Does ‘Ecstasy’ Live Up To It’s Name?

http://www.latimes.com/local/la-me-mdma-20140316,0,4729638.story#axzz2wFf3Afb4

“By some estimates, as many as 4,000 therapists were using MDMA in their practices before federal authorities banned the drug.”

MDMA, the active ingredient in Ecstasy, heals the traumatized brain, or so some patients and therapists believe. No science exists, only anecdotes. Is it compassionate to try a compound in which the stories sound compelling, even though it is illegal? This is the dilemma posed by this article which grabbed my attention both because of the ethical dilemma, and the intriguing neurochemistry. Let me start with the latter. Can we imagine a chemical which makes traumatic memories, memories from war-torn environments, memories from childhood sexual abuse, somehow seem less shameful and more open to discussion? Yes, I can imagine that. I can see how if the amygdala is suppressed, then the sting, if you will, of the memory is diminished, and thereby a narrative can flow without the obstruction of judgment or horror. As to the ethical dilemma, this is more troubling to me. Both sides of the dilemma make sense. On the one hand, people who are suffering need relief, and sometimes we have to think out of the box to obtain that. On the other hand, science is critical to advancement and so we should advocate for meticulous research before walking into territory which could cause more harm than good. Yes, it is true, that my professors did LSD research on autistic children, to see if the LSD would help with social skills, and so using illicit drugs for medicinal purposes is not a new idea. Yet, these professors used government funding to explore, what turned out to be, a failed experiment. For the clinician to advise MDMA ingestion, without the rigors of a clinical trial strikes me as well-intention, but misguided. The seduction that a medicine or a diet can alleviate human suffering creates an industry of hope and opportunity. If there were no side effects, like our relatively new gluten-free fad, then I am happy to emphasize the lack of science and encourage people to have their own trial. However, in the case of MDMA, fooling around with brain chemistry is a very scary proposition. I am waiting for the science, even though, as the article reminds us, no one seems to want to fund this. Having said that, I would rather use our current tools than to step over that anecdotal line which says,  “well, it worked for me, and so it might work for you too.” Ecstasy, the drug, in my clinical experience, is a wish for some, true for others, and a nightmare for the rest of the folks. I repeat. I am waiting for good data.

See also ……

Flashback to the 1960s: LSD in the treatment of autism.

Sigafoos J1, Green VA, Edrisinha C, Lancioni GE.

Author information

Abstract

Between 1959 and 1974, several groups of researchers issued reports on the use of d-Lysergic Acid Diethylamide (LSD) in the treatment of children with autism. This paper reviews that literature to consider how the authors justified these studies, as well as their methods, results, and conclusions. The justification for using LSD was often based on the default logic that other treatment efforts had failed. Several positive outcomes were reported with the use of LSD, but most of these studies lacked proper experimental controls and presented largely narrative/descriptive data. Today there is renewed interest in the use of psychedelic drugs for therapeutic purposes. While this resurgence of research has not yet included children with autism, this review of the LSD studies from the 1960s and 1970s offers important lessons for future efforts to evaluate new or controversial treatments for children with autism.

PMID:

 

17608329

 

[PubMed – indexed for MEDLINE]

Brain Stimulation: Literally Speaking

 

Deep Brain Stimulation (DBS), Transcranial Magnetic Stimulation (TMS), Electroconvulsive Therapy (ECT), and Vagus Nerve Stimulation (VNS) are all FDA approved treatments for neuropsychiatric disorders, heralding the new modality of treatment for psychiatric diagnoses. Darin Dougherty MD from the Division of Neurotherapeutics at a Harvard-affiliated hospital, presented his studies, demonstrating that when subjects were given active treatment, versus sham treatments, there was a high placebo response. To date, he has not been able to show the effectiveness of Deep Brain Stimulation, but he believes, that is because he has not determined where to place the electrode in the brain. Nevertheless, whereas drug companies used to sponsor most of the psychiatric research, now there is a lot of research sponsored by those who make these machines, such as Medtronics. Procedure-based psychiatry is the frontier, with hope of targeting a more specific area of the brain, moving us forward from ECT in which the entire brain has to seize in order to achieve the desired results. If we could localize the emotional brain, we could tickle it, and make folks feel better, or so the hope goes, for our future. In this way, this is an exciting time to be a psychiatrist, with the hope that like our medical colleagues, we hope to be able to offer our patients both pharmaceuticals and medical procedures which “fix” the underlying problem. Do I think this will put psychotherapists out of business? On the one hand, I would welcome the immediate relief that these procedures promise. On the other hand, I cannot imagine a substitute for working through difficult life decisions in a way in which one approaches junctures with thought and deep appreciation for the gravity of the decision. As always, I imagine these procedures could enhance psychotherapy by giving folks who are paralyzed by life’s traumas a way to move forward in psychotherapy so that they can navigate their world in a deeply conscious way. My work dovetails the work of those like Dr. Dougherty and so I welcome his neurotherapeutic  innovations.

Mirror Neurons

Marello Dapretto PhD http://faculty.bri.ucla.edu/institution/personnel?personnel%5fid=46838 spoke today about how mirror neurons are abnormal in those with ASD-autism spectrum disorder. It was one of those lectures where I felt like I already knew this, and so I was not learning anything, but at the same time, she was demonstrating with pretty fMRI pictures that what I/we have suspected for years, is finally being proven with our imaging technology. That is, we now can demonstrate that those individuals with ASD have a defective wiring in their ability to imagine what others are thinking or imagining. In other words, their “theory of mind” is impaired, and the level of their impairment matches the level of defect in their mirror neurons. In other words, this is a continuum of damage, resulting in the “S” or the spectrum concept. Sure, there are workarounds to the mirror neuron system. Children can learn to understand human behavior and they can learn empathy, but they will have to bring in another neurological system since their mirror neurons do not fire properly. For years, in my training from 1986-1991, we told families of those with ASD that there was a “wiring problem” without any specific knowledge about what that wiring problem might be. We felt certain that parents should not blame themselves for the social awkwardness of their children, but at the same time, parents can help fix the problem. Listening to Dr. Dapretto today, confirmed what we told parents, back in the day. Phew!