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Ecstasy: Rolling Towards Calming Victims of Post -Traumatic Stress Disorder (PTSD)
October 1, 2010
As a result of it’s euphoric and energy kick, ecstasy is mostly known for its presence in club scene. The drug allows users to dance for hours on end without feeling fatigued. Recently, ecstasy has found an unusual presence in psychology clinics and the backdrop is not filled with strobe lights but victims of PTSD.
PTSD: What is it?
PTSD is defined as exposure to a traumatic event involving real or imagined threats to the health, well being and/or life of the experiencing individual with a response of intense fear, helplessness, or horror (APA, 2000). Reactions to PTSD often differ with each case. Using remedies of time and therapy, some cases improve throughout the years while others worsen into severe conditions, disrupting lives and families.
Symptoms and signs of PTSD typically occur 3 months after the initial traumatic event, with a small number of cases taking years to develop. Symptoms can include but are not limited to flashbacks, trying to avoid discussion on the event, emotional numbness, hopelessness about the future, memory problems, trouble concentrating, difficulty maintaining close relationships, irritability/anger, guilt/shame, self-destructive behavior insomnia, being easily startled/ frightened, and auditory or visual hallucinations (Mayo Clinic Staff, 2009).
How common is PTSD?
PTSD is a crucial worldwide health concern, affecting many regions in varying degrees. The lifetime prevalence for PTSD in adults in the U.S. is about 8%, exceeding the lifetime prevalence of all other anxiety disorders (APA, 2000). One of the highest groups at risk for the disorder are U.S. Iraq and Afghanistan war veterans, as up to 17% exhibit PTSD, depression, or anxiety (Greene, 2005). War-torn areas have staggering percentages that indicate the potential of residents developing the disorder. For instance, Sderot, a town located near the Gaza-Israel border that is under incessant attack from militant rockets, demonstrates that anywhere from 75%-90% of its teenagers aged 4-18 are believed to display symptoms of PTSD and 30% have formally been diagnosed with PTSD (Grinberg and Ashkenazi, 2008). It is rational to assume that similar conflicting regions under similar conditions would have a percentages in the same range as those associated with the teenagers in Gaza. The numbers tell a grim story, and the persistence of the disorder adds nothing but depth to the percentages.
Methylenedioxymethamphetamine (MDMA), Commonly known as Ecstasy:
MDMA was first synthesized in 1912 by the pharmaceutical company Merck, but was not tested at that time in either humans or animals (Freudenmann, Oxler & Bernschneider, 2006). Until its prohibition in the U.S. in 1985 as a Schedule 1 controlled substance, MDMA was widely used as an adjunct to the psychotherapeutic process (Grinspoon & Bakalar, 1986). There is an estimate that during this period about 500,000 doses of MDMA were administered in psychotherapeutic settings (Rosenbaum & Doblin, 1991). Given the stigma that the Drug Enforcement Agency (DEA) has associated with MDMA, the idea to attempt to treat anxiety patients with the drug may seem to some brash and desperate. In reality, MDMA as a treatment was not all that rare.
Existing Treatments for PTSD
There are different types of therapy used to treat PTSD. One of these forms is cognitive therapy, which is a type of talk therapy used to help the victim identify and change self-destructive thought patterns (Mayo Clinic Staff, 2009). In addition, exposure therapy helps the victim safely confront the traumatic event he finds disturbing, so that the victim can effectively cope with it (Mayo Clinic Staff, 2009). There is also eye movement desensitization and reprocessing, a combination of exposure therapy with a series of guided eye movements that help the victim process traumatic memories (Mayo Clinic Staff, 2009). Finally, there is cognitive behavior therapy, an approach which combines cognitive and behavior therapy to help the victim identify unhealthy beliefs and behaviors in order to replace them with positive ones (Mayo Clinic Staff, 2009).
There are also medicines that are taken along with the aforementioned therapies. Paroxetine (Paxil) and setraline (Zoloft) for treating PTSD and are known to function by way of serotonin uptake inhibition (Doblin, Mithoefer & Julie, 2009).
Calling on the Unconventional: Why New Treatments are Needed
Although existing treatments are effective to some extent a significant amount of PTSD patients fail to sufficiently respond to established PTSD psychotherapies (Doblin, Mithoefer, & Julie, 2009). Furthermore a recent meta-analysis confirmed that all mainstream therapies, namely those aforementioned, had an average effect size of 25% (Mithoefer & Julie, 2009). Three out of every four affected still do not have an appropriate remedy for coping with the disorder. Concerning the anti-depressants administered, Paxil and Zoloft, there is the issue of dependency. Discontinuation of the drugs often causes relapse in PTSD patients, and because there is a limitation on the medicinal options, this is a major obstacle when seeking long –term relapse prevention (Goodman, 2009).
There are several reasons why MDMA could play a pivotal role in treating PTSD, one of them being the duration of its effects. In terms of psychological safety and the ability to regulate and monitor the user, MDMA is superior all other psychedelics. As compared with LSD or Peyote, which last 8-12 hours and are too volatile to be used to treat the kind of anxiety that occurs with PTSD, MDMA is relatively short. The primary effects of MDMA last up to 4 hours and take 2 additional hours or so to wind down to the baseline state (Doblin, 2002). More importantly, as opposed to the selective serotonin reuptake inhibitor treatments (SSRI), i.e. Paxil and Zoloft, who require routine usage to be effective, MDMA-based therapy requires the consumption of the drug less than a handful of times (Doblin, 2002).
How does MDMA work in terms of suppressing PTSD?
MDMA possesses unique and specific pharmacological and psychological properties that make the drug suitable for use as an adjunct to psychotherapy for PTSD patients. Individuals under the influence of MDMA can usually “negotiate” with their conflicting psychological material and often retain the ability to navigate at will toward or away from certain thoughts or emotions (Doblin, 2002). MDMA rarely complicates cognitive functioning or perception but instead produces a warm, emotionally grounded feeling with a sense of self-acceptance, and a reduction of fear and defensiveness (Doblin, 2002).
Even though knowledge about the connections between the neurological and therapeutic effects of MDMA lack a thorough completion, it has been observed MDMA sharply decreases activity in the left amygdala, a part of the brain associated with feelings of conditioned fear and defensiveness (Doblin, Mithoefer & Julie, 2009).
Examples of 2 Studies that Used MDMA as Treatment for Anxiety or PTSD:
Study 1: (Greer & Tolbert, 1998)
In this study a man suffering from multiple myeloma was seeking help for the excruciating traumatizing pain due to his cancer. Due to previous therapies he had developed the ability through meditation to reduce his pain to the level of narcotics, but the pain was still overwhelming. His goal was cope with pain in a better way and receive help adjusting to life changes. During each of his MDMA sessions, he felt completely pain free, and even though the pain would return about 2 weeks after each session, he felt that the pain-free experience from MDMA helped him reduce the pain on his own.
Also in this study there was a woman who suffered from anxiety attacks and premenstrual syndrome with irritability and emotional volatility. She had 8 MDMA sessions over the course of a year and after her sessions she finally felt the importance of living on the “brightside” instead of in the “dark underside” where she previously spent so much time.
The Journal of Psychopharmacology sponsored by the Multidisciplinary Association for Psychedelic Studies recently published a study that gave MDMA to 20 patients of chronic PTSD. Those in charge of administering the drug did not know if they were handing out the drug of placebo. Ten of the 12 patients (83%) who were given MDMA ceased to show PTSD symptoms after two months of treatment, no longer qualifying as PTSD patients (Cloud, 2010). This is a significant contrast with those who received the placebo, as only two out of those 8 patients showed comparable improvement to those had received the drug.
Arguments about the Negative effects of MDMA:
According to one the leading critics against MDMA use, the most pressing concern is the massive release of serotonin that can potentially lead to various crisis of the sympathetic nervous system, which deals with reactions such as panic, hyperthermia, and dehydration (Parrot 2001). Because the brain is depleted from serotonin after the consumption of MDMA, there is also the concern of the inevitable “mid-week depression” or “suicide Tuesdays.”
To Wrap Up Rolling:
After reviewing the evidence, there appears to exist enough reason and enough need to proceed with the approach of MDMA in psychotherapy. The little apprehension that I have comes from the fact that the studies are so small, but then again that is due to the current legal status of MDMA in the U.S. For the most part the results are incredibly positive, most users who were administered the drug have shown genuine improvement, improvement far more drastic than can be achieved with the other established more conventional treatments. Unlike the mainstream treatments, MDMA seems to have the ability to provide relief and a more normal life for even the most severe of cases, those who see little other options.
Goodman, E. (2009). An exploration of mdma in treatment of ptsd. Gallaudet Chronicle of Psychology, 2.
Doblin, R.D., Mithoefer, M.C., & Julie, H. (2009). A randomized, triple-blind, phase 2 pilot study comparing 3 different doses of mdma in conjunction with manualized psychotherapy in 16 veterans with chronic posttraumatic stress disorder (ptsd). Protocol MP-8,
Doblin, R. (2002). A clinical plan for MDMA(ecstasy) in the treatment of posttraumatic stress disorder (PTSD): Partnering with the FDA. Journal of Psychoactive Drugs, 34(2), 185-195.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Publishing, Inc.
Mayo Clinic Staff, Initials. (2009). Post-traumatic stress disorder (ptsd). MayoClinic.com,
Greene, R.A. (2005). Combat stress: As old as war itself. BBC News.
Grinberg, M., & Ashkenazi, E. (2008). Study: Most Sderot kids exhibit post-traumatic stress symptoms. Haaretz.
Freudenmann, R.W.; Oxler, F. & Bernschneider-Reif, S. (2006). The origin of mdma (ecstasy) revisited: the true story reconstructed from the original documents. Addiction 101: 1241-45.
Grinspoon, L. & Bakalar, J.B. (1986). Can drugs be used to enhance the psychotherapeutic process? American Journal of Psychotherapy 40(3):393-404.
Greer, G.R., & Tolbert, R. (1998). A method of conducting therapeutic sessions with mdma. Journal of Psychoactive Drugs, 30(4).
Cloud, J. (2010, July 20). Ecstasy shows promise in relieving ptsd. TIME.
Parrot, A.C. (2001). Human pharmacology of ecstasy(mdma): a review of 15 years of empirical research. Human Pharmacology: Human Psychopharmacology Clinical & Experimental, 16, 557-577.
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