Does Anaesthesia Prove Ketamine Placebo?

A methodological critique of the study that gave depressed patients ketamine-or-placebo under surgical anaesthesia (so they couldn't tell which) and found no ketamine advantage. Scott resists the 'ketamine is placebo' reading: the 15-point MADRS drop in BOTH arms is a real, too-fast-for-regression placebo effect (relevant to the anti-placebo-effect crowd he'd criticized); real effects are hard to detect atop saturating placebo; propofol (used in 88%) is itself an antidepressant; ketamine may not work while unconscious; and MADRS on post-surgical day 1 is confounded (surgery disrupts appetite/sleep/concentration). Concludes the study rules ketamine out as a cure-all but not as a 0.5-0.7 effect-size antidepressant, consistent with his own low-dose clinical experience.

Quality 71 · Strong. Strong: a clear, expert, useful takedown of an over-interpreted headline study, marshalling four distinct confounds plus clinical experience; solidly Strong.

Claude’s paradigm shift 48 · Moderate. Moderate: careful application of standard psychopharm/statistics reasoning; little novel frame.

Real-world impact 2 · Minor. Minor/within-blog: a study critique with real clinical relevance but no direct material footprint.