Ecstasy For Treatment Of Traumatic Anxiety

ScienceDaily (Jan. 10, 2009) — Treatment with a pharmacological version of the drug
ecstasy makes PTSD patients more receptive to psychotherapy, and contributes to
lasting improvement. Norwegian researchers explain why.

People who have survived severe trauma - such as war, torture, disasters, or sexual
assault - will often experience after-effects, in a condition called posttraumatic stress
disorder (PTSD). The symptoms can include anxiety, uncontrolled emotional
reactions, nightmares, intrusive memories, sleep and concentration difficulties,
evasion of situations that resemble the trauma, and feelings of shame or amnesia.

For many, the condition gradually goes away by itself. Other individuals experience
PTSD as a chronic condition that needs treatment, which typically involves drugs that
help with anxiety and depression, and/or psychotherapy.

More than just happy pills

Psychotherapy usually involves a combination of talk sessions and tasks. In exposure
therapy, the focus is to help the patient digest the traumatic event in a safe context.
So the patient realizes that the memories of the traumatic event and the situation
surrounding it are not dangerous. The patient learns to deal with the traumatic
incident as a painful memory, and not as if it will happen again.

“Studies show that exposure therapy can be a very effective treatment of post
traumatic disorders. Yet far too many patients receive treatment only with drugs. But
anxiety reducing drugs and anti-depressants may work against our efforts and
reduce the patient’s emotional learning”, says Pål-Ørjan Johansen, a psychologist at
the Norwegian University of Science and Technology.

Along with Teri Krebs, a neurobiologist at the university, he is now exploring what
happens when chronic trauma patients are treated with a combination of
psychotherapy and pharmacological versions of ecstasy, MDMA (3,4 methylenedioxy-
N-methyl-amphetamine). A U.S. study,* recently conducted by psychiatrist Michael
Mithoefer, has shown remarkable success with this combination.

More open with ecstasy

Mithoefer took 21 people with chronic PTSD, all of whom had been subjected to
documented abuse. All had also been through six months of treatment with
traditional therapy, in addition to a three-month treatment with drugs. None,
however, had shown any improvement from the treatment.

Under Mithoefer’s treatment, the patients stopped their usual anxiety-reducing drugs,
and began a new treatment with twelve sessions of psychotherapy. During two of
these therapy sessions, some patients were given doses of MDMA, while the others
were given a placebo (a fake pill).

Two months after the treatment, 92 percent of MDMA patients had clinically
significant improvement in their conditions: They were more open to therapy and
were able to process the trauma. They managed to escape from their shells and
shame, and to see lifelong patterns of behaviour. They were less dispirited, evasive
and afraid. In contrast, only 25 percent of the patients in the placebo group showed
progress. Everyone in this group was subsequently offered treatment with MDMA,
and the results have been good, with no serious or lasting side effects.

Neuropsychological tests suggested that patients had improved mental ability after
treatment. None of MDMA patients continued to take the drug after treatment. But
many of them had managed to transform a crippling trauma into "only" a memory --
a painful memory, but still more manageable than before.

Changes in brain activity

“This was a small study, and it must be followed up by more. But the results are
promising, both in terms of safety and the effects of treatment. It is also important to
stress that this is not about daily medication, but short-term, controlled use,"
Johansen and Krebs say.

The Norwegian scientists have investigated both this and a number of other studies,
and suggest the following explanation:

“For the first, MDMA contributes to increasing the level of oxytocin in the brain. This
hormone stimulates emotions such as connection, proximity and trust. In a
therapeutic context, it means that the patient may be better able to open up and
have confidence in the therapist.

For the second, MDMA increases activity in the ventromedial prefrontal cortex. This is
an area in the anterior part of the brain that processes fear, lowers stress, and
enables us to see events in perspective. This is where decisions are taken and
feelings are regulated. Activity here is closely linked to activity in the amygdala, the
area of the brain that is the centre for feeling fear. You could say that fear is formed
in the amygdala, but is processed in the ventromedial prefrontal cortex. While activity
in the cortex is increased with MDMA, the drug simultaneously reduces activity in the
amygdala. We believe this will help improve the regulation of emotions, allay fears
and reduce evasive behaviours in a therapy situation.

For the third, MDMA triggers the ‘stress’ hormones noradrenalin and cortisol. These
hormones are necessary to activate the emotional learning that leads to long-term
reduction of fear.

In summary, we suggest that MDMA is an emotional enhancer that helps the patient
feel safer and in control, better able to connect with memories, and more capable of
the emotional processing that is needed for improvement.”

Teri Krebs’ and Pål-Ørjan Johansen’s explanatory model is being published in the
Journal of Psychopharmacology.

*Mithoefer, M, Mithoefer, A, Wagner, M (2008) Methylenedioxymethamphetamine
(MDMA)-assisted psychotherapy in subjects with chronic posttraumatic stress
disorder: A Phase II clinical trial completed 19 September, 2008. Poster presented at
the 24th Annual Meeting of the International Society of Traumatic Stress Studies,
Chicago.


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