Saturday, June 28, 2008

Ecstasy Is the Key to Treating PTSD

When ecstasy was pulled from research in 1985, having by then become a popular street drug, there was a lot of promising data to suggest that MDMA might be highly useful in a therapeutic setting. Like all government hysteria around drugs, it was listed as a schedule-1 controlled substance, along with LSD (and the other hallucinogens) and marijuana, all of which have demonstrable medical uses -- and none of which are addictive (though this might be changing with the newer, stronger weed on the market).

Schedule 1 Findings required:

(A) The drug or other substance has high potential for abuse.
(B) The drug or other substance has no currently accepted medical use in treatment in the United States.
(C) There is a lack of accepted safety for use of the drug or other substance under medical supervision.

No prescriptions may be written for Schedule I substances, and such substances are subject to production quotas by the DEA.

Now 25+ years later, researchers are finally being allowed to resume studies of the drug. And it turns out that it might be highly useful in treating the tens of thousands of veterans coming back from Iraq with post traumatic stress disorder (PTSD).

It's worth pointing out that one of the concerns in using MDMA for therapy is the damage to the serotogenic system that occurs in the brains of users, which still show serious effects (reduced 5-hydroxytryptamine (5-HT) content and [3H]paroxetine-labeled 5-HT transporter density by 40-60%) in the frontal cortex, striatum, and hippocampus up to 1 week later.

However, the administration of alpha lipoic acid comepletey eliminates all damage to the serotogenic systems. Using the proper precautions, MDMA can be completely safe for therapy.

This is from AlterNet.

Ecstasy Is the Key to Treating PTSD

By Amy Turner, The Times of London UK. Posted June 27, 2008.

At last the incurably traumatized may be seeing the light at the end of the tunnel. And controversially, the key to taming their demons is the 'killer' drug Ecstasy

An Ecstasy tablet. That's what it took to make Donna Kilgore feel alive again that and the doctor who prescribed it. As the pill began to take effect, she giggled for the first time in ages. She felt warm and fuzzy, as if she was floating. The anxiety melted away. Gradually, it all became clear: the guilt, the anger, the shame.

Before, she'd been frozen, unable to feel anything but fear for 10 years. Touching her own arms was, she says, "like touching a corpse." She was terrified, unable to respond to her loving husband or rock her baby to sleep. She couldn't drive over bridges for fear of dying, was by turns uncontrollably angry and paralyzed with numbness. When she spoke, she heard her voice as if it were miles away; her head felt detached from her body. "It was like living in a movie but watching myself through the camera lens,"she says. "I wasn't real."

Unknowingly, Donna, now 39, had post-traumatic stress disorder (PTSD). And she would become the first subject in a pioneering American research program to test the effects of MDMA otherwise known as the dancefloor drug Ecstasy on PTSD sufferers.

Some doctors believe MDMA could be the key to solving previously untreatable deep-rooted traumas. For a hard core of PTSD cases, no amount of antidepressants or psychotherapy can rid them of the horror of systematic abuse or a bad near-death experience, and the slightest reminder triggers vivid flashbacks.

PTSD-specific psychotherapy has always been based on the idea that the sufferer must be guided back to the pivotal moment of that trauma the crash, the battlefield, the moment of rape and relive it before they can move on and begin to heal. But what if that trauma is insurmountable? What if a person is so horrified by their experience that even to think of revisiting it can bring on hysterics? After hysterics, the Home Office estimates that 11,000 clubbers take Ecstasy every weekend. Could MDMA the illegal class-A rave drug, found in the system of Leah Betts when she died in 1995, and over 200 others since really help? Dr Michael Mithoefer, the psychiatrist from South Carolina who struggled for years to get funding and permission for the study, believes so. Some regard his study approved by the US government as irresponsible, dangerous even. But Mithoefer's results tell a different story.

MDMA was patented in 1912 by the German pharmaceutical company Merck. To begin with, it was merely an intermediate chemical used in creating a drug to control bleeding. In the 1920s MDMA was used in studies on blood glucose as a substitute for adrenaline. The Merck chemist Max Oberlin concluded that it would be worth "keeping an eye on this field." Still, no further studies were carried out until 1952, when the chemist Dr Albert van Schoor tested the toxicity of MDMA on flies. "Flies lie in supine position, then death," he recorded.

MDMA's therapeutic potential wasn't realised until 1976, when the American chemist Alexander Shulgin tried it on himself. He noted that its effect, "an easily controlled altered state of consciousness with emotional and sensual overtones," could be ideal for psychotherapy, as it induced a state of openness and trust without hallucination or paranoia. It quickly became known as a wonder drug, and began to be used widely in couples therapy and for treating anxiety disorders. None of these tests was "empirical" in the scientific sense no placebos, no follow-up testing but anecdotally the results were almost entirely positive.

Word, and supplies, of the new "love drug" got out, and in the early 1980s it became popular in the fashionable clubs of Dallas, LA and London, where it was known as Ecstasy, X or "dolphins." As use became widespread, the US authorities panicked, and by 1985 MDMA was an illegal, schedule-1 drug. UK laws were even tighter: MDMA, illegal under the 1971 Misuse of Drugs Act, was categorised class A in 1977, carrying a sentence of up to seven years for possession.

Criminalization put paid to MDMA research almost overnight, at least until Mithoefer's current program began. But it didn't stop the ravers. The drug was popular in the late 1980s and early 1990s for its energizing, euphoric effects. There are no official figures for that period, but the UK Home Office estimates that in 2006/7, between 236,000 and 341,000 people in the UK took Ecstasy. Experts say the drug is far less fashionable now than in its heyday in 1988, the second so-called "summer of love."

The MDMA used in the studies the drug Dr Mithoefer gave Donna and other patients was the pure chemical compound, not the black-market Ecstasy bought by recreational users. " A lot of Ecstasy pills aren't MDMA at all," says Steve Rolles of the drug-policy reform group Transform. "They may be amphetamines, or unknown pharmaceuticals, or they can be cut with almost any drug in pill or powder form. That's when you magnify risks associated with taking a drug that's already toxic. Plus, people use it irresponsibly, mixing it with other drugs, not drinking enough water or drinking too much."

The images of Leah Betts and Lorna Spinks lying in hospital on life-support, bloodied and bloated, are familiar to all of us we know drugs cost lives. But has MDMA's reputation been tarnished so badly that its potential medical value has been overshadowed? That question is the reason that Donna agreed to speak to The Sunday Times about her MDMA treatment. "It's so important people know what it did for me, what it could do for others," she says. Her voice trembles: it isn't easy to talk about what she went through.

In 1993, Donna was brutally raped. She was a single parent living in a small town in Alaska, working as a dental nurse for the Air Force. She was due to work an early shift the next day and her two-year-old daughter was staying with a friend for the night. She was alone at home. At midnight she opened the door to a stranger who said he was looking for his dog. He asked if her husband was at home, and a second's hesitation was enough. He burst in, backing her up against the fireplace in the living room. Donna picked up a poker to defend herself. He said: "If you co-operate, I won't kill you. I've got a gun." And he reached into his jacket.

"I dropped the poker and that was it,"she says. "I thought, this is how I'm going to die. No life flashed before my eyes, I didn't think about my daughter. Just death. I left my body and I stayed that way. The next thing I remember, the cops were coming through the door with a dog."

She endured the rape with her eyes squeezed shut. That she hadn't physically struggled would later form a large part of the guilt and shame that contributed to her PTSD. "I guess a lot of women would say, Someone would have to kill me before I'd let that happen.' Well, I did what I thought I had to do to survive," she says. When she heard a shuffle of feet outside the door she screamed for all she was worth. Her attacker beat her. Two policemen, probably alerted by a neighbor, broke down the door and arrested the man, then drove Donna to the Air Force hospital where she worked. "Of course it was full of people who knew me," she says. "It was completely embarrassing. And after that, nobody knew what to say. People avoided me, they looked at me funny. It was miserable."

Afterwards, convinced that getting on with life was the best thing for herself and her child, Donna carried on as usual. She was embarrassed that people who knew her also knew about the rape, particularly as she was still working at the hospital. But she couldn't remember much of the attack itself, and didn't try. So she was surprised when, four years later, her symptoms started to kick in. "I had no idea it was PTSD. I couldn't understand why I was so angry, why I was having nightmares, flashbacks, fainting spells, migraine, why I felt so awful, like my body was stuffed with cotton wool. Things had been going so good."

She started drinking heavily and went from relationship to relationship, finding men hard to trust and get close to. Convinced that she was dying and wouldn't live to see her next birthday, she went to the Air Force psychiatrist. " And that's where it started take this pill, that pill. I've been on every kind of antidepressant Zoloft, Celexa, Lexapro, Paxil. Wellbutrin made me feel suicidal. Prozac did the same. The pills were just masking the symptoms, I wasn't getting any better."

Yet she met her "soul mate," Steve, and married him in 2000. "When I first saw him I thought, This is the man I'm going to spend the rest of my life with.' We were like one person, finishing each other's sentences,"she says. They muddled along, with Donna putting on a brave face. She had two more children. But getting close wasn't easy: "The longer we were married, the worse I got."

Once, Steve and Donna were watching TV when she had a vivid flashback to the night she was raped. "I looked at the door, I saw it open, and that feeling came over me all over again.

I thought, My God, why won't this go away?' Steve tried to understand, but unless you've been through this, you don't know what it's like."

Donna moved to South Carolina in 2002 when Steve also in the services was posted there. She began seeing a psychiatrist called Dr Marcet, who diagnosed her with PTSD and attributed it to the rape. It helped to know that whatever it was had a name and a cause: "I was like, why hasn't anybody told me this before?"It was Marcet who referred her to the Mithoefers.

Donna had never taken Ecstasy before. "I was a little afraid, but I was desperate. I had to have some kind of relief. I didn't want to live any more. This was no way to wake up every morning. So I met Dr Mithoefer. I said, Doctor, I will do anything short of a lobotomy. I need to get better.' "That's how, in March 2004, Donna became the first of Mithoefer's subjects in the MDMA study. Lying on a futon, with Mithoefer on one side of her and his wife, Annie, a psychiatric nurse, on the other, talking softly to her, she swallowed the small white pill. It was her last hope.

Read the rest of this lengthy and informative article.


Unknown said...

I a a woman with Complex PTSD from years of being molested and raped by multiple male members of my family, mostly by my father. These experiences encompassed my entire childhood, from my earliest experiences as a small girl until I was nearly 18.

I have been in therapy with a trauma specialist for two years now (I am 24), and was on anti-depressants for the first year. The anti-depressants prevented me from being suicidal, but interfered with the process of trying to connect with my body in any meaningful way. Since quitting those a year ago, I have made huge strides both in and out of therapy, and have already become an entirely different person (while there is still a long way to go in recovery).

I have only taken ecstasy a few times, and I have to say that the effects were amazing. For the first time, I was able to feel my feelings and laugh, cry, grieve, without dissociating from my body...without having an equal anxiety reaction rise up and cause me to shut down. I felt like I could breathe for the first time (I have a tendency to hold my breath regularly).

For what it's worth, also, smoking cannabis was my first experience with feeling safe in my skin, although that seems to just numb the fear response, it doesn't facilitate emotional expression the way the ecstasy does.

Studies on the body's endo-cannibinoid system are fascinating...seems to deal with the extinction of fear-based memories.

I am relieved that MDMA is under study at the moment, and am looking forward to having the opportunity to obtain it for clinical use without having to resort to buying it on the street (which I won't do).

I have found your blog to be very informative and helpful...thank you for sharing all of your personal experiences and information here. I particularly have found your work with subpersonalities to be very helpful, as recovery from C-PTSD/dissociative disorders involves parts work and it's hard to find anyone talking about their actual experiences.

william harryman said...

Hi Amanda,

Thank you so much for sharing your story here. And I am SO sorry to read what you have been through -- and glad you getting good help.

I'm glad to hear that you have had some good experience with MDMA -- just be careful -- if you use it anymore, do some research on using alpha lipoic acid to minimize damage to the serotonin circuits in the brain.

And thank you for the kind words about the blog. I'm grateful that you have found this site useful.

All best,

Unknown said...

Hi Bill,

I can't find an email address for you on your blog, and I'd like to run a few thing by you, if you wouldn't mind.


william harryman said...

billharryman (at) gmail (dot) com