Science Questions

How does Ecstasy help treat PTSD?

Wed, 20th Nov 2013

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Question

Kimberley Philbey asked:

How does MDMA affect the brain circuitry and memory in soldiers with PTSD during psychotherapy?

 

Current successful trials of MDMA use in treatment-resistant PTSD analyse data up to six years after use but is this period long enough to confirm that the drug was effective?

 

Would dependency of MDMA be of concern given the short-term use?

Answer

Amy -   So, MDMA which is also known as ecstasy.  Itís a very, very dirty drug Ecstasythat has a lot of different effects on the brain.  A few of the things that it does is mainly to increase levels of particular chemicals - so, dopamine, noradrenalin, serotonin, and oxytocin.  So, these are all modulatory chemicals in the brain that influence cognitive function in a very sort of diffuse way.  

But certainly, dopamine and oxytocin have been linked to feeling attached to people and euphoria and feeling good about yourself.  

MDMA used to treat posttraumatic stress:  there has been some evidence that MDMA reduces the activity of the amygdala.  So, that might be why MDMA appears to be effective in conjunction with psycho therapy which it ultimately reduce the activity of the amygdale.

Hannah -   And that reduces that feeling of fear and anxiety?

Amy -   Yes, exactly.  So, the amygdala is really important.  Itís important for a number of different emotional memories, but in the case of PTSD for the storage of those fear memories.

Hannah -   And Kimberly also asked, would dependency of MDMA be a concern, given the short term use for any military personnel or anyone suffering from PTSD?

Amy -   So, that's a really good question.  In the study, they used MDMA in conjunction with psycho therapy and they only gave three doses of MDMA.  

So that, I would consider as being more like the doctors giving morphine in a hospital when somebody is in a lot of pain and we know that people who are given morphine for pain in a hospital donít tend to go out and seek heroine on the street.  So, you wouldn't necessarily expect people whoíve been given MDMA during psychiatric treatment to necessarily go out and seek it themselves.  

And anecdotally from that study, the authors comment that the patients really bought into the idea that it was enhancing the psycho therapy and wouldn't have thought of going and taking the drug in the absence of that psycho therapy.  There's certainly no reason not to explore this as a potential therapeutic option.

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How well would it work for the treatment of chronic pain? Pmb, Wed, 11th Dec 2013

By boosting dopamine, noradrenalin, serotonin, and oxytocin, articles say it has full body analgesic properties, and can relieve both physical and psychological pain. It doesn't seem to interfere with cognition, or at least not in the same way that central nervous system depressants do. But the problem with using it chronically is that our nervous systems often stubbornly resist any long term adjustments or increases in neurotransmitters, by changing the number or function of receptors on cells. So the danger is ending up worse off than you started, with possibly permanent irreversible changes.

It's a problem with a lot of drugs - the nervous system resists attempts to up regulate or down regulate it, and responds by compensating with the opposite effect. That's essentially what happens when one builds tolerance. And it explains why the side effects of withdrawal are usually the opposite of the drug, that is, people withdrawing from alcohol will be jumpy and agitated, unable to sleep. People withdrawing from stimulants like cocaine or amphetamines will be tired and sluggish. 

ps. I don't know why this doesn't seem to be a problem with long term use of SSRI antidepressants, or at least not that I've read. This article suggests the mechanism of antidepressants might be more complicated than previously thought.

http://www.scientificamerican.com/article.cfm?id=unraveling-the-mystery-of-ssris-depression&WT.mc_id=SA_FAcebook cheryl j, Wed, 11th Dec 2013


What's the difference between that and long term use of opiods? Pmb, Wed, 11th Dec 2013


What's the difference between that and long term use of opiods?


One article I looked at said that there is actually little research about the long term effects on the brain from chronic opioid use, and what if any changes are permanent,  which is  surprising given how long these drugs have been around. The article said it's complicated by the fact you have to break people down into a lot of separate groups to study - such as patients who had or continue to have untreated chronic pain (since pain itself may change the brain) patients who became addicted primary from recreational use, patients who had pain but then became addicted for other reasons, patients became dependent but never developed addiction, that is, never demonstrated drug seeking behavior once pain issues were adequately addressed. And of course, there may be significantly different effects from prescription vs illicit opioids. This particular article looked at changes in the structure of and connections to the amygdala in one group of patients with long term opioid use.

The second Medscape article notes hormonal suppression with long term opioid use (because of effects on the hypothalamus and pituitary gland) although this article has very pro-pain treatment viewpoint despite these problems. I don't know what if any changes would be permanent.

The third article mentions hyperalgesia or hypersensitivity to pain as a result of long term use, and although most articles I've read say it goes away eventually with discontinued use, other articles suggest that some degree of hyperalgesia, as well as tolerance may remain in certain patients.

http://brain.oxfordjournals.org/content/133/7/2098.full

http://www.medscape.com/viewarticle/782660

http://www.iasp-pain.org/AM/AMTemplate.cfm?Section=HOME&CONTENTID=7618&SECTION=HOME&TEMPLATE=/CM/ContentDisplay.cfm cheryl j, Thu, 12th Dec 2013

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