Research Riluzole Or Ketamine?

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Powder

MyPTSD Pro
I am a chronic, lifetime PTSD sufferer about to turn 40. Damned if I don't do something to help find a decent treatment of any kind.

Yoga was helpful to me in feeling better overall during a time of almost remission, but gave me massive headaches. I'm not sure why. SSRI's made me feel absolutely worse by about 50-100%.

New drugs are being studied as researchers seek treatments that are easy/cheap. There are so many people with PTSD now due to long term warfare, multiple deployments, Traumatic Brain Injury and other traumatic injuries, terrorism, rape, and other world wide chaos problems.

Prevention of PTSD in the first place would be ideal by creating a better world, especially for the next generation. That ought to remain in the forefront of today's leaders' minds.

And for all of us with unrelenting and chronic PTSD as a life sentence, a set of tested and safe treatments is needed very badly to treat the whole disorder or at least multiple symptom clusters, which clearly affect each other.

In this post, I am interested in Ketamine and Riluzole. I'm new to learning about this class of drug. So any information you have is relevant to my inquiry. I am not on any Rx for PTSD as of June, 2016. I have decided none of them do my any good. I tend to feel worse on any drug. I use daily Grapefruit juice, which I find seems to regulate my hormones (it has clinically significant effects on Estrogen levels) to the extent that this aids my body's ability to regulate "fight/flight/freeze" response to daily triggers, external and internal. (I still get triggered, but my body doesn't seem to react with the same level of FFF, and I am usually able to keep doing normal life things while processing through the trigger and talking my way out of it). I still feel the emotions of fear, dread, horror, anger, helplessness, guilt, blame, etc.. But I am able to "feel" that I'm feeling them without them taking control of my actions. I dissociate less without drugs in my system.

So I am not, at this time, a big fan of any Rx treatment for chronic PTSD, as it's not been very helpful to me other than taking Clonodine and Xanax during total overwhelm until stress levels are more normal and natural management takes over again. That said, I believe that I am not a fan due to the fact that most drugs treat only one subset of symptoms, and nothing has been made that will be effective and not have side effects and "negative" symptom side effects, such as feeling more numbed, drugged, and less alive.

If you have participated in a study to test the efficacy of Riluzole or its cousin Ketamine, or have used Ketamine, recreational use, I am interested in your experiences and opinions on this class of drug. I am curious because it is one of several drugs being studied by more than one agency for potential PTSD FDA approval in less than 3 years (they desire).

This is a 4-year study (2014-2018) being done "A Pilot Study of Riluzole in Patients with PTSD" : A Pilot Study Of Riluzole In Patients With Post Traumatic Stress Disorder (PTSD) - Full Text View - ClinicalTrials.gov
by Yale. The participant will take 12 weeks of the experimental drug and undergo clinical assessments to measure results.

This study will end next year, 2018, and if proven efficacious enough and safe for use, it will be used for PTSD, perhaps offlabel, as is Clonidine now. However, it is also a controlled substance, so not especially convenient.

The study needs 20 people to complete it, and that would seem easy to do in less than four years. Both Yale (Christopher Kelly) and the National Center for PTSD in Connecticut (Chadi Abdallah, M.D.) report doing the same study within the same years (so far as I can tell). It may be a case of sharing data or private Yale vs. public National center.

Either way, there is hope of developing an FDA approved drug specifically for PTSD. While Zoloft and Paxil are currently the only two drugs approved by the FDA for PTSD, neither is proven effective. In fact effectiveness falls well below placebo effect.

I personally took both when they were new in the late 90's and felt worse on all SSRI's. I was placed on Zoloft, then Paxil, then Effexor. I would never use any of these again. I was placed on Prozac, low dose, later, but this leads to over-stimulation.

The research I have read says that PTSD doesn't work on the same neurotransmitter pathways as clinical depression, which is why SSRI's do not work for PTSD.

Ketamine is an anesthetic used for human and veterinary surgery. Vets with burns who had surgery who were given Ketamine as the surgical anesthetic were found to have PTSD at lower rates (20% rate range) vs. those who were given a different anesthetic (40% range). Also, after a single IV dose of Ketamine, patients with severe depression felt the depression and suicidal tendencies totally lift for up to 7 days post med.

Taking Ketamine long-term has serious side effects. But research is focused on targeting it's IV administration along with exposure and memory reconsolidation because Ketamine may help to take the traumatic memories away from the PTSD storage pathways and move the memories to the more normal narrative memory pathways, thus rerouting them, and shutting down PTSD's intrusive memories, lowering depression and pain, and creating a new neural pathway.

I am not expert in any of this, but I wanted to know about anyone's experiences with this class of drug and PTSD.

I like that researchers are combining the drug with new takes on traditional talk therapies, such as in "
TIMBER Psychotherapy and Ketamine Single Infusion in Chronic PTSD."

Any thoughts welcome! Thanks in advance for your ideas.
 
Thank you for the detailed notes! I learned some things.

From what you say, it sounds like ketamine may have a role in treating PTSD. I feel that any discussion these days on new meds for PTSD should at least mention MDMA. My understanding and personal experience is that MDMA is likely to result in major, long-lasting improvement.

I have used MDMA therapeutically and I've used ketamine recreationally (but only after my PTSD was in remission). I have a family member who uses ultra-low-dose ketamine daily, in combination with her prescribed meds, to stave off the extreme emotions of bipolar disorder. My experience with ketamine leads me to think that it could be useful, but it doesn't have MDMA's laser-sharp focus of identifying and resolving trauma. I'd be happy to answer any questions from those perspectives.

Ketamine, while not causing physical dependence, can be quite enjoyable and habit-forming. MDMA seems to have less abuse potential, partly because it can't really be used again in quick succession. This shouldn't be a deciding factor, but it does make MDMA a potentially better choice for a population already prone to substance-use disorders.

I support having a broad array of tools to treat PTSD, so any competition for MDMA is welcome in my book. Some say that MDMA is the perfect tool for PTSD. I don't know about "perfect," but it has been literally life-saving for me, another family member, and some on this forum. Since MDMA is in phase-3 FDA trials now and results have been glowing, I think we're likely to see it available in prescription form within the coming years.
 

joeylittle

Administrator
I do know that Ketamine had some bad trials for treatment of depression. I am starting to suspect that there's a bit of stabbing in the dark now, as researchers try and figure out how to get something good out of Ketamine.

MDMA is showing more promise, currently. But the US being what it is, I don't know how trials will proceed here.

Riluzole is a less understood glutamegeric drug - same as Ketamine, but less study done on the particular receptors it affects.

I have noticed in general that, drug-wise, trials that start looking for depression treatments move on to PTSD and post-partum depression when they start to fail as a potential MDD drug. I've no idea if that means anything, it's just interesting.

This article might be helpful to this conversation. Do glutamatergic drugs have a role in treating depression?
 

ROBERT TALON

Confident
I am a chronic, lifetime PTSD sufferer about to turn 40. Damned if I don't do something to help find a dece...
You mentioned talking therapies which I feel is less intrusive physically health wise. We are all different and often medication seems to be an option which is pursued given in this modern world people seem to have less time to spend on talking therapies. Environment also plays a part in recovery . I live in a beautiful part of the world out in the countryside where nature is very much a neighbour. A combination of the spiritual with a caring someone to talk to is for me a very positive medication which has no side effects. I listen to uplifting and relaxing music or poetry for 20-30 minutes before sleep. This clears my mind of all the trash that might otherwise fill my thoughts. Hope this helps Happy and positive 2017 . We are all in this together
 

Powder

MyPTSD Pro
Why try things out on depression and then take them into PTSD trials?

Why not go searching for PTSD treatment from the start? I guess that makes no logical sense to me and must be down to money. No other reason.

I assume more people (with any disorder conceivable) seek help for the depression side of their disorder, so that is an opportunity to "sell" them a pill for that.

Again, our system is about money and will therefore supply-demand treat symptoms first rather than getting to the root of the problem. When researching most pathology, disease, or disorder, 'etiology' or causal pathways are usually not known by Western Medical science. Only the disease progression phases and some treatments for that, which usually address symptoms.

Thank you for sharing the MDMA for PTSD idea. I had not looked at this. I can see how this could work for those unable to verbalize their trauma.

In my case, I have done that, relived and narrated my traumas, and yet I still have PTSD, but not as bad as it was. I do not find myself "cured" by any means. Not by a long shot.
 
Discussing traumas under the influence of MDMA may provide immense benefit, even if you already can discuss the traumas in great detail.

It is not only for those in the first stages of treatment. The trials in which it has performed so well are specifically for patients who have tried conventional treatments, often with immense effort, yet still qualify for a PTSD diagnosis.
 

Powder

MyPTSD Pro
@Lady McCormick thank you for this information. Can you cite it for me to follow up?

I showed my husband some MDMA information, and it was about a women who could not talk about her trauma previously.

I also found a woman who had remembered much of her traumas in childhood, but under MDMA she encountered much, much more that previously she had not been able to remember normally. Also, she was able to see it in different perspectives. She said she could accept that her perp/father was actually dead (he was) but had previously not "felt" like he was dead, in that his trauma was very much alive in her.

I do think based on what I've watched and read that MDMA offers something for those with PTSD, even chronics like me.

I read that only two (2!) uses with 8 hours of therapy to go with the effects led to 2/3 of the sufferers to walk away no longer qualifying as having PTSD. Of course, they still had the trauma. (Anthony is spot on here with this.) And they still have to live with it. But they no longer spend a good deal of time on PTSD symptoms running their lives. They still have the emotional work to do, but maybe they can do it, is the idea. No they can face it and do the work that they couldn't get to before.
 
Here's a video that explains in straightforward terms the benefits of MDMA to a veteran who had been through countless therapies before. I apologize, but I haven't been active enough on this forum to post links. To find the video, search Google for: BNxuRs6tTuw.

For more scientific info, read on:
Patients are less likely to feel overwhelmed by their emotions during [an MDMA] session and can hopefully restructure their intrapsychic framework so as to develop a greater behavioral and emotional response to the stimuli that trigger PTSD symptoms.

Source: search for [ Stefan Bumol ]

chronic PTSD refractory to both medications and psychotherapy showed significant clinical improvement in response to just two sessions of MDMA-assisted psychotherapy supplementing a more conventional course of psychotherapy [ . . . ] [MDMA could] assist a patient in re-engaging with traumatic memories with less interference from emotional centers, thereby helping to gain executive control of the memory of the trauma. [ . . . ] MDMA might enhance psychotherapy not only by improving the therapeutic alliance but also by reducing self-referential emotional processing without diminishing declarative memory

Source: search for [ pm360online mdma therapeutic comeback ]

When we encounter a trigger, we re-live emotions of the original trauma. If the memory wasn't associated with such strong emotions, flashbacks and other symptoms would not occur. This is the goal of many PTSD treatments such as exposure therapy — to re-encode the memory without as much fear, so you won't experience such strong symptoms upon recalling the memory. If you have experienced ANY benefit from exposure therapy, you have re-encoded memories to reduce their emotional impact.

MDMA greatly reduces your fear response while you're under its influence. In some cases, the effect is near elimination of fear. By revisiting your traumas in this state, you can recall your traumatic memories without the intense negative emotions that usually accompany them. This lets your brain re-encode the same memory, but without the intense fear that previously accompanied it. The effect is dramatic.

For this reason, the effects are long-lasting, even indefinite. This is unlike nearly all other medications, that only have an effect for as long as you continue to take them.

Again, the clinical trials for MDMA have been for treatment-resistant PTSD — this means that both psychotherapy and medications had been unsuccessful.

I hope this helps answer your question. I know it's a complicated subject, and it's really hard to convey the implications of living a few hours with 'fear turned off.' It can be, as studies continue to prove, life-changing.
 
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