Saturday, 24 May 2014

Fighting fire with fire - Part 1 (PTSD with MDMA)

An exciting aspect of neuropharmacology is the idea of using a harmful or illegal substance to treat a medical condition, hence "fire with fire". There are numerous examples of this throughout medicine, and recent research developments are now working towards providing relief from neurological diseases such as PTSD, or even the elusive cure for cancer. This week is the first of a 3-part series. In this instalment, I have explored PTSD and the new unconventional methods being developed in the hopes of providing sufferers with relief.  

A soldier undergoing neurological tests.
Source: Jae C Hong/AP
PTSD, or Post Traumatic Stress Disorder, is a debilitating anxiety disorder that stems from the victim experiencing an extremely distressing event. A few examples of PTSD causes include military combat, natural disasters (floods etc) and violent personal assaults. PTSD can either arise immediately after an event, or develop over an extended period of time, and is characterised by the sufferer experiencing disturbing flashbacks, depression, anxiety, phobias and “hyper-arousal” (a feeling of being on edge). Interestingly, although PTSD is primarily neurological it can also manifest into physical symptoms such as headaches or chest pain.

Currently, the main method to help those with PTSD is Cognitive Behavioural Therapy (CBT) – this is a form of psychotherapy that involves trying to completely re-conceptualise the issue at hand and consolidating the new idea. This can take place in the form of face-to-face therapy sessions, use of computer software programs and reading self-help CBT guides. However, a new controversial method for treatment of PTSD is currently being explored.

This method involves the use of MDMA, also known as 3,4-methylenedioxy-N-methylamphetamine or more commonly ecstasy. MDMA is an illegal recreational drug, but despite its criminalisation, actually began as a therapy drug in the early 1970s. Now, its therapeutic potential is starting to be reconsidered.

Source: http://www.nclitigation.com/files/2013/05/FightFireWithFire3.jpg

Once ingested, MDMA works by changing various activity levels in your brain. Specifically, it reduces activity in the amygdala (an area associated with fear), increases activity in the frontal cortex (an area responsible for putting things into perspective) and increases the release of hormones oxytocin and prolactin (commonly associated with feelings of bonding or love). It is understandably follows then that MDMA can induce feelings of euphoria, a sense of intimacy with others and fundamentally, reduce anxiety.

The understanding of how memory works is also key to the development of this new form of therapy. Every time you remember something you are recreating the memory (through firing of various neurons in the brain etc) and have the ability to alter it slightly. In the case of those with PTSD, every time a stressful event is recalled the feelings of fear and severe anxiety are brought back. In other words, there is a strong negative association with their memory of the event.

This is where MDMA comes in useful. In the proposed treatment of PTSD with MDMA, patients would receive psychotherapy following the currently available method, but with the addition of administration of MDMA. The idea is that when the sufferer then recounts their memories of the event to a therapist, they will have reduced anxiousness, and so will learn to associate their euphoric feelings (resulting from the drug) with the memory instead.  

MDMA tablets
Source: http://www.usdoj.gov/dea/programs/forensicsci/microgram/mg0103/mg0103.html
    
A clinical trial regarding this examined two groups of people with PTSD, one given a placebo tablet and received intense psychotherapy sessions, following the same methods used today (CBT etc). The other was given an MDMA tablet and also received the same psychotherapy. Amazingly, two months after this, 83% of the patients in the MDMA group no longer qualified as PTSD sufferers due to their lack of symptoms, compared with only 25% in the placebo group. This is an irrefutably significant difference!

However, the first clinical trial regarding PTSD and MDMA took place all the way back in 2000. Even though the results of this were extremely encouraging, it is not surprising that the idea to use an illegal drug in medicine has been met with controversy. It is also, however, important to realise that MDMA is not a "magic drug" that will immediately "cure" someone. PTSD is a serious neurological condition, and although MDMA will help to alleviate the symptoms more easily, it will not just erase them.  

MDMA is an illegal drug, but should its therapeutic benefits should be prioritised and researched more thoroughly regardless? Or would the acceptance of MDMA use in therapy send out a message of more lenient drug policy? 

What do you think?

Click here for an excellent short film on this issue.

Next week, in "Fighting fire with fire - Part 2", I will be looking into the fight against cancer, and potential use of HIV mechanisms as treatment!

1 comment:

  1. Very interesting- sometimes I do get annoyed that the governments of the world are very against research of illegal drug mechanisms. Surely there are ways to isolate the active compounds! Ho hum!
    With regards to your next post... Have you seen about the use of HIV mechanisms to treat SCID (severe compromised immunodeficieny disorder)?

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