasticity.
But DO NOT determine the direction of the neurplastic change/response.
This helps explain:
Why socioeconomic factors are strong predictors of treatment response.
Why some folks respond to antidepressants and others don't.
Why psychotherapy acts as the ultimate "setting" for recovery.
These findings can help inform decisions on:
Whether to start SSRIs (e.g., setting can help predict response).
Protocol development for psychedelic settings & psychedelic-assisted psychotehrapy.

III. The Mechanistic Overlap Between Psychedelics And SSRIs
New findings suggest a mechanistic overlap between these drugs.
Both compounds reopen critical periods of learning in the brain.
These are windows of high sensitivity to environmental input.
They modulate neurotrophins like BDNF to enhance plasticity.
This process allows neural networks to be reshaped by experience.
However, this plasticity is not inherently positive or negative.

IV. Understanding Undirected Susceptibility To Change
SSRIs may not fix mood directly but act as a catalyst for change.
This is known as the theory of undirected susceptibility to change.
The medication makes the brain more sensitive to its context.
If the environment is stressful, symptoms can actually worsen.
If the environment is positive, the medication facilitates recovery.
This explains why some patients do not respond to treatment.

V. How Socioeconomics Influence Treatment Outcomes
Socioeconomic factors are strong predictors of SSRI response.
Low income and unemployment are linked to poorer outcomes.
High doses of SSRIs amplify the influence of living conditions.
One study showed a 37-fold increase in socioeconomic effects.
Non-responders may simply be living in adverse environments.
Addressing these factors is crucial for personalized medicine.

VI. Psychotherapy As The Optimal Setting
Psychotherapy acts as a controlled, positive environmental exposure.
It provides coping strategies during the window of plasticity.
Therapy encourages healthy relearning despite life stressors.
It effectively serves as an extension of the pharmaceutical treatment.
This makes therapy essential rather than just optional support.
Integrating care helps guide the brain toward positive adaptation.

VII. Additional Resource Support
For additional resource support, please visit: https://notebooklm.google.com/noteboo...

VIII. Source
Kozak, Z., & Miller, C. W. T. (2024). Beyond psychedelics: set and setting in general psychiatric practice. International Review of Psychiatry, 36(8), 833–840. https://doi.org/10.1080/09540261.2024...

#neuroplasticity #psychiatry #mentalhealth #ssri #depressiontreatment #psychedelicscience #brainhealth #clinicalpsychology #mentalhealthawareness #psychotherapy #setandsetting #setting #naturevsnurture #neurogenesis #serotonin #criticalwindow

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