Alexandre Liblik🍄🌵

Psiconauta e músico ruidoso por milímetro. Médico em permanente desconstrução. Navegando com o chão em chamas (Piroceno)

[Alexandre Liblik🍄🌵 @ALiblik]

Ou seja, "diagnosticos" psiquiatricos não são diagnósticos...

[JAMA Psychiatry @JAMAPsych]

This narrative review suggests mental disorders are statistical clusters of biopsychosocial properties, not sharply defined categories, mirroring concepts in species classification and supporting dimensional #MentalHealth frameworks. https://t.co/SfES3sUTlh

[Julie Holland, MD @BellevueDoc]

Efficacy and Safety of a Single Dose of Psilocybin for Chronic Suicidal Ideation: An Open-Label [no placebo] Trial

https://t.co/0MYaWtMHMr

[Mark Horowitz @markhoro.bsky.social @markhoro]

“When in doubt or there are uncertainties, blame patients”

I am glad Awais wrote this piece because it is a very useful summary of where I think most psychiatrists are and it is useful to see it laid out in his mostly careful and thorough style. Given how much Awais is a bellwether for mainstream opinion from psychiatry (the irony of his blog being named ‘from the margins’!) it is important to respond to it which I will do in the next few days but just wanted to comment quickly.

It is riddled with errors and misunderstandings of the theory and evidence for withdrawal and hyperbolic tapering (the section on receptor occupancy is particularly full of howlers – this is the double edged sword of blogs. They allow people to put out work quickly but there is no peer review which would normally catch basic errors before they are put out to thousands of people) but it also raises some useful points about holes in the field and points for research, many of which I agree with (e.g. where is the line between an injury due to exposure and an injury due to withdrawal).

What I find most concerning about it is the overall tone of it is written as a ‘gotcha’ piece to expose what he believes to be inconsistencies and illogic in the experience of large numbers of patients (and the researchers and intellectuals that work in this area). Some of his ‘gotchas’ are based on misunderstandings of the science or erroneous conclusions, which can be clarified.

But what can’t be altered is his desire (and I am not pointing the finger at Awais specifically, he is just the most outspoken and articulate of his cohort) to reveal that patients are wrong. Transparently, this is because it is couched as an ‘us against them’. If patients and the research that ‘supports’ their experience is valid then it puts psychiatrists in a difficult position of having to grapple with prescribing treatments that cause devastating consequences for a portion (and not an insignificant portion) of patients. Easier to blame the patients.

And this is what he does at every point of uncertainty. Instead of saying ‘hmm, this is pretty concerning: there are people experiencing debilitating symptoms years after stopping antidepressants (like for many classes of psychiatric drugs and matching the neurobiological evidence of similar long-lasting brain alterations) I wonder what the hell is going on here?’ he jumps to saying ‘this makes no sense (based on a few throw away assumptions and no careful reading of the literature)’ and these patients must be hysterical or ill in some way.

The same thing was said in response to tardive dyskinesia from antipsychotics (said for years to be due to the illness), to withdrawal effects from benzodiazepines, to PSSD for antidepressants, metabolic effects from newer antipsychotics, etc, etc. It is a common response from a discipline that often feels itself on fragile ground and finds it more convenient to blame patients for the issues caused by its treatments.

I agree with Awais that there are unexplained phenomenon in withdrawal but I wish that Awais (and other psychiatrists) came at this in the spirit of open-minded inquiry and concern rather than a desire to dismiss, minimise and belittle. This really does prompt me to have to update my blog on ‘why doctors don’t see withdrawal’ in which I was trying to be as sympathetic as possible to doctors, acknowledging that at some point I also had no idea about withdrawal. But I need to add an important factor that doctors don’t want to see this because of all the implications for them.

[Alexandre Liblik🍄🌵 @ALiblik]

https://t.co/FFGJqhMgLi

[Marc Landers @marclanders]

These reports are based on two studies, both of which are fatally flawed. I posted about both yesterday.

Study 1 failings, https://t.co/yu0G3cnsgg

Study 2 failings, https://t.co/Ig17H3e4G2

[Alexandre Liblik🍄🌵 @ALiblik]

O cientista: Cannabis não demonstra benefícios em estudos.

Como concluiu isso?

A partir de mais uma meta-análise mal desenhada.

Concordo com a escassez de evidências definitivas mas tem gente que escolhe qual é o artigo ruim que vale só pra poder lacrar.

[Jose Gallucci @josegallucci]

👉Para a surpresa de zero pessoas da área de saúde mental. Cannabis medicinal, no caso o Canabidiol, é outra hype que não se sustenta cientificamente, salvo p/raríssimas situações.

[Alexandre Liblik🍄🌵 @ALiblik]

@reumalho Cara. Voce precisa ampliar teu conceito de "patologia". A cannabis pode trazer beneficios sim para diversas condições funcionais. A nao ser que considere as condições funcionais como "frescura" e nao como causas de sofrimento reais.

[Marc Landers @marclanders]

Medical cannabis isn’t an effective treatment for anxiety, depression or PTSD, new research shows

Part two. Here's the second study the media are peddling. Bookmark this too for prohibitionists.

Here are the failings of this study.

Heavy reliance on low-quality or observational evidence

— Much of the data comes from observational, cross-sectional, or retrospective studies rather than high-quality randomized controlled trials (RCTs). These designs struggle with confounding factors (e.g., people with more severe symptoms may self-medicate more, reverse causation where mental health issues lead to cannabis use rather than vice versa, or co-use of tobacco/alcohol not fully controlled). Critics note that conclusions about risks (e.g., worsening mania in bipolar disorder or increased psychosis) often rest on these weaker sources, while the absence of strong benefits may partly reflect the lack of rigorous trials rather than definitive proof of no effect.

Insufficient high-certainty evidence overall

— The review itself repeatedly highlights "low-certainty," "largely insufficient," or "poorly studied" evidence for both benefits and some harms (e.g., long-term effects on anxiety, depression, ADHD, or PTSD). This is a failing of the field more than the review, but it means strong negative claims (e.g., "no clear benefits") can feel overstated when data gaps persist. Emerging evidence for CBD alone in anxiety is noted as low-certainty but promising, yet not emphasized as much as risks.

Limited long-term, prospective data — Many associations (e.g., 2- to 11-fold psychosis risk in adolescents/young adults with high-THC use) come from observational cohorts with potential residual confounding. Reverse causation or self-medication bias is hard to rule out entirely, especially for conditions like anxiety or depression where people report using cannabis to cope.

Link in the comments. 👇

[Alexandre Liblik🍄🌵 @ALiblik]

@Kevin_McKernan Shamanic cosmotechnics envisions diplomacy between different agents. Western cosmotechnics assumes that everything is object materiality, without the capacity for agency.

[Alexandre Liblik🍄🌵 @ALiblik]

@Kevin_McKernan Exactly. It is the perception of ontological reality (or the perception of its dissonance) that is therapeutic. This is, in fact, the difference between the use of these substances by different worldviews.

[Alexandre Liblik🍄🌵 @ALiblik]

@TheProjectUnity https://t.co/7P420kHHGD

[Alexandre Liblik🍄🌵 @ALiblik]

@jvbessa https://t.co/AvynfMFMRN esse aqui tambem...

[Alexandre Liblik🍄🌵 @ALiblik]

@DrMcFillin well...the "antidote" for mdma (an empathogen) is serotonin reuptake inhibitors... it is meaningful

[Alexandre Liblik🍄🌵 @ALiblik]

@marclanders I agree, very nice work indeed!

But there are issues... any thoughts about this? -> https://t.co/6d21dkYdps

[Alexandre Liblik🍄🌵 @ALiblik]

@algekalipso Nah, Pyrocene

[Alexandre Liblik🍄🌵 @ALiblik]

@kochkochkochk A gente está dando voltas...

[Alexandre Liblik🍄🌵 @ALiblik]

@alieninsect I've been working on that the last 10 years. Now I am starting to write about it. I am glad that I see you are in the same way of reasoning😉

[Alexandre Liblik🍄🌵 @ALiblik]

@RCarhartHarris "psychedelic use specifically in illegal contexts"

I understand what they mean...

[Alexandre Liblik🍄🌵 @ALiblik]

@Grandaddy Cant see Brasil there... come on guys!