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Ecstasy could help patients with post-traumatic stress disorder
March 09, 2009Ecstasy may help suffers of post-traumatic stress learn to deal with their memories more effectively by encouraging a feeling of safety, according to an article in the Journal of Psychopharmacology published today by SAGE.
Studies have shown that a type of psychological treatment called exposure therapy - where the patient repeatedly recalls the traumatic experience or is repeatedly exposed to situations that are safe but still trigger their traumatic feelings - can be effective in relieving stress responses in patients with post-traumatic stress disorder (PTSD) and other anxious conditions. The therapy works by helping the patient to re-learn the appropriate response to the trigger situation, a process known as extinction learning.
But this approach can take some time, and 40% of patients continue to experience post-traumatic stress even after their treatment. To improve outcomes, scientists have been investigating the use of drug therapies to enhance the effect of exposure therapy, making the result of exposure to the fear trigger easier, faster, and more effective. MDMA (the pharmaceutical version of Ecstasy) is one such drug.
"A goal during exposure therapy for PTSD is to recall distressing experiences while at the same time remaining grounded in the present. Emotional avoidance is the most common obstacle in exposure therapy for PTSD, and high within-session emotional engagement predicts better outcome," explain authors Pål-Ørjan Johansen and Teri Krebs, who are based at the Norwegian University of Science and Technology and supported by the Research Council of Norway.
Psychiatrists that have administered MDMA to anxiety patients have noted that it promotes emotional engagement; strengthens the bond between the patient and doctor, known as the therapeutic alliance; decreases emotional avoidance; and improves tolerance for recall and processing of painful memories.
According to Johansen and Krebs, "MDMA [ecstasy] has a combination of pharmacological effects that-could provide a balance of activating emotions while feeling safe and in control."
They suggest three possible biological reasons why ecstasy could help individuals with PSTD. First, ecstasy is known to increase the release of the hormone oxytocin, which is involved in trust, empathy, and social closeness.
Because people with PTSD often report feeling emotionally disconnected and unable to benefit from the supportive presence of family and friends or therapists - a situation that is likely to contribute to the development and maintenance of the disorder - use of ecstasy might also help ameliorate these symptoms, suggest the authors.
"By increasing oxytocin levels, MDMA may strengthen engagement in the therapeutic alliance and facilitate beneficial exposure to interpersonal closeness and mutual trust," they write.
The second biological explanation for ecstasy's useful effect is that it acts in two brain regions to inhibit the automatic fear response (mediated by the amygadala) and increase emotional control (mediated by the ventromedial prefrontal cortex) and therefore permits bearable revisiting of traumatic memories.
Thirdly, ecstasy increases the release of two other hormones, noradrenaline and cortisol, which are known to be essential to trigger emotional learning, including the process that leads to fear extinction, on which therapy for PTSD relies. But, caution the authors, while these compounds enhance extinction learning they may also temporarily increase anxiety in people with PTSD because the hormones are naturally released as part of the body's response to stress.
Ecstasy combined with psychotherapy is a treatment already being tested in clinical trials to help patients with PTSD. All of these trials have a similar design in which ecstasy or placebo is administered to patients a few times during their therapy sessions as part of a short term course of psychological treatment. According to the Johansen and Krebs, recent preliminary results from two of these randomized controlled trials shows that the therapy might have promise.
"Reduction of avoidance behavior linked to emotions is a common treatment target for all anxiety disorders. MDMA [ecstasy] has a combination of pharmacological effects that, in a therapeutic setting, could provide a balance of activating emotions while feeling safe and in control, as has been described in case reports of MDMA augmented psychotherapy-.Future clinical trials could combine MDMA with evidence-based treatment programs for disorders of emotional regulation, such as prolonged exposure therapy for PTSD," conclude the authors.
SAGE Publications UK
"A goal during exposure therapy for PTSD is to recall distressing experiences while at the same time remaining grounded in the present. Emotional avoidance is the most common obstacle in exposure therapy for PTSD, and high within-session emotional engagement predicts better outcome," explain authors Pål-Ørjan Johansen and Teri Krebs, who are based at the Norwegian University of Science and Technology and supported by the Research Council of Norway.
Psychiatrists that have administered MDMA to anxiety patients have noted that it promotes emotional engagement; strengthens the bond between the patient and doctor, known as the therapeutic alliance; decreases emotional avoidance; and improves tolerance for recall and processing of painful memories.
According to Johansen and Krebs, "MDMA [ecstasy] has a combination of pharmacological effects that-could provide a balance of activating emotions while feeling safe and in control."
They suggest three possible biological reasons why ecstasy could help individuals with PSTD. First, ecstasy is known to increase the release of the hormone oxytocin, which is involved in trust, empathy, and social closeness.
Because people with PTSD often report feeling emotionally disconnected and unable to benefit from the supportive presence of family and friends or therapists - a situation that is likely to contribute to the development and maintenance of the disorder - use of ecstasy might also help ameliorate these symptoms, suggest the authors.
"By increasing oxytocin levels, MDMA may strengthen engagement in the therapeutic alliance and facilitate beneficial exposure to interpersonal closeness and mutual trust," they write.
The second biological explanation for ecstasy's useful effect is that it acts in two brain regions to inhibit the automatic fear response (mediated by the amygadala) and increase emotional control (mediated by the ventromedial prefrontal cortex) and therefore permits bearable revisiting of traumatic memories.
Thirdly, ecstasy increases the release of two other hormones, noradrenaline and cortisol, which are known to be essential to trigger emotional learning, including the process that leads to fear extinction, on which therapy for PTSD relies. But, caution the authors, while these compounds enhance extinction learning they may also temporarily increase anxiety in people with PTSD because the hormones are naturally released as part of the body's response to stress.
Ecstasy combined with psychotherapy is a treatment already being tested in clinical trials to help patients with PTSD. All of these trials have a similar design in which ecstasy or placebo is administered to patients a few times during their therapy sessions as part of a short term course of psychological treatment. According to the Johansen and Krebs, recent preliminary results from two of these randomized controlled trials shows that the therapy might have promise.
"Reduction of avoidance behavior linked to emotions is a common treatment target for all anxiety disorders. MDMA [ecstasy] has a combination of pharmacological effects that, in a therapeutic setting, could provide a balance of activating emotions while feeling safe and in control, as has been described in case reports of MDMA augmented psychotherapy-.Future clinical trials could combine MDMA with evidence-based treatment programs for disorders of emotional regulation, such as prolonged exposure therapy for PTSD," conclude the authors.
SAGE Publications UK
Ecstasy Current Events and Ecstasy News RSSLocal health investigation sheds light on gastroschisis birth defect
Results of an investigation conducted by University of Nevada, Reno researchers, public health officials and area physicians published this week in the Archives of Pediatrics & Adolescent Medicine, indicate that Washoe County experienced a cluster of a particular birth defect, gastroschisis, during the period April 2007 - April 2008.
Wastewater used to map illicit drug use
A team of researchers has mapped patterns of illicit drug use across the state of Oregon using a method of sampling municipal wastewater before it is treated.
Knock-out drugs: Narrow window for detection
Drug-facilitated sexual crimes are increasing. The Bonn Institute for Forensic Medicine has recorded that the number of examinations on the use of intoxicants in sexual offences within their catchment area increased 10-fold between 1997 and 2006.
Young people are intentionally taking drink and drugs for better sex
Teenagers and young adults across Europe drink and take drugs as part of deliberate sexual strategies. Findings published today in BioMed Central's open access journal, BMC Public Health, reveal that a third of 16-35 year old males and a quarter of females surveyed are drinking alcohol to increase their chances of sex, while cocaine, ecstasy and cannabis are intentionally used to enhance sexual arousal or prolong sex.
Club drugs inflict damage similar to traumatic brain injury
What do suffering a traumatic brain injury and using club drugs have in common"? University of Florida researchers say both may trigger a similar chemical chain reaction in the brain, leading to cell death, memory loss and potentially irreversible brain damage.
Recreational cocaine use may impair inhibitory control
The recreational use of cocaine has rapidly increased in many European countries over the past few years.
World's smallest radio uses single nanotube to pick up good vibrations
Physicists at the University of California, Berkeley, have built the smallest radio yet - a single carbon nanotube one ten-thousandth the diameter of a human hair that requires only a battery and earphones to tune in to your favorite station.
Breaking up may not be as hard as the song says
The devastation caused by a broken heart has been a dominant theme throughout the ages of great literature and pop culture alike.
A study undertaken at the University of Navarra relates the neural damage provoked by Ecstasy with the ambient temperature at which it is consumed
There exists a direct relationship between the consumption of MDMA, or Ecstasy, at a high ambient temperature and an increase in the neural damage which this drug provokes.
Leading toxicologist warns against new drug of abuse
Professor Alison Jones said benzylpiperazine was a "new drug of abuse" which could have serious clinical effects - similar to those of ecstasy to which it is structurally related.
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