New realities in psychotrauma

Isolde de Jong started her internship with APRA in November 2018, ever since she is reporting activities within the organization. As a student of applied psychology with a main interest in psychedelic research, she developed a strong curiosity in the biological mechanisms of certain entheogenic plants and other substances. With this internship she hopes to achieve a better understanding of psychedelic research and to help destigmatize the subject.

 


New realities in psychotrauma

by Isolde de Jong
Edited by Jennifer Them

 

Can MDMA help in treating posttraumatic stress disorder  (PTSD)? Eric Vermetten, MD, PhD., is a clinical psychiatrist who visits soldiers who suffer from PTSD. He is the main coordinator for a training program for MDMA-assisted therapy for Post-Traumatic stress disorder in the Netherlands. Eric Vermetten was invited to speak at APRA’s journal club about his medical model of MDMA-assisted treatment for PTSD. APRA recorded the event. Visit the link below if you are interested in watching the full lecture.  


Over a hundred years ago, MDMA got synthesized by a German pharmaceutical company. The company’s initial aim was to research a compound that could stop excessive bleeding but the results were not considered successful. Little did they know about the impact their discovery would make a century later in the field of assisted therapy.

MDMA got well known in the eighties, used by people on the dancefloors all across the globe. From Ibiza to the hippie paradise of Goa, everywhere MDMA was strongly associated with the rave-culture and electronic festivals. On July 1st 1985, MDMA got banned by the American DEA due to its potential harmful side effects on the public, around that time research had shown MDMA cause brain damage in rats. The Dutch government followed suit by placing MDMA on the list of illegal substances in 1988. Main reason was the Dutch government’s fear of large scale illegal production and trade of the drug. This made it harder for scientists to conduct research with MDMA as a tool for it became illegal all over the world. However, some researchers still managed to do controlled studies with the drug, especially in fields of behavioural science.


This all changed in 2017, when the results of Phase 2 clinical trials funded Multidisciplinary Association for Psychedelic Studies (MAPS) was so outstandingly positive, that the FDA granted MDMA with a breakthrough therapy designation. The designation as Breakthrough Therapy also means a close collaboration between the FDA and MAPS with the goal of providing guidance for the development of an efficient program for MDMA-assisted therapy. To briefly explain background information on the study, all 107 participants had chronic treatment-resistant PTSD and had suffered from PTSD for an average of 17.8 years. 61% of the participants that were suffering from PTSD did no longer qualify for PTSD after three sessions of MDMA-assisted psychotherapy two months following treatment. MAPS is now determined to make MDMA-assisted psychotherapy a legal prescription treatment by the year 2021.

But what makes this substance so well-suited for assisted psychotherapy? To answer this and other MDMA-related questions, I went to the lecture hold by Prof. Eric Vermetten

Eric Vermetten is a clinical psychiatrist working with veterans and other uniformed officers as Strategic Advisor of Research at the Military Mental Health Service with the Dutch Ministry of Defense, Arq Psychotrauma Research Group and at UMC Utrecht. And he is the main coördinator for the training program for MDMA-assisted therapy in the Netherlands.

During his lecture, Eric explained how it’s like to live with PTSD according to his patients. He spoke about the detachment to society that patients often experience, how they live with symptoms like night terrors, panic attacks, hyperventilation, extreme fear and avoidance associated with the recall of traumatic memories called flashbacks. Patients often self-medicate and/or (ab-)use different substances to lower down their discomfort. But that doesn’t solve the problem. Patients can’t seem to escape the horrific symptoms of PTSD. “For a patient, it feels like the traumatic event is engraved in their brain and body”, Eric Vermetten added.  

One of the criteria to be diagnosed with PTSD according to the DSM-V, a Diagnostic and Statistical Manual of Mental Disorders, is to be exposed to great danger and stress. In response to stressful situations our bodies releases a set of catecholamines, like epinephrine and norepinephrine, which in return makes our heart beat faster, our pupils dilate and our breathing increase. To deal with sudden threat some of our normal brain functions like our short time memory stop working. When developing PTSD memories aren’t processed in the usual way. Simultaneously, our brain records everything we see, smell, hear, or taste in this experience, and stores it in the traumatic memory. Those inputs, however small and seemingly irrelevant, can become triggers later on, letting you experience the traumatic event all over again.

Above you have read a few of the core features of PTSD, some of these characteristics can be linked to an over-stimulated Amygdala which is the part in the brain that regulates fear and stress. To oversimplify PTSD we could say that PTSD is a disbalance between the activating input of the amygdala, and inhibitory input of the medial prefrontal cortex (mPFC). The function of the inhibitory input of the mPFC is to evaluate and regulate the bottom-up fear response from the amygdala. When somebody experiences a flashback from one of the triggers the mPFC fails to intervene the strong fear-response of the amygdala. To put in simpler terms, due to that failure those triggers can make a normal situation turn into one’s trauma. The brain cannot make out the difference between real danger a memory of a previously experienced traumatic experience.

Now let’s take a look at some of the psychopharmacological characteristics of MDMA. MDMA acts on various 5-HT receptors and inter alia causes the release of serotonin. This has been linked to feelings of well-being, happiness and reduced depression and anxiety.
Additionally, mediation on the 5-HT2A is thought to cause alterations in the perception of meaning which in combination with the latter helps patient develop new insight about their experiences.

In therapy, patients with PTSD usually have to relive their traumatic experience. As mentioned above, PTSD can cause overstimulation of the amygdala and it seems according to Eric that the use of MDMA reduces this activity which makes it much easier for a patient to revisit memories without the intense feelings of fear. And because MDMA stimulates the release of dopamine and noradrenaline, which raises levels of arousal, a patient is put into the so called “optimal arousal zone” which in turn makes them appropriately alert and motivated to engage in the psychotherapeutic process.

Last but not least MDMA has been shown to release oxytocin which plays a important role in social contacts, care-giving and romances. But this also produces a stimulating effect on motivation to engage in therapy.

“How can we help patients to reconnect with a world in which they have lost confidence”

MDMA assisted-therapy could be the answer to this question that was repeated by Eric in his lecture. It seems that MDMA helps patients to connect with their therapist to be able to talk more openly and without fear about their traumatic experience and to dive deep into their autobiographical memories. Slowly peeling off the layers of shame, anger and guilt. However it is important not to forget that this form of therapy has been so successful not only because of the consumption of MDMA but due to the form of therapy that is long and intensive, focusing on preparation and integration. The therapy is highly personalized and a lot of time is spend on motivational readiness and expectations that are scaled down into realistic outcomes. But let’s not get too much ahead of ourselves the future of MDMA assisted-psychotherapy. It looks positive but we still have to wait for the results for the final phase of research required before the FDA decides on the approval of MDMA as a legal prescription treatment for PTSD.


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Watch Eric’s talk for APRA:

 

 

Photo by Paul Talbot on Unsplash

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