News Ecstasy... A Possible Treatment For PTSD

[heidi]

Once LSD cured my migraines for a year. I wonder what that was all about.

 

[Philippa]

One of the experimental studies I participated in used ketamine in the active treatment arm. Ketamine is also an NMDA antagonist - like MDMA - but not as much a shotgun approach to extinction of the fear wrought by the amygdala. The ketamine doses were modest and given over the course of an hour and gauged not to do any permanent damage. MDMA on the other hand can cause permanent damage to receptors due to toxic levels of glutamate release. No one should think that doing Ecstasy is going to cure them.

I agree...it doesn't cure them, but it can open their hearts up long enough for them to have a taste of what is possible for them, with enough of the proper therapy.

 

[Girl3]

When I got the ketamine infusion I felt as if my body were extremely heavy but at the same time floating about 2 feet off the hospital bed. I felt as if I couldn't move. So I would move my legs, or my hands to make sure that I could. The IVs and the monitors kept me from moving too much.

There was a point during the infusion where I thought I needed to rip out the IVs and run. So instead I joked with the anesthesiologist while the psychology student asked me the questions regarding my traumas and my reactions. It took about an hour for the infusion part.

They would come back every so often and ask me questions regarding the traumas - seeing if things changed from before the infusion, during the infusion and after. I stayed in the hospital that night, and had two more question sessions with my psychiatrist the next day.

I felt so normal and relaxed the next day. It was miraculous. But not long lived I'm afraid. We were in New York City and I was trying to go to the bathroom in a public bathroom when a woman stuck her face up to the opening between the door and the wall, staring. She would leave. I fell apart in the public restroom - my mother was obsessed with my bowel habits and was always watching me, giving me enemas, making me eat only foods that would produce a bowel movement. Suddenly I was pushed back to being a child. I couldn't move or speak.

I finally got my brain together. Upon exiting the bathroom my husband announces very loudly "Where the hell have you been." Very angry tone of voice.

I keep waiting for ketamine infusions to become a treatment - but next time I want to go someplace without my husband and avoid getting into a situation that would trigger me.

MDMA scares me a bit, simply because it can destroy the nucleus acumbens. I can't practice medicine without the ability to take information and put it into immediate and long term memory.

 

[freefloat]

I hope this is the right area to post this.(OK i didn't and now its over here)

Here is a link to the [DLMURL="http://www.maps.org/research/mdma/"]http://www.maps.org/research/mdma/[/DLMURL] site. Has a lot of sound scientific data about the use of MDMA to treat PTSD. It not a maintenance protocol as that would be ridiculous. Its a protocol that has had some great success in studies through the world. Secondary studies are being done in more countries. The patient takes some clinical MDMA and discusses their trauma with a psychologist. This is done a finite amount of time with some showing great success.

It’s been a few days since I posted the above. Anthony brought this to my attention. Can I share? There is a lot on that site and I'd just like to point out some information.

I find it odd about the Norwegians 'News' article as at the time of their releases this had been in clinical trials for several years with the protocol being developed years prior. With the first clinical trial starting in 2000 In Spain. The next study to be completed was an American one in 2010.

From their new release:

On July 19, 2010, the results of this study were [DLMURL="http://www.maps.org/mdma/ptsdpaper.pdf"]published in the Journal of Psychopharmacology[/DLMURL]. Our paper was the journal's most downloaded article in 2010.

On July 27, 2010, data collection was completed for the long-term follow-up to this study. We collected Clinician-Administered PTSD Scale (CAPS) measurements from 17 of the 20 subjects who received treatment. All 20 subjects filled out a questionnaire developed internally to assess long-term effects. The average length of time between the final experimental treatment session and the follow-up data collection was three and a half years. Preliminary analysis of the results suggests the benefits of the treatment were maintained. The data is currently being analyzed and Dr. Mithoefer and colleagues will write a new paper for submission to a scientific journal in January 2012.

Now being further studied in: Australia, Canada, Israel and Switzerland. It can be challenging to get across the ridiculous notion of waking up, dropping E and of you go for the day. Like one would with other meds of a similar pharmodynamic.

A few things I'd like to address from previous posts. Most of the stuff sold on the street as MDMA and know as Ecstasy is usually speed. At times it can contain more nefarious chemicals. There have been 18 deaths in Western Canada in recent months from drugs been sold as E. Its not MDMA that is killing people. In clinical form it has a very low risk of injury. Same thing with heroin. Can be to strong or have dangerous other drugs in it and people die. Id never touch the stuff thank you very much. But when I’ve needed analgesics in the hospital and they give me morphine i don’t refuse it due to the dynamics of street heroin. The typical dose they give in the study is 125mg. Far below any toxic quantity. Street E and clinical MDMA have much different profiles.

The coroner in New York City did a study a few years back. He wanted to know if E was in deed killing people. 70,000 cases were examined were approx 16 had MDMA on board. In ALL cases E did not play any part in the death. Compared to 1,200 or so deaths from averse reactions to prescribed medications. In its self and taken in moderation has a very, very low risk of injury.

I read the protocol and for the test subjects to be accepted they had to have taken it less than 3 times in their life. I believe they all had never taken this. They all had treatment resistant PTSD. The progress they made has been very encouraging. After 2 session of MDMA therapy. It is used as an adjunct to therapy.

Its not a magic bullet. If it was, I'd been cured years ago. Not saying it is, it helps. MDMA was banned in 82 or 83 in the states and soon around the world. Banned meaning a schedule 1 drug IE. no therapeutic use. It had been used for years by T's and had overwhelming anecdotal evidence. That was ignored and no time to study and present scientific support of its efficacy.

It will be years before this treatment will be available. The US group is undergoing follow ups. The data so far is looking to be very encouraging. I believe in informed consent in medical and psychotherapy. There’s some more info. If someone gave me the choice of MDMA or the mind wrenching, suicidal making, paranoia, hypo-manic causing SSRI. I'd feel a lot safer in a room with a doc and a therapist with some Cat Stevens playing softly in the background. Rather than rattling around my house on my own in the SSRI state of mind. I'd chose the former.

 

[Girl3]

Freefloat - very informative posting, and your facts are indeed facts. I do remember the data of the NY medical examiner. When I spoke about MDMA destroying the nucleus acumbens, that is from brain scans in people who use it more than three times in their whole life, like weekend partying.

I worry when people see research articles wherein they're using medical grade pure drug in known parmacological doses - and then go out and try stuff off the street.

Ketamine is a drug that I have given to people over the past twenty years as an anesthesiologist. It also has been shown to be neurotoxic especially newborns. I wouldn't use it on myself even now after having gone through the experimental trial. But if I had the choice of going through the infusion again, being watched over by both an anesthesiologist and a psychiatrist - I'd do it in a heartbeat.

Harkening back to the 60's and 70's, in my hometown we had people who dropped acid and did PCP. I hung out with those people. (They were the antithesis of my rapists who were clean-cut basketball heroes.) I never did anything but try pot, mushrooms, and some stuff called DMT - it all made me feel panicked and horrible. It is one thing to be in a highly controlled experiment versus being at home, alone or with people who cannot help you should you become suicidal.

After the study I currently am in, the next one I am slated for is a trial involving a pure cannabinoid, pill form, because it works on all the upgraded receptors that PTSD folk have in their brains. In the Phase I trials it doesn't make people high - just gives them a sense of calmness. But those were people without PTSD. There is a very real chance that in the PTSD patient the effect could be one of terrible paranoia - they don't know yet. But I will be in a hospital setting when I take it, fully monitored.

 

[freefloat]

Thank you for the validation of my facts. I wasn’t aware of that consequence. I used to see people get tachycardia from its cousin MDA back in the day. So my brain is still safe. Whew. :)

Yes I share your concern. I would imagine informed consent would help eliminate a lot of the risks. It's been shown that when people have the right information and constantly right they will listen. How ever with drugs of use, abuse and addiction we face a climate that sees accurate information as condoning its use when that’s not the issue. I worked in the addictions field for 18 years mostly in opioid replacement therapy. I brought an anesthetists on board so that we could assist people with proper pain management, asses for and treat addictive issues the patient may be struggling with. We ended up triaging a lot of 'difficult' cases for the GP’s in town. Was a great synergy. Yes it was very controversial work and I had a struggle getting the evidence accepted. Not doing so lead people to unnecessary suffering and death.

OK I've k-holed on LSD, MDMA and marijuana cigarettes and im still symptomatic. Where did my research go wrong? Next thing you'll tell me that you people give out rat poison in hospitals? ;) Do you support that prolonged and extreme use of K (3.5gr, 7/7, IV) can remove the lining in the bladder? I ran across that recently on National Geographic documenty on Ketamine. Drink 20l of water in an hour and see how you feel. Everything needs to be managed, as everything can be dangerous even water.

DMT is back. I was offered some last summer. I haven’t looked into it so i didn't take any and was unsure of the source. I have to say I thought it left in the early 70s. I came of age in the 70s. Did allot of drugs. Thought I was a limited only by my finances and availability. I think if weren't for LSD i would have suicided as a teen. Self medication.

I find it odd that the media's lens is always looking at the issue from the wrong end. Threre was a tragedy in Calgary lats December where an 18 yr old man died from E. He had been drinking heavily in a bar and took some E. He was kicked out of the club with no coat nor shoes. It was -12C out. Approx 1.5 hours later his friends found him and took him home. After some grilling the parent learned he had taken some E. The 18 yr old was shaking and incoherent. He was taken to emergency where he died from internal organ failure. It seems to me hypothermia was overlooked due to an incorrect understanding of E and its effects. Was the sole focus and deemed causal.

I had a heck of a fight convincing people what we were doing was safe and appropriate. I know I was able to change substantial policies that lead to less misery and lost lives. With just the facts presented articulately and assertively. You should have seen what i did to the D.A.R.E. guy. Oops, sorry officer. Whats next Docs and T's lecturing on the criminal code? I better stop there.

I am very interested in learning more on your study use K. Is it at MAPS? Is the canabanoid THC or ?. Came across crystal 'T' in the late '70s a few times. Apparently was synthetic or chemically extracted THC. Real body stone.

I coomend you for the work you do and the work you will undertake to get some more tools in the kit. I can imagine the adversity you may receive for it.

Sincerely
Freefloat: PTSD sufferer and Harm Reduction pioneer.

 

[Girl3]

Ah Freefloat - more like pressured speech and flight of ideas hon.

DMT - one of the ketamine/PCP type drugs - it was put on pot and smoked. There was a comedian in the 70's whose skit was about a clay-mation cartoon character who forgot how to breathe because he smoked DMT. It stopped time. It made you 100 times heavier than you were but you were able to see a fly actually fly - but you couldn't do anything. Your heart pounded inside your chest like a huge kettle drum - but slow. Awful stuff, but in 1975 it didn't seem like such a bad thing considering some of the reality I had been through.

The reason experimental situations are "better" is several fold: you are getting pure drug without fillers, substitutions, excipients, etc. You are being monitored both physiologically and mentally/emotionally. Your thoughts are being examined via questions, observation, recording. It is a very safe environment when you undergo a well run study. Like being in a womb of sorts.

I underwent the ketamine study at Mount Sinai in NYC. The PI has changed, but I think some permutation of that study is on-going. Ketamine all alone would be a trip I would be unwilling to take. LSD was not something I wanted to play with - likewise PCP. I knew I was suicidal and so stayed away from things that I observed people getting too far away from reason. (Weird sentence, but cogent - I think.)

THC is not pure per se. There are compounds more pure than that which are yet to be named. The study I will be eventually in still has a number. The one I participated in last year which was a short half-life cannibis derivative for the purpose of looking at receptors, was almost like anti-pot. I laid in a PET scanner for 2 hours and 21 minutes while they looked at what this drug did in my brain. I shook - whole body tremors, crying uncontrollably, it was horrific - but this is how we will win this war.

And you're right - even water can kill you if you take in too much at one time or it is salty instead of fresh.

Getting high or stoned is just another way to numb up emotionally and numbing doesn't fix PTSD.

 

[Hashi]

Surely there are therapeutic risks too? Like, the client trusting a therapist not because that trust is deserved but because they're stuffed with chemicals. Or, impairing their judgement about how much to disclose/face, at what pace, and whether the therapist is right for them to be doing that in the longer term. Or, down the line, finding it hasn't been the therapeutic journey that it would have been otherwise, learning to trust and accept support, managing to establish healthy boundaries and behaviours and finding it in themselves to face down demons rather than bypassing that with a bottle of pills.

Sounds to me like yet another magic bullet that will turn out to be not that great after all. Some benefits, some risks, maybe some side effects (medical or psychological), some people it won't work for anyway, some people who'll miss out on a more effective approach because of it. How many times have we been there before? If all the wonder drugs of yesterday had really turned out to be so wonderful, no-one would need to look for another.

I'm trying to be reasonable, but really my main reaction is - sounds like a good way for lazy or not very good therapists to get some results.

 

[Girl3]

The logistics of all studies is benefit vs risk vs population efficacy, so you're right in many studies there is some inherent risk. Phase I trials just look at does this drug make your skin fall off or your hair turn green - not whether it works. I won't participate in a Phase I trial. You don't know what the side effects are going to be.

Phase II trials are based on some known action of a drug being likely to benefit a study population who has the problem. I have participated in several Phase II trials. These are typically randomized - so 50/50 chance you get active drug at some point. If it is a cross-over trial, then you will get active drug, but it may be in the first part and you'll get placebo for the second part. The great part of Phase II trials is that you will be tested repeatedly to see how you are doing.

PTSD can be helped considerably by cognitive based therapy - but the time to change the brain is long. The new drugs are looking for ways to heal some of the messed up physiology, while you also work on cognitive therapies so you don't wind up returning to the scene of the crime.

And just like in high blood pressure or diabetes or high cholesterol, not all patients respond the same to any given drug. PTSD isn't going to be different. There will be more than one treatment, possible several overlapping or serial treatments. But we are a long way off at this point of any drug that magically heals the PTSD brain.

There are therapists who are not as capable at helping those with PTSD as they are someone with ADHD. There are no good PTSD psychiatrists where I work or where I live - so I participate in trials and I do e-therapy/phone therapy and make periodic personal appearances at the university where my psychiatrist does some of his research.

 

[freefloat]

Preamble: Thought this would be a brief response to a comment. In the following I in no way condone the use of illicit substances to manage mental health issues. There are other options. Hopefully we will see logic and reason provide for more efficacious options, I believe we are seeing this in the MDMA trials. The argument for those treatments should be placed where it belongs in the data. Not the political/legal arena. The war on drugs is a war on people. It has accomplished nothing but misery, crack cocaine, poison sold as near harmless substances, a drop in the cost of heroin and cocaine by 80%. Billions spent in health care and legal interventions that could be avoided. Unmeasurable loss of life and human suffering. That has effected the options we all should have access to. Options we should be evaluating with informed consent. Not rejected due to being brain washed of critical thinking and mein kamphesque propaganda techniques. Ie. shout a lie often enough and loud enough people will see it as truth.

I like others I write in this from as way to heal from what has partially brought me to live this misery of PTSD. One year I lost 26 people I know. 25 due to drugs(od, homicide, pickton, AIDS, etc) including my father, the 26th was my wife.

I feel it is my right to determine what is right for me as long as it doenst harm others. My choices may not be right for you. I respect yours as I hope you respect mine.

----------------------

One thing in one of your previous posts I'd like to comment on: 'Getting high or stoned is just another way to numb up emotionally and numbing doesn't fix PTSD.'

My history is somewhat unusual due to the age and extent of my use. But in doing approx 1,200 psycho -social assessments(99% heroin dependent) for addictions treatment and studying theories of addiction at a graduate level; I have to say I’ve never heard of that as a theory of addiction/drug abuse.

Its common place to look at illicit drug use as a coping mechanism for those with con-current disorders. There is no expectation of a 'fix' in its literal sense of the word. In slang terms a fix is referring to heroin use in dependant people to get unsick, to get fixed.

SSRIs, Exposure therapy, CBT, MDMA, Ketamine, etc are not expected to be seen as a fix nor do people use to get fixed. They are of an incremental benefit.

In those assessments I would talk to people of the reenforcing feelings they benefited from that allowed them to use a substance that put them at 100x the mortality rate. Risk vs reward. Id hear ' I feel like everything will be OK', 'it's like a warm cocoon', ' i feel safe'.

One of the strongest predictors of problematic drug involvement is trauma. More so than genetic per-disposition. That supports my observations in being involved with the treatment of over 2,000 people as well as the info from the formal assessments over an 18 year period.

If someone is expecting to get 'fixed' by using, I'd say they are looking for their first hit of whatever. Combined with a gross lack of knowledge of the intended drug.

We were able to stabilize someones physiology in typically 3-4 weeks using methadone. Only saw 2-3 patients that immediately stopped using opiates when we reached therapeutic levels. It wasn’t the chemical dependance that kept them using in itself. The dependance and legalities just threw gas onto the fire so to speak. Leading to more traumatic, and other, events experienced by the person.

Drug addicts live in a scarey, harsh world. Routinely traumatized and in this never ending circle of increase trauma and attempts to self medicate. One study found that 50% of people that became heroin addicts while serving in Vietnam stopped using immediately upon returning to the States. Our laws and hysteria keep addicts 'in country' so to speak. In World War II the average allied solder would see 19 day of combat per year. In Vietnam it was 240 days year. Drug addicts have 365 days of a violent traumatic existence with death, disease and destruction all around them. From my prospective deserving of no less compassion than those drafted for active service. That is until I find someone that voluntarily, willingly and with full knowledge become an addict.

At one point we had several people transfer to us from another city for treatment, on excessive doses of methadone(280-320mg o.d.). The typical therapeutic range is 80-120 m.g. o.d.. 50mg. is seen as the toxic threshold for non opiate dependent people(IE it will most likely kill you). Those doses refer to oral ingestion.

I asked on of my docs that had just moved from that city what was up with the high doses. He stated it was great as they are finding high doses of methadone made the patient non symptomatic of mental health issues. I informed him if he wanted to prescribe like that to find another clinic to do so in. These guys were so heavily opiated they could barely walk let alone function, let alone display any emotion or thought. That’s the only time I've seen a drug 'fix' a mental health issue. One issue was isolated and other areas of concern for the patient ignored much to their detriment.

The term 'self medication' is used addictions to define those patients that are medicating mental health issues. The reenforcing aspect of drug use is in obtaining some relief of the suffering from their mental health issues. An incremental benefit is expected not a curative one. I’m sure if people would have had effective and timely interventions for mental health issues we would not see the level of illicit drug abuse and addiction we do. They could medicate in a safe manner without the legal issues, health, social and spiritual consequences. All of the damage by drugs is caused by keeping it illegal and spreading inaccurate information(see D.A.R.E. et al.). We criminalize people for lack of appropriate access to mental health services and medications based on laws routed in bigotry, ignorance, arrogance, profit and the industrial criminal complex.

MDMA is a very pleasurable experience not to be feared if taken responsibly, IMHO. I've been to events were there are about 12,000 people and I'd guess 80% are on MDMA. No MDMA overdoses, no fights, no issues! Test kits are provided and there is staff that are professionally trained that monitor anyone if they look like there is a problem. Alcohol is prohibited. People look out for each other in away I have yet to see anywhere in North American society. It's part of the culture. It fulfills peoples need for safety and belonging.

In this area there is a large country music festival. Rapes, aggravated assault, assault, drunk driving and deaths from drunk driving have occurred and are common place. Where the pervasive drug isn't MDMA but alcohol. Laws don't reflect potential harm. It's sophomoric to assume they do.

An ex of mine, who is a lawyer, told me the first thing she learned at law school was that the law doesn’t equal justice. So true. MDMA therapy has been going on for 40 years. Was above ground and went underground due to Nancy's hysterics and political traction from making it schedule 1. People who practice that face serious jail time..for what? For responsibly helping others. Well that’s unjust isn't it?

So now we await the approval of these therapeutic interventions that have to be re-proven. In an culture that pervasively rejects its efficacy unless its 100% curative. I found that dynamic in methadone treatment; the most studied drug in history. All the results are nearly the same yet maintains a mythology. In itself it isn’t curative. So its a crutch and of no value. Lay people, medical and other in addictions throw it out as not being a 'fix'. Yet the evidence has never stated it was. Only the uneducated and biased claim that expectation. And I'm the crazy one? I saw many people withdraw from treatment due to the influence of others. Only to result in relapse and death from overdose. One of my clients fell victim to a religious group that influenced him to stop treatment. We were also providing counseling and psych meds. A few months later he became psychotic and stabbed a 17 yr old to death in an unprovoked situation. He walked up to this kid at a bus stop and stabbed him repeatedly with a knife. God's will?

Albert Einstein once said that repeating the same action and expecting a different result is the definition of insanity. Should we as a society continue to wage war on those that suffer and seek some remedy from their mental health issues? The war on drugs is a war on people. There is no humanity in it. It's insane. The collateral damage is to high. It includes the premature rejection of valid ideas.

I hope MDMA can bridge that gap where it is seen as helpful adjunct to talk and other therapies. The solution comes from a bio, psycho, social and spiritual model being applied. Using only one aspect of that model and expecting it to yield the best results is a foolish notion.

I hope some find this thought provoking and leads to those making educated choices with informed consent when struggling with PTSD and considering options present and in the future for some relief. That’s the best we can hope for isn't it? That's what we expect from the treatments we now currently undertake. Throwing new strategies under the bus,un justly, leads to more unnecessary suffering from those that could benefit. If they chose to undertake them.

In seeking treatment we need to inform ourselves. We have this responsibility and right. Trust the professionals but verify what they are saying is right for you. The cost of bad treatment can be your life. It doesn't have to be illegal to cause you harm.

Just as we dont wish this illness upon our selves nor do addicts. Just as them we seek to remedy our lives to a better one. We use a variety of bio, pscyho, social and spiritual techniques to accomplish that goal. Best results are when we have access to those in an unfettered way in a truthful way with informed consent.

Factoid: In order to finance the war in Afghanistan the Taliban have increased heroin production 1,000%. According to the UN that dope is killing 100,000 people/year in NATO countries.

 

[Hashi]

All of the damage by drugs is caused by keeping it illegal and spreading inaccurate information(see D.A.R.E. et al.).

I'm sorry, but I find this an astonishing statement, especially given what you say elsewhere about addicts' repeated trauma attempting to self-medicate because of lack of adequate mental health care.

I tried to google D.A.R.E. et al but this reference wasn't specific enough for me to identify what study you're referring to.

My issue is with your use of the word "all" as if the legalisation of every drug would remove every problem.

Perhaps you have some valid points to make about MDMA but I'm afraid that throwing things like this into the mix probably doesn't support your argument.

I'm addicted to a legal drug. I therefore have no problems arising from it being illegal, but I have a lot of problems arising from the drug.

I'm not even going to go there with the trauma I experienced, at the hands of people who were high on drugs. If you believe it was purely the illegality of the drugs andl lack of correct information that was the problem, then I beg to differ. And I was there.

I'm sorry for the traumas you've experienced and I respect that your views are different from mine. In fact we agree that mental health care is inadequate and I would go much further than this and say that that the education system, social system and many other things contribute to trauma and other issues. But I find it very difficult to read a view that says all the problems are because of illegality and misinformation. Maybe the law is misused maybe it's misinformed to an extent, but I think the fact that many drugs are illegal is also because they affect people's judgement, health and behaviour in a very damaging way, and there's an attempt to protect people from that. Drugs themselves can be a war on people.

 

[Zef]

freefloat and hashi,

This is the best discussion presenting both points of view on this subject that I have ever read. . .so thank you. Both positions are valid arguments, in my mind.

The problem as I see it, is not so much a question between legal/illegal, it is a question of politics and corporate corruption being in a position to make decisions about health. Because money dominates politics, media AND health care, money decides what is acceptable health care vs non-acceptable.

Because of this, we are in a situation where many possible cheap treatment options cannot get studies funded or the treatments get 'demonized' for the public, much like MDMA. Until that situation is resolved, people will suffer and people will needlessly die because of it.