Description: I have posted a number of times in the past on the topic of PTSD (Post Traumatic Stress Disorder – search PTSD in the Weekly Updates search window). Symptoms of PTSD are worryingly common among retiring military veterans. The rate in the general population is just under 10% while the rate among returning vets is in the neighbourhood of 35 to 40%. A variety of approaches to support and to treatment seem to possibly help — look at the results of the search I recommended above, and you will see references to animal assisted therapy, support animals, EMDR (look it up), and general cognitive behavioral therapy. In addition, medical marijuana has shown some possible positive effects though the Canadian ministry of Veterans affairs recently seriously cut their budget for medical marijuana for vets citing exponential cost increases and the lack of sufficient numbers of vets in Canada to support a properly controlled study of the effects of medical marijuana on the symptoms of PTSD (sound fair?). So, what might research tell us about the possible positive impact of otherwise illicit drugs (and yes marijuana WILL soon NOT be illicit in Canada, but it will still not be free for those that potentially need rather than want it) on the symptoms of PTSD and as an add-in the psychotherapy? Well the article liked below talks about a research study recently published that looked at the effects of different levels of MDMA (yes ecstasy, like what was given to an octopus in the posting I put up last week). Before you read the article think about how you would design a study looking at the effects of MDMA as an adjunct to psychotherapy with people suffering symptoms of PTSD. Would you want the participants to know if they had been given MDMA? Would you vary the dosage? How would you fold the drug and therapy together? Once you have thought about these design issues have a read through the article linked below to see what the researchers did.
Source: PTSD and Ecstasy: Science and Perception. Eugene Rubin and Charles Zorumski, Demystifying Psychiatry, Psychology Today.
Date: October 3, 2018
So, did the double-blind design seem to work? Why try for a double-blind design? Why might it have not worked at all dosage levels? If the results are replicable these results could suggest a powerful approach top therapy for veterans with PTSD. It is worth thinking about what sorts of ethical concerns we might have to address before moving forward with such an approach to treatment (assuming it works). I hesitate to suggest that, if the data bears this approach to treatment out perhaps the relative cost of marijuana and MDMA might also be a consideration in deciding how to proceed.
Questions for Discussion:
- What is it about MDMA that might support therapy effectiveness for those with PTSD?
- What sorts of research is still needed before this approach the treatment of PTSD get green-lighted?
- Are there other disorders or populations that might be considered for similar exploratory treatment research?
References (Read Further):
Mithoefer, M.C., Mithoefer, A.T., Feduccia, A.A., Jerome, L., Wagner, M., Wymer, J., Holland, J., et al. (2018). 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. Lancet Psychiatry. 5:486-497.
Danforth, A. L., Struble, C. M., Yazar-Klosinski, B., & Grob, C. S. (2016). MDMA-assisted therapy: a new treatment model for social anxiety in autistic adults. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 64, 237-249. https://www.sciencedirect.com/science/article/pii/S0278584615000603
Parrott, A. C. (2007). The psychotherapeutic potential of MDMA (3, 4-methylenedioxymethamphetamine): an evidence-based review. Psychopharmacology, 191(2), 181-193. https://www.researchgate.net/profile/Andrew_Parrott/publication/6507021_The_psychotherapeutic_potential_of_MDMA_34-methylenedioxymethamphetamine_An_evidence-based_review/links/0912f50a2402128711000000/The-psychotherapeutic-potential-of-MDMA-3-4-methylenedioxymethamphetamine-An-evidence-based-review.pdf
Bouso, J. C., Doblin, R., Farré, M., Alcázar, M. Á., & Gómez-Jarabo, G. (2008). MDMA-assisted psychotherapy using low doses in a small sample of women with chronic posttraumatic stress disorder. Journal of psychoactive drugs, 40(3), 225-236. https://www.researchgate.net/profile/Gregorio_Gomez-Jarabo/publication/23468856_MDMA-Assisted_Psychotherapy_Using_Low_Doses_in_a_Small_Sample_of_Women_with_Chronic_Posttraumatic_Stress_Disorder/links/0912f50d3a77e79aa1000000/MDMA-Assisted-Psychotherapy-Using-Low-Doses-in-a-Small-Sample-of-Women-with-Chronic-Posttraumatic-Stress-Disorder.pdf
Parrott, A. C. (2014). The potential dangers of using MDMA for psychotherapy. Journal of psychoactive drugs, 46(1), 37-43. https://www.researchgate.net/profile/Andrew_Parrott/publication/262381558_The_Potential_Dangers_of_Using_MDMA_for_Psychotherapy/links/556436d308ae86c06b696c8a/The-Potential-Dangers-of-Using-MDMA-for-Psychotherapy.pdf
Sessa, B., & Nutt, D. (2015). Making a medicine out of MDMA. The British Journal of Psychiatry, 206(1), 4-6. https://pdfs.semanticscholar.org/8be9/603af17ccaf893165d96fa65551d182988e0.pdf