How does MDMA affect nightmares
Substance research : With ecstasy against fears and trauma
Ecstasy is the most popular illegal party drug of our time. Its active ingredient MDMA (3,4-methylenedioxy-N-methylamphetamine) was discovered at the beginning of the 20th century, but only became popular in the 1970s and 80s, especially on the dance floors of the international electronic scene - until the substance was released in the USA and 1985 1986 was finally banned worldwide. But now a comeback for the substance could be imminent - quite legally, as a drug. A study by psychotherapist Michael Mithoefer of the University of South Carolina of 26 patients with post-traumatic stress disorder (PTSD) found that 67 percent of them had no PTSD symptoms one year after treatment.
The patients were considered "exhausted"
Those treated were members of the military, the fire brigade and the police who had been traumatized by missions. They have suffered from PTSD for an average of seven years. Many of them were considered "exhausted" and therefore took part in the study, published in the journal "The Lancet Psychiatry", because conventional psychotherapy could no longer help them. The study was funded by the US Multidisciplinary Association for Psychedelic Studies (MAPS), a non-profit organization that has been campaigning for the decriminalization of MDMA since 1986.
But how can the medical benefits of the active ingredient, which will make you happy for around six hours, be explained? Doesn't the drug just create a brief high that leaves patients just as sick as before? "To answer these questions, you first have to understand the disease to be treated better," says Torsten Passie, lecturer in psychiatry at the Hanover Medical School and an expert on hallucinogens.
The effectiveness of MDMA in the psychotherapeutic treatment of PTSD is best documented. This mental illness is triggered by a traumatic experience of shorter or longer duration. Examples of this are accidents, war experiences, violent crimes or natural disasters. "A trauma occurs when an experience exceeds a person's psychological processing capacities, such as in the case of rape," says Passie.
Those affected experience a loss of control associated with fear and defenselessness, which can develop into PTSD with a delay. The disease can also be detected in brain scans. In those affected, the amygdala, the fear center of the brain, shows a significantly increased activity. It is estimated that one percent of the population in Germany is affected by PTSD (PDF), in the USA it should be up to eight percent - depending on the statistics.
The suffering of those affected is enormous: They have nightmares and keep experiencing flashbacks. Physically, the disease often manifests itself in the form of insomnia, difficulty concentrating, and frightfulness.
Talk therapy often doesn't work
"I know it's embarrassing to be afraid of going to your own house or being home alone in your mid-thirties," says Gail Westerfield, who took part in one of Mithoefer's MDMA studies. She has suffered from depression for most of her life, resulting from a child abuse case and college rape. She was later diagnosed with PTSD. "I've had these recurring dreams since I was a little kid," says Westerfield, describing her suffering. "I am walking through a house, the lights go out and then suddenly this power overwhelmed me."
Currently, patients like Gail Westerfield are treated with a mix of psychiatric drugs and talk therapy. The psychotropic drugs are used to stabilize the patient's condition and alleviate their symptoms. In talk therapy, the therapist builds trust in the patient and tries to cope with the trauma together with him or her. In doing so, you approach what you have experienced together, analyze and reevaluate it. "The aim is to integrate the traumatizing experience that was stored unprocessed during the trauma into the patient's psyche," says Torsten Passie.
"Unfortunately, normal talk therapy does not work in about half of patients with PTSD," says Ben Sessa, a psychiatrist from Imperial College London, who is also researching MDMA-assisted psychotherapy. These patients cannot face their internal trauma, not even under therapeutic guidance. Once the memory is evoked, pain and fear overwhelm it. This also explains the link between trauma and alcoholism - sufferers often try to drown the pain associated with the trauma in alcohol.
When normal talk therapy fails, treating the symptoms is often the only option. Sleeping pills for insomnia, mood enhancers for depression, tranquilizers for panic attacks. But psychotropic drugs have side effects: some are associated with an increased risk of suicide, make them dependent on them in the long term, or impair the patient's body.
Gail Westerfield also took psychiatric drugs for many years. "But none of the drugs worked properly for me," she says. "I was always prescribed new drugs, but none of them really improved my situation."
The drug inhibits the fear center and makes therapy possible
MDMA-assisted psychotherapy could be a chance of recovery for these people with chronic PTSD. "The MDMA puts the patient in a state in which it is almost impossible to feel fear because the substance releases the neurotransmitters serotonin, dopamine and oxytocin," says Ben Sessa. The otherwise hyperactive fear center of the brain, the amygdala, shows hardly any activity under the influence of MDMA, as can be seen in brain scans of the test subjects. At the same time, the hippocampus, the brain's thinking center, is working at full speed: The patients are fully conscious, mentally clear and productive.
"In this state, the patients can work productively with the therapist," says Sessa. "It is easier for you to face your trauma and work through what you have experienced with the therapist." MDMA works as a catalyst for psychotherapy. The psychotherapeutic approach is the same as in classic talk therapy. The therapist builds a relationship of trust with the patient and then tries to process the trauma together with him.
"MDMA is not a miracle pill," says Sessa. "Even under the influence of MDMA, hard psychotherapeutic work is necessary." The drug gives patients the psychological strength they need to face their trauma. The processing and integration of the experience is nonetheless an exhausting and difficult process. But under the influence of MDMA, many patients find it easier to build trust and talk about their experiences without being overwhelmed by them. Being able to think about the trauma without fear - this experience alone carries many patients through everyday life even after the session.
Previous studies are too small
This is how Gail Westerfield experienced the therapy. "I was always afraid that I would be engulfed by my trauma if I confronted it," "she told Tagesspiegel. "But in therapy it was suddenly very easy. I wasn't afraid anymore and could talk about all these terrible things."
Gail Westerfield is one of those on whom the therapy worked. It has been ten years since her last MDMA therapy session. She hasn't had any nightmares since.
Even if the approach is noteworthy, euphoria is premature, says Boris Quednow from the Psychiatric University Clinic in Zurich: "The studies published so far work with very small samples." The results must first be replicated in larger studies before one can speak of the effectiveness of MDMA-assisted psychotherapy.
MAPS is currently preparing such a large-scale study. "If this study with around 300 participants is positive, the chances are good that MDMA will be approved in the US in 2021 as a tool in psychotherapy," says Brad Burge, communications director of MAPS. So far there has been no funding - $ 26.7 million is needed for the study, which the organization has almost put together through donations from foundations and private individuals. For pharmaceutical companies, MDMA is economically uninteresting due to the lack of patent protection. And only a few public research institutions invest in MDMA research. "MDMA as a drug contradicts the social stigma," says Torsten Passie.
"Never use the drug on your own"
And there are good reasons for this stigma, studies by Boris Quednow show. People who have taken MDMA every weekend for years have an average memory performance by their mid-twenties that is equivalent to that of sixty-year-olds. "You shouldn't downplay MDMA," says Quednow. "It may not have the harm potential of heroin or cocaine. But it is certainly higher than that of cannabis and alcohol." David Nutt contradicts this. With regard to possible harm to consumers and the social environment, the former drug commissioner for the British government ranked MDMA 17th out of 20 in a study published in the journal "The Lancet" in 2010, far behind alcohol and cannabis.
In Mithoefer's study, 20 of the 26 participants reported side effects. These included anxiety, fatigue, headaches, and insomnia. In some subjects, the researchers also observed an increased intention to commit suicide when taking MDMA treatment. It is essential to carefully examine the participants psychologically and physically before treatment and to prepare them for the experience with MDMA, says co-author Allison Feduccia. Furthermore, psychotherapeutic monitoring during the sessions and good follow-up care are important. In this setting, MDMA could support psychotherapy and play a role in the future treatment of PTSD. "But we wouldn't recommend anyone using these drugs on their own to treat mental disorders," says Feduccia.
Even if the study, which MAPS plans to conduct initially in the USA (later also in Europe), confirms the effectiveness of MDMA-based psychotherapy, the regulatory authorities will have a close look at the associated side effects.
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