The Potential Benefits of Ecstasy-Affected Memory Reconsolidation ...
Recent messages in the media describe medical professionals treating patients with MDMA (3,4-methylenedioxymethamphetamine) to treat post-traumatic stress disorders (PTSD). This may seem like an unorthodox approach or use with a few exceptions. Although unorthodox, that is not the case either. The treatment has been thoroughly tested and the US Food and Drug Administration (FDA) has allowed the treatment to proceed to phase 3 clinical trials. It has also been given the status Breakthrough Therapy.
While the potential dangers of MDMA are very real and recreational use of the drug is illegal and not recommended, medical professionals have reported significant results. They used the drugs in conjunction with psychotherapy to a limited extent during the treatment of PTSD. One of the most striking studies, in which 26 veterans and first responders were diagnosed with chronic PTSD, discovered that 52,7 percent of participants who received active doses of MDMA (75-125 mg), and then participated in therapy sessions involving two therapists, both male and female, no longer met the criteria for PTSD by the end of the study. This was more than double the percentage compared to participants in the control group (22,6 percent). Symptom reduction was reported to 3,5 years after the trial.
What is MDMA?
MDMA is a psychoactive compound that promotes the release of neurotransmitters such as dopamine, serotonin and norepinephrine, as well as neurohormones, especially oxytocin. Because MDMA is an amphetamine derivative, it produces effects similar to other stimulants, such as cocaine. The most notable effects, however, are an increased feeling of it empathy or connectivity with others, euphoria and reduced anxiety reactions.
MDMA is commonly called ecstasy, molly, E or M. It was criminalized in 1985 and subsequently labeled as a Schedule I drug by the Drug Enforcement Agency in 1986 by the Drug Enforcement Agency. According to the DEA such an indication means that the drug “has no currently accepted medicinal use and a high potential for abuse. Other drugs on schedule I are heroin, LSD and peyote.
The fact that MDMA is considered a potentially dangerous drug is beyond dispute. People who experience the acute effects of the drug can exhibit reckless behavior that may be life threatening. Moreover, MDMA demonstrably increases blood pressure and body temperature (hyperthermia). Although this in itself is not particularly life threatening, this phenomenon can lead to heat stroke if a person dances rigorously at a party or night club. Because illegal MDMA is still strongly present in dance clubs, this is not uncommon and occurs very regularly.
Frequent use can have more harmful consequences, which can disturb the concentration, sleep and appetite. Heavy use can lead to depression, heart disease and impaired cognitive function. However, addiction is not common. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) claims that it is one of the rarest drug use disorders.
What is a post-traumatic stress disorder? (PTSD)
Post-traumatic stress disorder (PTSD) is one biopsychosocial condition that affects as many as 8 million adults in, for example, a country like the United States. It is characterized by a state of fear after a traumatic event. It is not the case that all individuals who go through traumatic events develop PTSD. However, all patients with PTSD have endured at least one traumatic event. In some cases, the event is a long experience, such as being kidnapped, being tortured, or fighting in or living through a war. In other cases, it may be associated with a single event, as is the case with victims of sexual assault (sexual or otherwise), witnesses to horrific acts of violence, or survivors of catastrophic events ranging from serious car accidents to natural or human caused disasters.
The symptoms of PTSD are not uniform. In some cases, the most striking feature of PTSD is a patient's avoidance behavior. They can avoid memories of the traumatic event (s) or external memories of the event (s), such as people, places, activities, situations, or objects. In other cases, the patient cannot recall the traumatic event (s) due to dissociative amnesia. In still other cases, the patient may develop persistent and recurring dissociative symptoms. Dissociative symptoms can manifest in either depersonalization, where the patient feels detached from their own body, or derealization, where patients feel that the surrounding world is distant or dreamlike world.
In addition, patients may project overly negative feelings on themselves or on others; blame themselves for the traumatic event (s); enduring persistence, despondency, or indifference to pleasurable experiences anhedonia; notice that they are unable to feel positive emotions; or suffer from alienation or detachment. Additional symptoms include angry outbursts, self-defeating behavior, paranoia, hypervigilance, inability to concentrate and trouble sleeping.
Due to the wide range of symptoms, not all patients with PTSD behave the same way. Some patients may be able to function well in normal environments, but may experience extreme psychological distress when in the presence of stimuli related to the event (s). Others may feel that they are reliving the traumatic event (s) as a result of frequent intrusive and involuntary memories or nightmares of the event (s), even without the presence of negatively associated stimuli. In other cases, after the traumatic event, the patient may continue to fall back on this, re-experience it, and become increasingly withdrawn, anxious, or depressed.
Another common feature of PTSD is the high degree of comorbidity with depressive disorder, anxiety disorders and substance abuse. Those who suffer from PTSD also have an increased risk of disorders associated with substance abuse disorders (heart disease, liver disease, memory loss), and may experience impaired social functioning leading to unemployment, homelessness and relationship problems.
How MDMA can help people with PTSD
There have been numerous approaches to the treatment of PTSD. Unfortunately, few have really been effective. Of those who receive traditional treatments less than half remission of symptoms after 40 months. below veterans The data is even more daunting: More than 72 percent of veterans who received treatments with cognitive processing therapy or long-term exposure therapies (two of the most common non-pharmacological treatments for PTSD) still met the criteria for PTSD after treatment. Given this context, it is no surprise why there is so much excitement following the successful Phase 2 trials for MDMA treatments.
However, the question remains: why does it seem to work so well?
This requires understanding how the brain stores episodic memories in clusters of neurons known as engrams. Individual engrams are not only stored as objective pieces of information. Memory is linked to emotion through the brain's limbic system, including the thalamus, hippocampus, and amygdala - the latter being responsible for responding to potentially dangerous stimuli and triggering fight or flight responses. In other words, not only the details of the event are remembered, but also the emotional state they were in when the engram was created. When a memory is reactivated, the emotional state can also be reactivated. If the memory is traumatic enough, the corresponding psychological distress can push the amygdala into overdrive.
Researchers believe that engrams are not impervious to change. They can be affected by a patient's emotional state upon recall, meaning that it is theoretically possible to disconnect the non-emotional components of the traumatic engram from the emotional components. In many ways, this kind of fear eradication and retention is the same theoretical approach behind one of the most conventional treatment modalities for PTSD, prolonged exposure. Both therapies involving MDMA and long-term exposure rely on memory re-consolidation, a term that "... describes a type of neuroplasticity in which the process of an established memory is reactivated, destabilized, and then modified or updated with additional information," said a recent review of the experiments with MDMA.
"A prediction error or mismatch of the memory trace to present momentary events can be a very strong signal to cause a malleable state of the engram," they continued. "Hypothetically, when trauma memories are retrieved while under the influence of MDMA during therapy, a strong prediction error is generated by the unique internal state of MDMA-stimulated neurochemical / hormone elevation and the supportive therapeutic setting."
MDMA is an unconventional treatment for PTSD. However, the underlying theory behind why it is effective in treating the non-dissociative subtype of PTSD appears to be good. Additionally, the mechanisms it intends to use are not that different from traditional exposure therapies that have been in use since the XNUMXs. The euphoric effects of the drug only accelerate the disconnection of anxiety-inducing stimuli from psychological trauma, and this disconnection continues after the effects of the drug wear off.
While it is certain that more studies are needed to confirm the results of Phase 2 studies, and that more testing should focus on how this approach affects the subset of PTSD patients with dissociative symptoms, this appears to be a promising way of research for a condition that is very often resilient to treatment.