Using MDMA to Treat PTSD?

[Marauder06]

Seems like a non-starter to me. But...

In yet another misguided attempt to address the legitimate plague of PTSD in America, the FDA recently approved a large scale trial to treat the condition with a powerful mind-affecting drug. You’ve probably heard of this drug before. It’s called methylenedioxymethamphetamine. You might know it as MDMA, or what is often referred to as the party drugs “Mollie” and “ecstasy” or simply “X.”

That’s right folks, the government approved a big study to treat PSTD with X.

 

[Ooh-Rah]

 

[TLDR20]

I disagree pretty hard here.

To me the argument basically comes across as "I don't know why this would work, stoner's will take advantage and therapy is better."

I think this is arguing against what is not the actual point of this study. The idea is to use the drug in a low dose on people with long term history of PTSD to enhance therapy. It has had great success in the past, going back to the 1970's. Notice though they aren't giving people unsupervised access to MDMA. I doubt people are willing to spend years in therapy to have access to a drug in a therapy session, that they can get on any college campus in America within a few minutes.

There is a known correlation between dissociative agents and effective treatment of PTSD. It isn't just because people are stoned/rolling.

I think people should have the ability to utilize the best options possible if they are effective. If this is found to be effective via this study, why should it not be used, other than due to our preconceived ideas about "stoners" and what we think works best...

 

[x SF med]

There is a known correlation between dissociative agents and effective treatment of PTSD.

Thus the lower incidence of PTSD in battlefield trauma since the introduction of Ketamine in the initial treatment pharmacology, the dissociative/amnesiac properties seem to help..

 

[Il Duce]

I don't see the hate on MDMA vs some other drug. If it's clinically shown to help we should use it. I think the puritanical view of some drugs as 'bad' vs others as legitimate is misplaced. All drugs have side effects and consequences - we should leverage them with the interest of the patient in mind in all cases and not our cultural prejudices.

 

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[policemedic]

Ketamine seems to act as prophylaxis for PTS. MDMA will be used after the fact to manage symptoms. It's true the two drugs are somewhat similar in effect, but the study populations will be different.

I'll be interested to read the study and examine the results. I'm not opposed to the supervised, controlled and therapeutic use of any drug within a recognized course of medical treatment.

 

[RackMaster]

I think it's great that all options seem to have research being funded. The key here is using it in a controlled environment during other therapy.

I'd like to see similar research for medicinal cannabis, which is showing great results with PTS and chronic pain; among many others. There's research being conducted up here but not at the scale needed to influence policy change.

 

[Diamondback 2/2]

A buddy of mine had his foot blown off in Afghanistan, they hit him with Ketamine. He said that shit took him to the land of unicorns and rainbows. Can't remember shit about the incident.

As for PTSD, if works for a some guys to get all loopy on X, well whatever let them have at it. There is no one treatment for all answer to PTSD. Some dudes smoke dope, some dudes turn into workout freaks, some pet puppies, I prefer a good bottle and wide open space with nobody around for miles. I tend to straighten my bullshit out best that way. Fishing, hunting, hiking, just alone with my thoughts.

I haven't found much use for medication, honestly things tend to go to hell pretty quick any time I am on medication, pain, muscle relaxers, psych, etc. Just don't do well loopy headed.

 

[Six-Two]

If I'm not mistaken, a friend of mine from Catholic school is on this team. I was all about it when he told me, and now, as a more mature adult, I'm all about it for a slew of different reasons.

People have been using psychotropics to augment modern psychiatric treatment for a long time; painting with a broad brush and taking some drugs off the table because hippies like 'em and leaving other ones on that can cause everything from rashes to seizures and myoclonic spasms to actual death is fucking backwards to me. Couples with relationship trouble in the 70s were treated with MDMA. Babies with serious epilepsy to the tune of 300 grand mals a week experience a reduction in symptoms with CBD oil. My mom's best friend used 'shrooms to find some peace when she was dying of breast cancer. Hell, even Bill Wilson spoke highly of Acid trips. Meanwhile, a kid in my high school jumped off a roof after taking Wellbutrin, and a buddy of mine had a full-on psychotic break after going down the Adderall rabbit hole.

I don't mean to sound like some Scientologist whackjob, but antidepressants - which are most relevant to the subject of PTSD - are also the largest offender in my estimation. Formulated almost exclusively on empirical data rather than observable, provable chemistry; overprescribed to the tune of hundreds of millions of dollars a year; a massive, bloated, overpriced strain on healthcare costs in our country; physically debilitating, and continuously proven to be less effective than CBT.

I honestly can't understand the ludicrous double standard when it comes to so harshly judging the recreational potential of a drug against its relative benefits when we spend hundreds of millions of dollars a year on drugs that can destroy your life. OK, hippie rant over.

 

[TLDR20]

If I'm not mistaken, a friend of mine from Catholic school is on this team. I was all about it when he told me, and now, as a more mature adult, I'm all about it for a slew of different reasons.

People have been using psychotropics to augment modern psychiatric treatment for a long time; painting with a broad brush and taking some drugs off the table because hippies like 'em and leaving other ones on that can cause everything from rashes to seizures and myoclonic spasms to actual death is fucking backwards to me. Couples with relationship trouble in the 70s were treated with MDMA. Babies with serious epilepsy to the tune of 300 grand mals a week experience a reduction in symptoms with CBD oil. My mom's best friend used 'shrooms to find some peace when she was dying of breast cancer. Hell, even Bill Wilson spoke highly of Acid trips. Meanwhile, a kid in my high school jumped off a roof after taking Wellbutrin, and a buddy of mine had a full-on psychotic break after going down the Adderall rabbit hole.

I don't mean to sound like some Scientologist whackjob, but antidepressants - which are most relevant to the subject of PTSD - are also the largest offender in my estimation. Formulated almost exclusively on empirical data rather than observable, provable chemistry; overprescribed to the tune of hundreds of millions of dollars a year; a massive, bloated, overpriced strain on healthcare costs in our country; physically debilitating, and continuously proven to be less effective than CBT.

I honestly can't understand the ludicrous double standard when it comes to so harshly judging the recreational potential of a drug against its relative benefits when we spend hundreds of millions of dollars a year on drugs that can destroy your life. OK, hippie rant over.

Preach. Great post IMHO.

 

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If I'm not mistaken, a friend of mine from Catholic school is on this team. I was all about it when he told me, and now, as a more mature adult, I'm all about it for a slew of different reasons.

 

[Six-Two]

Preach. Great post IMHO.

Thanks, boss. Appreciate the compliment.

 

[Six-Two]

I do not disagree with you and do not mean to shoot your post down, I'm actually in favor of the MDMA study. You made mention of a suicide after the patient began taking Wellbutrin, which is used in some cases of clinical depression. I'll use this as a teaching case if you will. People with severe clinical depression are living with terrible psychological pain, lack of energy, and an inability to concentrate for more than a few seconds. They don't read because they lack the ability to remember what they just read, same with watching a TV program. The lack of energy and inability to concentrate can be the only thing preventing suicide; they are unable to formulate a suicide plan and carry it out. Living with severe depression is life in a very deep, and very dark world, that is hard to understand or explain. Some antidepressants are energizing in nature and increase the risk of suicide while improving the overall depression. The risk/ benefit ratio is something physicians balance all the time when deciding on a particular medication; sometimes any prescribed antidepressant can result in suicide. The first rule of medicine is not being trampled by prescribing antidepressants, with or without PTSD. That agents such as MDMA are being looked at, speaks well of the medical research community.

Look, I don't think your assertion - that the Bupropion, through (and I'm speculating here) modulation of cholinergic and serotonin receptors, essentially enabled the patient to have the energy to act out underlying suicidal ideations that were already present but not presenting due to fatigue/lethargy - is unsound. I think the method in which we evaluate their efficacy, and more importantly, the method by which we Rx them, is. I think when you have a drug that could - through pharmacodynamic mechanisms not fully understood - bring about suicidal ideation in a patient, you need to pull it back off the table until the pharmacodynamic mechanisms are understood. Which yes, will mean longer and more expensive clinical trials that could potentially keep life-saving drugs from people who need them. But when the efficacy - even after dozens of years on the market - of these products is so limited, that balancing act tips further, in my estimation, towards further testing. More importantly than longer clinical trials is the experience of the medical professional prescribing them. I question the wisdom of entrusting prescriptions of poorly-understood drugs whose sides can cause death to a GP rather than an experienced psychiatric clinician. I question the sanity of incentivizing it. That pharmaceutical reps are even allowed to set foot in an MD's office is fucking batshit to me. You combine that incentivization with poorly-understood methods of action, and you open a can of anecdotal, off-label worms that winds up with our kids, friends, and family worse off than when they started. First-line antidepressants should not be first-line treatment, and the notion that a patient's psychiatric care - which is so riddled with intangibles and requires something quite beyond bedside manner - should be entrusted to a GP is wrong. I think if, say, drugs had to undergo quintuple the amount of positron emission tomography so as to be very, very well understood and able to be articulated in terms that a GP can understand the dynamics of, it's a less risky practice. But the fact that I can go into a doctor's office and walk out with an Rx for bupropion and amphetamine for lethargy and benzodiazepines to calm me down afterwards - as probably dozens of people I know have - and have zero non-pharmaceutical care to go with it is bonkers.

Another point I want to get out of the way is this: at therapeutic doses, none of the unconventional drugs that've been floating around - MDMA, Cannabis, ketamine - have side effects attributed to them that can even hope to compare to the insidiousness of the sides of even the most widely-accepted first- and second-line antidepressants. That alone should immediately lend their - even limited - results substantially more credibility in the eyes of the medical community.

I hope none of this sounded insubordinate; I respect your assertions as a medical professional immensely.

Just my thoughts.

-6-2

 

[Six-Two]

P.S. Sorry for the sheer density of that post; I'd edit it to un-Piracetam-ify it but I don't have editing privileges.

 

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[Six-Two]

I appreciate your kind words. I think it is hard to explain the dilemmas a provider has when looking at an empty prescription pad with his/her name printed on the top of it. That said, an opinion changes with education, training, and experience.

A word or two about drug reps. They are employees of a pharmaceutical company, and they come with differing takes on a wide variety of medicines; we get that. Do not presume that we take them at their word and nothing else. There is research done to prove a point, and when looking at it, it can be convincing. On the other hand, there is research done to find the truth. Graduate education in many fields brings an understanding as to what research really is. We know enough to do our own research, and what to look for when treating patients. To think we simply let the drug rep tell us what to do is rather unkind, and is an uninformed opinion of the medical profession. So when it comes to deciding what antidepressant medicine to use, I let the psychiatric community decide that. After all, they are the people who have done the five-year post doctoral training to make those difficult decisions. Medical advice is always best left to those with the education, training, and experience to do so.

First off, apologies if it sounded like I was suggesting physicians weren't capable of making their own assessments and weighing pros and cons of a course of treatment. That wasn't my intention at all.

I suspect I'm dangerously close to veering off-topic, but my concerns are manifold. They're all separate issues to tackle as well, but I think together they form an especially bad combination of circumstances.

Chief among them is the prevailing wisdom still seems to be that SSRI's and MAOI's are the gold standard in mental healthcare. And their appeal is enormous - who'd want to sit down with somebody once a week, maybe forever, when they could just pop a pill and feel better? With regard to the military specifically, there is a culture of not talking about things, which is especially toxic, because then you're giving pills to a community that's already at risk for prescription abuse while stigmatizing holistic treatments.

And while yes, I'm sure the majority of health care professionals are not so easily wooed by pharma reps as to have it affect Rx's, I simply can't accept the notion that Americans would still spend $330-Billion-with-a-B a year on prescription drugs if what amount to pharmaceutical lobbyists weren't constantly cloying MD's to prescribe their wares. According to a Mayo Clinic study, 70% of Americans are on 1 prescription drug. Over 50% are on 2. Honestly, this video articulates my gripes with the pharmaceutical industry better than my sleep-deprived mind can swing right now:

But of primary concern to me is the "fix-it-with-a-pill" mentality that is so widespread in our country. Or, as it pertains to this issue specifically, that we'll accept pills with insidious side effects and limited efficacy, but giving some amputee a quarter hit of Molly so he can get through a therapy session without breaking down into tears is this big fuckin' hoopla.

Again, no offense intended to the MD's, just of the mind that in this case, we're way behind the curve.

 

[RackMaster]

@Six-Two you are mistaken about the mental health "gold standard". Medications are meant to stabilize in order to attend therapy. It's a "bandaid" for the brain. With that, the individual has to want to get healthy and participate in the treatment plan. That's usually where things go wrong. It's not an instant fix. Frankly there's not enough in-treatment during initial prescription treatment. They all affect our brain chemistry different and not all may work for everyone. I know for myself it took 4 or 5 meds before we found the right one and 2 or 3 dosage adjustments. During that time, without my wife around to monitor me; things could have ended badly.


As for the MDMA research, it is only done under strict medical supervision and therapy is required part of the treatment. They aren't just popping pills and sending them on their way.

 

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