“Ecstasy” For Treating PTSD


CNN has been running a wonderful series on the use of MDMA, the Schedule I drug (meaning highly addictive and no medicinal value- both false) to treat PTSD. Focusing on the store of Rachel Hope, a woman who survived childhood sexual abuse and a car accident that left her with severe PTSD, who finally, for the first time in her life, found relief with MDMA as part of a pilot study done by MAPS in 2005. (Their site on MDMA for PTSD, more specifically on the current work to treat returning Afghan and Iraq war veterans can be found here. )

Part I

(CNN) — Rachel Hope was 33 years old when she received a painful reminder: She couldn’t outrun the past.

Hope was trying to help a new assistant at her Maui rental property business, but it wasn’t going smoothly. Part of it was Hope herself.

“I had this startle reflex,” she explained. “The phone would ring, and I’m literally three feet off the floor, screaming.

“My new assistant said, ‘You’re driving me crazy!’ And I would say, ‘I’m really sorry, just please try to ignore it. It’s embarrassing, but let’s keep working.’ “

But the young man, a teacher on break, wasn’t pushed off easily. Soon after, Hope said, “he walked over to my desk and dropped a stack of papers two inches thick. It was every single PTSD study that was online, and he just said, ‘pick one.’ “

A few days later, Hope was dialing the number of South Carolina psychiatrist Dr. Michael Mithoefer. Her plan: to see whether she could free herself of a lifetime of torment by taking a drug he was testing — a drug most people know as Ecstasy.

A teetotaler, Hope wasn’t looking for a thrill. She’d been born to a young hippie mother who couldn’t stand the thought of parking their VW bus in one spot. After seeing psychedelic casualties all along the road, to Hope, drugs signified a lack of control. That was the last thing she needed. It was hard enough to hold things together stone sober.

Truth be told, Hope didn’t need her new assistant to tell her what the problem was. She just didn’t know how to fix it. She’d been diagnosed with post-traumatic stress disorder, traced to a period of sexual abuse as a child and a life-threatening car accident.

She’d been hospitalized four times for the debilitating symptoms, and stress had caused bleeding ulcers bad enough to send her to the emergency room twice more.

Along the way, she tried cognitive behavioral therapy, hypnosis and acupuncture. She tried an established therapy called eye movement desensitization and reprocessing, where a therapist used physical stimuli — light tapping and guided eye movements — to try to retrain her brain. It made her eyeballs feel like they would burst out of her head. She tried gestalt therapy, screaming out her rage.

“Nothing worked,” she says. “I got to the point where I just said, ‘I’m handicapped. I’m just going to have to live my life like this.’ It was pretty horrible.”

A formal plan

More than 7 million Americans suffer from PTSD, and by most estimates, only half of them — at best — are ever cured. A decade ago, the widely acknowledged need for better treatments opened the door to Mithoefer and his unconventional approach.

By the time he took Hope’s call in February 2005, the soft-spoken, ponytailed Mithoefer had managed to convince the Drug Enforcement Administration to green-light a study of Ecstasy as an adjunct to psychotherapy.

Of course, he wasn’t calling it Ecstasy. Neither were the scientists from the Food and Drug Administration and certainly not the DEA agents who had picked over Mithoefer’s bungalow in Charleston, South Carolina, making sure it was “secure” in case drug-hunting criminals tried to break in and grab the stash.

He’d gotten the 3,4-methylenedioxy-methylamphetamine (MDMA) — the chemical name for pure Ecstasy — from Rick Doblin, the founder of a MAPS, the Multidisciplinary Association for Psychedelic Studies. The group’s stated purpose is to develop “medical, legal and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.” It wants to turn mind-altering drugs like Ecstasy into prescription medicine.

The advocacy unsettles some people, but this was no Timothy Leary operation. Doblin says he was determined to do things the right way.

“Doing science that gets reported, that’s an idea we can sort of leverage,” Doblin said. To win broader acceptance for MDMA — and for cousins like LSD and psilocybin, the mind-altering compound in so-called magic mushrooms — “the medical route was the only route. Everything else was blocked.”

That meant a formal plan for drug development: study protocols, institutional review boards and the rest. Mithoefer, a University of Virginia-trained clinician who specializes in trauma and had a long-running interest in MDMA, was the perfect partner.

When Mithoefer enrolled the first patient in the new study in 2004, U.S. troops were in Iraq fighting the longest-running war in American history. They just didn’t know it yet. Even then, there were men and women jumping out of their shoes at the sound of a car horn and waking up in the middle of the night drenched in sweat from another nightmare. But most troops hadn’t come home yet. America wasn’t ready.

A sense of crisis was years away, but Mithoefer — and other specialists in psychological trauma — were bracing for a wave of tortured souls. Before taking Hope’s call, the doctor had spent nearly three years navigating the federal bureaucracy to win approval for his small experiment, designed to test a simple question: Is MDMA, used in a clinical setting, safe?

The point is sometimes lost, but even today, civilians make up the vast majority of people struggling with PTSD.

As Mithoefer launched his research, he wouldn’t be working with veterans. He’d be working with civilians, mostly female survivors of sexual assault. All had tried conventional treatments — either therapy or medication — without success. On average, they had suffered their debilitating symptoms for 19 years. Hope was patient No. 7.

‘It just wouldn’t stop’

Hope was used to putting on a front. To a casual visitor, she seemed fine. Her rental property business in Hawaii earned a steady living, and she and a close friend were happily raising a 13-year-old son through an unconventional co-parenting arrangement. She was restless on Maui, but after a bumpy childhood, it seemed she’d found a kind of peace.

But you didn’t have to look hard to see a dark side. “I was argumentative and defensive, and I was very angry,” she recalled. “I was having panic attacks and anxiety attacks and all the physical problems that come with it. I had irritable bowel syndrome, and I couldn’t sleep.”

To survive, she pushed people away. “It makes intimate relationships very difficult,” she said. “Some part of me was on guard, and it just wouldn’t stop.”

PART II

(CNN) — Post-traumatic stress disorder begins as a natural response to danger, according to psychiatrists.

Rachel Hope says her life had been the stuff of nightmares. She reached out to South Carolina psychiatrist Dr. Michael Mithoefer in 2005 after suffering the effects of PTSD for years and trying various treatments, to no avail.

“My mom was 19 when she had me, and she was very ill-equipped,” Hope said.

But the worst arrived when Hope was 4 years old and her mother went on vacation, leaving her with a male friend who’d agreed to babysit.

As it turned out, says Hope, he was a pedophile who raped her repeatedly over the six-week stretch that her mother was gone. When they finally reunited, her mother noticed a change.

“She told me, ‘I just wondered why you were kind of withdrawn and weren’t the happy child you used to be,’ ” Hope said. But the angry, bewildered child didn’t tell tell her mother what had happened, and no one put the pieces together.

Not long after, Hope went to live with her grandmother in San Diego, where she did well in school and became accustomed to a “normal” life.

Read the first installment of this three-part series

But five years later, another catastrophe struck — literally. She was hit by a delivery truck as she was riding her bike to a dance lesson. Hope nearly died. As it was, she needed two reconstructive surgeries on her face and was partially paralyzed for four months.

Yet, she survived. The 11-year-old found strength in stoicism.

‘”That was good and bad. I mean, it was heartbreaking to be a kid like that,” she said. “To realize, there’s not gonna be a magical fairy that shows up. ‘Bad news, kid, no one’s saving you.’ And that was a big turning point.”

Seemingly against all odds, she pulled her body and mind back together. She became fascinated by notions of human potential, the way the mind works.

And she asked herself the big questions. “I wanted to make sense of it all.”

It took years, however, to reach out to Mithoefer. Her plan: to see whether she could free herself from torment by taking a drug called MDMA, commonly known as Ecstasy.

Party drug and forbidden substance

The compound known as 3,4-methylenedioxymethamphetamine, or MDMA, was first synthesized in Germany in 1912. No one quite knew what to do with it. It was studied by the military in the 1950s and eventually emerged from the lab in the late 1970s.

The first report on its effect in humans was published in 1978 by independent chemist Alexander Shulgin and David Nichols, a professor of pharmacology at Purdue University.

At the same time, Shulgin was churning out the drug in his lab and sharing it with a handful of psychiatrists and therapists who saw MDMA as a lever for human growth.

Dr. George Greer helped Shulgin make an early batch and offered it to interested couples and individuals. “MDMA reduced the fear response, so people could talk about the things that made them afraid or upset,” he recalled.

At the same time, “people were able to have normal cognitive function, and the insights they had were able to translate to everyday life.” A few people had mild panic attacks, says Greer, “but in general, it was well-tolerated.” He described his experiments in a paper, detailing the experiences of 29 people.

Not everyone was so careful. By the mid-’80s, Ecstasy was also in use as a party drug. In the spring of 1985, the alarm was sounding, and Ecstasy was making headlines.

Congress held hearings, and the Drug Enforcement Administration put MDMA on the list of forbidden substances alongside heroin and LSD.

The uproar left the small community of MDMA therapists shaken. Greer submitted testimony asserting the drug’s safety to the DEA, but to little avail.

Rick Doblin, a soon-to-be Harvard graduate student who would later found the Multidisciplinary Association for Psychedelic Studies — a group wanting to turn mind-altering drugs like Ecstasy into prescription medicine — saw the writing on the wall. Shortly before MDMA was banned, he persuaded Nichols to synthesize two kilograms for researchers, for the cost of materials.

“Doing science that gets reported, that’s an idea we can sort of leverage,” Doblin said. To win broader acceptance for MDMA — and for cousins like LSD and psilocybin, the mind-altering compound in so-called magic mushrooms — “the medical route was the only route. Everything else was blocked.”

That meant a formal plan for drug development: study protocols, institutional review boards and the rest. Mithoefer, a University of Virginia-trained clinician who specializes in trauma and had a long-running interest in MDMA, was the perfect partner.

Before taking Hope’s call, Mithoefer had spent nearly three years navigating the federal bureaucracy to win approval for his small experiment, designed to test a simple question: Is MDMA, used in a clinical setting, safe?

‘I got to survive. But for what?’

As a teenager, Hope marched with a precocious sense of purpose. At age 13, she moved across the country to live with family friends in New Jersey.

A year later, she was back in California, where she found a full-time secretarial job while completing her high school coursework. She built a strong relationship with her father, who had separated from her mother when she was an infant.

By the time she was 17, she was back with her mom but supporting herself financially.

She was wary of relationships but wanted a family, and at 19 she found a like-minded colleague who agreed to co-parent a son. They moved to Hawaii, because she had fond memories of a childhood vacation.

“I think there was a part of me that thought I could run away from all that crazy horrible stuff,” she said. “I was trying to find ways to be okay.”

But the peace was fragile. When her father died in 1991, Hope became so depressed, she fell into a stupor. She was hospitalized, and for the first time, a psychiatrist listened as she talked about her childhood abuse. It was eye-opening, but therapy offered limited relief. She grew well enough to leave the hospital but found little joy outside.

In 1998, she suffered another breakdown after learning from a friend that the man who’d sexually abused her was under investigation for molesting another girl.

Under the weight of stress and emotion, Hope’s carefully constructed shell began to crack.

“I started having these outrageous flashbacks, and body memories,” she recalled. “The first time, I thought someone slipped me a drug. Because it would be these unstoppable, full-body blackout memories, and people would tell me later, ‘You were just screaming for an hour.’ “

She stopped sleeping. Her stomach problems worsened; she vomited every time she ate.

Once again, she checked herself into the hospital. Once again, it was all the doctors could do just to tape the pieces back together.

“I became like a survival machine. And I’m kind of blessed, because I didn’t become violent or hostile or self-destructive,” she said.

At the same time, a “normal” life felt out of reach. “It was kind of like, ‘OK, I got to survive. But for what?’ “

PART III

(CNN) — When Rachel Hope picked up the phone in 2005 to call Dr. Michael Mithoefer, she didn’t have high hopes.

“I had very low expectations,” said Hope, who suffered from post-traumatic stress disorder for years before investigating whether the drug Ecstasy might be able to free her from her torment. Her PTSD was traced to a period of sexual abuse as a child and a life-threatening car accident.

In the initial 45-minute conversation, Mithoefer determined that Hope didn’t have other serious psychological problems. He agreed to fly her to South Carolina to take part in his study of the experimental therapy. There, she underwent more psychological testing and a physical exam. There were standard therapy sessions, so Mithoefer could understand Hope’s past and her symptoms. Finally, she was ready.

Light streamed through the skylight as Hope lay back on a futon in Mithoefer’s office, in the rear of a small bungalow.

On either side sat Mithoefer and his wife, Annie, a nurse.

Annie put in a CD and music started playing. As Hope placed a capsule on her tongue, they began to talk. Thirty minutes later, she began to feel deflated. Even though she had no experience with drugs, she knew: she’d been given a placebo.

True to their protocol, the Mithoefers continued the therapy, as if Hope were under the influence of MDMA. Said Hope, “We went through the process, but by the end, I’m like, ‘I’m not different.'”

A week later, Mithoefer called back. He had permission to conduct MDMA sessions with test subjects who’d previously received the placebo. Would Hope like to fly back to South Carolina?

Read the first installment of this three-part series

And so once again, Hope found herself on the futon, the light streaming, the music playing, the capsule on the tongue. This time, everything changed.

“It was like my whole brain was powered up like a Christmas tree, all at once,” recalled Hope.

Listening to audiotapes, it isn’t obvious what’s happening. The conversation is fractured. But something was going on inside Hope’s brain.

“Somehow, I became aware of the hardwiring decisions that my brain had made to explain why all these traumatic things happened to me, and what they meant to me about being a woman, a child living in the world, about sex, about violence,” she said. “What the medicine did, it brought everything up for question.”

Mithoefer said he lets patients drive the direction of the session. Typically, they alternate between talking and stretches of pure introspection. The trauma, he said, “always seems to come up.”

“It’s not that people just have a blissed-out experience and feel great about the world,” he cautioned. “A lot of the time it’s revisiting the trauma, and it’s a painful, difficult experience. But the MDMA seems to make it possible for them to do it effectively.”

Hope said it certainly worked for her. She estimates that 80% of her symptoms disappeared after that first MDMA-assisted session. “It allowed me to rewire my brain,” she said. Another 10% of her symptoms went away over the next few weeks, she said.

According to results published last month in the Journal of Psychopharmacology, the effect was typical. Of 19 subjects in the study, more than two-thirds still showed significant improvement more than three years later — what Mithoefer and colleagues describe as “meaningful sustained reductions” in their symptoms.

With PTSD, a common measure of severity is the so-called CAPS score, determined by answers on a detailed questionnaire. To be part of the study, patients needed a CAPS score above 50, which generally signifies moderate to severe symptoms. Hope rated a score of 86. At long-term followup, about three years after their final MDMA-aided session, only two people in the study had scores as high as 50. The CAPS score for Hope was 14.

One patient, who chose to stay anonymous, described a sense of new freedom: “I was always too frightened to look below the sadness. The MDMA and the support allowed me to pull off the controls, and I … knew how and what and how fast or slow I needed, to see my pain.”

“The question is whether this was just a flash in the plan, where people just feel good from taking a drug,” said Mithoefer. “The answer to that turns out to be no, it really wasn’t just a flash in the pan for most people.”

For all the promise, however, 19 people is still a tiny study.

Read the second installment in this three-part series

‘Rebooting a computer’

Not surprisingly, there are skeptics. Dr. Edna Foa, who developed a widely used treatment for PTSD called prolonged exposure therapy, or PE, met with Mithoefer to review audiotapes of MDMA-assisted therapy. She walked away shaking her head.

“I was completely confused,” Foa said. “They were all over the place. They didn’t use evidence-based therapy, which would be CBT (cognitive behavioral therapy), PE or EMDR (eye movement desensitization and reprocessing). They were just kind of going with feeling. I don’t know the rationale.”

She was also jolted by the frequent hugs the Mithoefers gave patients at difficult points in the session. “It’s very unusual,” Foa chuckled. Foa said she never touches a patient “unless they ask for it. And then I hold their hand.”

Mithoefer said the key feature of his approach is that it’s “nondirective,” in that what happens during the session is determined primarily by the individual’s own process and needs. He said he often includes elements of other types of therapy — including PE and CBT — but that it depends on the patient’s response.

Even those who see promise in MDMA-assisted treatment aren’t sure how it works. “It’s not well understood by any means,” said Mithoefer. “We think it gives people this window of time in which they can process things without being overwhelmed by emotion, but also not being numbed up.”

He said brain imaging studies, while crude, support the theory that MDMA alters hard-wired connections between conscious thought and emotional reactions — or overreactions.

“We do know that MDMA decreases activity in the left amygdala, and increases it in the prefrontal cortex” — brain areas associated with emotion and higher thinking, respectively, he said.

David Nichols, a professor of pharmacology at Purdue University, said no one really knows why MDMA, as well as drugs like LSD and psilocybin, have such a profound effect on the brain.

“I liken it to rebooting a computer,” he said. “But when it comes to things that change the fundamental structure of personality and consciousness, and changes who you are, we don’t really understand that.”

Nichols warned against a simple explanation. “You could talk about neurotransmitters, but that’s really superficial. (MDMA) releases serotonin, dopamine, norepinephrine. It activates other hormones. But what does that all mean?”

‘Why do we need this MDMA?’

Uncertainty is easier to take if you think there’s no other option, and Foa argued it’s a misperception that existing treatments are ineffective.

A recent study by psychiatrists at the National Center for PTSD tracked 171 patients who received either PE or CBT therapy. After 10 years, fully 80% still enjoyed milder symptoms. However, about one in four of those treated could not be found for followup.

“With PE, you get about 40-50% (cured) of PTSD, and you get about 80% getting improvement,” said Foa. “So we have good treatments, that have no side effects. The question is, why? Why do we need this MDMA?”

Foa also cites concerns about neurotoxicity, although a 2011 study by Harvard psychiatrist Dr. John Halpern found that occasional MDMA use produced no cognitive damage.

Dr. Julie Holland, a psychiatrist who is overseeing the safety of an MDMA study Mithoefer is now conducting on veterans, said most risk is eliminated by the controlled nature of the experience.

For casual Ecstasy users, said Holland, “The biggest risk is not knowing what they’re taking.” Apart from being illegal, the street drug is often contaminated with other substances. Holland added that, “The next big one (risk) is heatstroke, if you get out and dance for six hours.”

“The third biggest risk is overhydration,” she explained. People are taught to stay hydrated, but MDMA causes the body to retain water. Combined with the drug’s disorienting effects, this can lead users to overdrink, to a condition known as hyponatremia, a dangerously low concentration of sodium in the blood. “This is the main reason MDMA users die,” said Holland, “from drinking too much water.”

In a controlled setting, said Holland, “You get an incrementally higher heart rate, higher blood pressure and body temperature, but there isn’t real danger as long as you’re moderately healthy.”

‘Real people are paying the price’

Additional studies using MDMA against PTSD either have been completed, are planned or are under way in Colorado, Canada, Spain, Switzerland, Israel, Australia and Great Britain. Meanwhile, Mithoefer is conducting a study treating military veterans and firefighters; so far 11 people have enrolled and more than 280 have called to see if they might take part.

While the military and Department of Veterans Affairs have expanded services in recent years, they struggle to keep pace with the inflow of new patients. The number of active-duty military personnel seeking treatment for PTSD rose from 10,408 in 2002 to 281,468 last year, according to Cynthia Smith, a Department of Defense spokeswoman.

One reason MDMA seems tempting is the sense that existing treatments are not enough. “It’s not like we don’t have effective treatments for PTSD,” said Dr. Boadie Dunlop, director of the Mood and Anxiety Disorders Program at Emory University. “But there are many people for whom these therapies don’t work.”

Retired Brig. Gen. Loree Sutton, who headed the DOD’s Centers of Excellence for Psychological Health and Traumatic Brain Injury from 2007 to 2010, said she left the Army in part because she felt existing treatments often do more harm than good.

“We invested in conventional approaches towards research, but I also knew we had to go beyond that,” said Sutton. “Real people are paying the price for our failure to harness knowledge.”

The National Center for PTSD, a branch of the VA, says approved treatments include a type of antidepressant known as SSRIs (selective serotonin reuptake inhibitors), along with EMDR, CBT and PE, developed by Foa. In some studies, more than three-quarters of those who complete PE therapy are “cured.” But success can be hard to evaluate, in part because treatment is too emotionally painful for many patients to complete.

The DOD and VA also support a variety of research, much of it to try to fine-tune existing approaches. For example, Foa is leading a study offering more sessions in a shorter amount of time — twice weekly — to soldiers at Fort Hood, Texas. About 360 people are expected to enroll.

Neither the VA nor the military is part of clinical MDMA research, but Sutton said that before leaving the Army, she did call Rick Doblin to encourage his work. Doblin is the founder of MAPS, the Multidisciplinary Association for Psychedelic Studies, which wants to turn mind-altering drugs like Ecstasy into prescription medicine.

“With MDMA — Ecstasy — if rigorously designed studies show there’s a benefit, better than existing therapies, then we should use it,” Sutton said.

Doblin said he’s working with the Defense Department to develop a protocol involving active-duty troops, and said he would gladly give up his status as the prime backer of MDMA research: “If there are other people who have a better idea, or want to try it with cognitive behavioral therapy, or whatever — if there are other people trying to fund MDMA research, we think that would be great.” With a laugh, he added, “We could even provide them with free MDMA. We have a lot more than we need.”

Encouraging signs

Hope no longer has flashbacks or night terrors, and she no longer jumps when the phone rings. After finishing with Mithoefer, she decided to abandon her quiet life on Maui and moved to Los Angeles.

In 2008 she felt strong enough to have a second child. “That’s another part of the gift of MDMA,” she said recently. “Before those sessions, I just couldn’t get it together, to expand my family the way I wanted to.”

Crowds no longer faze her. In fact, she spent two months this fall as a full-time climate-change protester, doing street theater in a polar bear hat in front of hostile crowds at presidential debates and similar events.

“It gets pretty intense,” she said. “It’s something I couldn’t have done, before the treatment.”

Grateful as she is for Mithoefer’s study, she feels as strongly as ever about avoiding recreational drug use. “I have a very, very serious respect for that medicine. You really don’t want anybody to do this without professional supervision. It could open portals, in a way that could really damage you.”

Chatting in his office, where books about shamanism sit side by side with standard psychology texts, Mithoefer remained cautious.

“I think at this point, what we know is that MDMA can be administered safely to people with PTSD, to the right people in the right setting with the right screening. It shows very encouraging signs of being effective, you know, but the numbers are too small to say we can definitively prove that.”

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About drugsandotherthings

I am a criminal. Because I have used cannabis and psychedelics extensively. I have tried many other drugs, but never cared for the uppers, downers, or dissociatives. I love craft beer, and absinthe, but don't care much for alcohols effects- which quite frankly, are boring and dangerous. Science is my religion. I am in my 40's, and have travelled extensively. And often forced myself outside of my confort zone. I am employed, a respected member of my communtiy, an animal lover, an environmentalist, a political junkie, and the realities I have experienced continue to push me further to the left of the political spectrum.
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