LW - Best in Class Life Improvement by sapphire

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Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Best in Class Life Improvement, published by sapphire on April 4, 2024 on LessWrong.
There is an enormous amount of crappy self-help advice. Most supplements do nothing. However, some substances and practices can dramatically improve your life. It's worth being explicit about what those are in my experience.
The American medical system endorses all of these treatments and methods, and you can implement them with a doctor's supervision. The only way I differ from the American medical system is that they operate under a paradigm of treating diseases or perhaps what might be better understood as serious deficiencies. But if a technique is powerful enough to help the ill it is plausible it can also help the well. Make your own choices and set yourself free.
Before reading this advice, it is important to note that
drug users use a lot of drugs.
In general, recreational drug users take their drugs at doses so much higher than psychiatric patients that they're basically two different chemicals. A lot of our impressions of drugs, what side effects they have, and how dangerous they are get shaped by the recreational users, not the patients. This is sometimes even true for the doctors who are supposed to prescribe to the patients and give them good advice.
While studies of recreational user populations can sometimes be helpful in flagging an issue for consideration, we should be judging the clinical risks based on studies of clinical populations.
Ketamine
Ketamine is extremely effective and extremely fast-acting. It often solves depression in a single day. Hence, it should be among the first things you try if you have mood issues.
From
Scott's writeup:
The short version: Ketamine is a new and exciting depression treatment, which probably works by activating AMPA receptors and strengthening synaptic connections. It takes effect within hours and works about two or three times as well as traditional antidepressants. Most people get it through heavily regulated and expensive esketamine prescriptions or even more expensive IV ketamine clinics.
Still, evidence suggests that getting it prescribed cheaply and conveniently from a compounding pharmacy is equally effective. A single dose of ketamine lasts between a few days and a few weeks, after which some people will find their depression comes back; long-term repeated dosing with ketamine anecdotally seems to work great but hasn't been formally tested for safety.
6: How effective is ketamine?
Pretty effective.
Studies find the effect of ketamine peaks about 24 hours after use. A
meta-analysis finds that by that time, around 50% of patients are feeling better (defined as 50% symptom reduction) compared to less than 10% of patients who got a placebo. A
more recent Taiwanese study finds roughly similar numbers.
Another way to measure effectiveness is through effect size statistics. The effect size of normal antidepressants like SSRIs is around 0.3. The effect size of ketamine is between
0.6 and
1.0, so about two to three times larger.
Ketamine is a psychoactive drug. The state it induces is hard to describe, but it can be psychedelic in its own way. My advice is to take enough ketamine that you are clearly quite high but not so much you are 'out in space.' Ideally, the experience won't be very scary. Ketamine is very short-acting. The peak high should only last about 45 minutes, and the total trip should be under two hours.
I recommend either doing a very simple breathing meditation (described in detail later in this document) or enjoying media you find uncomplicatedly pleasant. Watch a nature documentary about trees. Don't watch one about predators. Listen to music that makes you happy.
It's important to get your setting right. Moving around on ketamine makes people nauseous. So, have water and nausea meds (ondansetron or Dramamine) rig...