Based on the results of recent brain scan studies and theoretical advances, Torsten Passie, a German researcher who is a visiting professor of psychiatry at Harvard, has developed an intriguing theory about how MDMA might help resolve PTSD. It’s complicated but worth trying to grasp: Sights, sounds, scents, and sensations from the sensory organs input into an egg-shaped region at the center of the brain called the thalamus. The thalamus then distributes that sensory data back up to be processed by the more sophisticated and evolutionarily recent brain regions involved with conscious thought. The processed material—sorted for context and assessed for significance—returns to the thalamus, which then deposits it into a tuber-shaped portion of the brain just above the brain stem called the hippocampus, where it is stored as memory. In the case of a severely traumatic experience, the brain’s ability to process is overwhelmed and a more primitive method for storing memory takes over. The sensory information passes through the thalamus and is stored directly in the hippocampus without higher processing. These “raw” memories can bolt into awareness as destructive flashbacks or nightmares. The brain senses that potential as a constant threat, which engages the fear-response system, centered in an almond-shaped structure perched atop the hippocampus called the amygdala. The amygdala acts as a guard, imperfectly suppressing the unprocessed traumatic memory to attempt to keep it from barging into consciousness. It’s not a healthy arrangement. The constant tension of having the nasty, poorly kept secret hidden in the brain’s basement poisons the psyche, which flails around in pain, creating PTSD’s self-destructive symptoms. Enter MDMA. Brain scan studies suggest that MDMA creates a negative image of PTSD, suppressing the amygdala and stimulating the prefrontal cortex—the planning-analyzing-conscious area of the brain. Passie theorizes that as the amygdala lets down its guard, the traumatic memories can reemerge from the hippocampus to be sent up for the processing the brain never had a chance to do. Possibly assisted by the emotional learning and fear extinction properties of the hormones MDMA releases, the memories can at last be integrated into the personality in a healthy way. That was the theory. Until MDMA therapy proved to work in real lives, it would be nothing more. [...] In the end, ten of the twelve trial subjects who had been assigned the MDMA in the double-blind part of the study found dramatic relief. Their scores on the assessment test given four days after their MDMA sessions, and again, two months later, no longer merited a diagnosis of PTSD, a clinical success rate of 83.3 percent after just two therapy sessions. Of the eight participants who initially got therapy with a placebo, only two (25 percent) had similar improvements in their PTSD symptoms, and all but one opted to do an additional open-label session with MDMA. All seven who did the further session responded dramatically and retested below the threshold for PTSD at four days and again at two month. The single trial, successful as it was, didn’t persuade skeptics of MDMA’s efficacy, or safety. Andrew Parrott, a psychologist at Swansea University in Wales who devoted much of his career to studying the dangers of MDMA, shrugged off the positive reports. “MDMA is a very powerful, neurochemically messy and potentially damaging drug,” he said. The government “should never have given it a license for these trials. Certainly I would not give it a license for any further trials.” Others pointed at the weak double-blind as a cause to be suspicious. Scott O. Lilienfeld, an Emory University psychologist, said, “These subjects knew if they got the drug or the placebo. Particularly when you have a very dramatic and powerful intervention, people may change but not in a longstanding way.” Mark Wagner, the psychologist who did the assessments, disagreed. “I didn’t know much about the clinical use of MDMA before this,” Wagner said, “but I’ve seen each and every one of these patients, and, just as a clinical psychologist, it is impressive to see the degree of treatment response these folks have had. There are a couple of areas in medicine, like hip replacement, where one day you are bedridden, and the next you’re out playing tennis. Or with LASIK surgery, you’re blind, and then you can see. Nothing in psychology is like that. But this was dramatic. “The chance that a placebo effect would last for three months is very slight. And for it to last for a year or more, which anecdotally we believe might be the case here, would be extremely remote. Wagner would further test that idea in another MAPS-funded study. He and Michael assessed the subjects of the original trial from a year and a half to more than six years after their MDMA treatments. Of the sixteen subjects who were retested, all but four had held on to their significant gains after an average of three and a half years. None felt that the experience had made them want to seek out illegal street Ecstasy or diminished their cognitive abilities. All of the four who had reexperienced PTSD symptoms said they felt another MDMA therapy session would help restore their health. One of the four was Donna Kilgore. For a full year after her two MDMA sessions, Donna considered herself symptom-free. In the years that followed, problems accumulated. Her husband got laid off from a good job; they had to move; she had a difficult job at a dental practice for children. One day Donna was doing paperwork in her office when “I started to have catastrophic thinking again.” It was a resurgence of the paralyzing, unreasonable fears characteristic of PTSD that she’d had for so many years before the MDMA sessions. “It wasn’t in the best part of town. I just started being convinced that someone was going to come in with a gun and start shooting. And then I just couldn’t listen to the children screaming in the next room. . . .” This was three years after her MDMA therapy sessions. She had to quit the job. Speaking about it then, she began to cry. “I know I can work through it,” she said, her voice breaking a little. “I know what I’m fighting now, and I can fight it.” Ten years after the experimental treatment, Donna still struggles off and on with occasional symptoms, but she credits the experience of the first study for giving her the tools to deal with all of it as well as she has. “I can’t convey how much hope that gave me, and how much good it did,” she said. In 2012, Michael and Annie got the FDA to approve a new study to gauge the efficacy of re-treating those who relapsed after the first study. It was too late for Donna, who had recently discovered she had clogged coronary arteries, which, though successfully treated, disqualified her from the Mithoefers’ relapse study. The three other subjects who experienced some degree of relapse underwent an additional MDMA therapy session. Immediately following the session and two months later, all three tested free of PTSD. ~ Tom Shroder - Acid Test ( tomshroder/books/acid-test/synopsis/ ) one good review here: washingtonpost/opinions/book-review-acid-test-on-lsd-as-therapy-for-ptsd-by-tom-shroder/2014/09/11/fc43f954-23c2-11e4-86ca-6f03cbd15c1a_story.html
Posted on: Tue, 23 Dec 2014 12:31:09 +0000
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