Opinion | Why Do We Think Suffering Is Good for Us? - The New York Times - 0 views
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as a psychiatrist — and an admittedly impatient one — I know that just because something feels bad doesn’t necessarily mean that it’s good for you. I’m pretty confident that people who are suffering prefer relief sooner rather than later and that if there was any way to make the treatment — be it psychotherapy or medication — more effective, they would gladly try it.
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So I am cautiously optimistic that on Tuesday, the Food and Drug Administration approved esketamine, a nasal version of the drug ketamine, which appears to relieve depressive symptoms far faster than other antidepressants.
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I have been wondering if esketamine could be used for another purpose, too: to strengthen the effects of therapy. This is because it targets the neurotransmitter glutamate, which plays an important role in learning and memory.
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There is intriguing neuroscience research that suggests that it may be possible to boost the efficacy of psychotherapy with drugs that share some of ketamine’s effects, somewhat the way athletes can enhance their performance with steroids
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How might this work? D-cycloserine is an antibiotic that, like ketamine, increases the activity of glutamate in key brain regions, which promotes connections between neurons. It seems to amp up the molecular machinery of learning. And psychotherapy is all about learning — to overcome fear and to better handle stress, among other lessons.
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For decades, psychoanalysts were against medicating anxiety at all, because they believed it would interfere with the therapeutic process. Fortunately, those days are largely over. Many are now comfortable giving patients anti-anxiety benzodiazepines like Klonopin if they are having a hard time grappling with issues that arise in therapy.