Sunday, December 4, 2011

MDMA Therapy

MDMA is illegal and I am not endorsing its use, nor am I qualified to. The following is a review of techniques, etc. in documented literature.

It’s been a long time since I’ve written anything controversial. Given the subject of this post, I feel it is necessary to make a couple of important statements. First of all, I do not condone the use of drugs for recreational purposes and it is not my intention to influence people to do so. Also, a reminder that I am not a doctor; I have no clinical or personal experience with this therapy. The information provided here is based on opinions I have heard from professionals and research studies.

That being said, I think there are some benefits to this therapy. Taking a small dose of a drug once is likely safer than taking multiple doses of antidepressants, etc. for years (provided it is obtained from a reliable source. There are testing kits you can buy, but these appear to have quite a few limits, see here for a detailed description. You can also check PillReports.com to compare what you have with their database). People with treatment resistant depression or PTSD who suffer from severe loneliness may find that the reported effect of MDMA of feeling connected can help them to understand what not-loneliness feels like so that they can cultivate this feeling more efficiently in the future without the aid of medications (or MDMA).


MDMA use in Psychiatry:

MDMA is being tested for PTSD, anxiety, depression (a recent study with rats showed a dose dependent response that peaked at a certain dose. The study also demonstrated no antidepressant effects of methamphetamine), pain management, and cancer (both for helping patients deal with their cancer situation and possible as an anti-cancer drug).

Other potential uses, particularly because of the feelings of connectedness that are induced, include couples therapy, family therapy, and group therapy.

There has been a lot of research into the therapeutic effects of MDMA. Recently a group published a paper examining long-term effects:

“In long-term follow-up, averaging 3.5 years after the initial treatment, most of the people remained free of PTSD — of the 16 patients who participated in the follow-up study, 13 still did not meet the criteria for PTSD. Mithoefer [the author] notes, however, that the people who have not yet elected to participate in the long term follow-up may have done so because they had not fared well.”

"MAPS and Mithoefer's major breakthrough showed that over 80 percent of the subjects in the MDMA group no longer qualified for a diagnosis of PTSD, as compared to 25 percent in the placebo group," he told AlterNet. ‘An even more important breakthrough, which we are currently working to write up in a scientific paper, is from the results of our long-term follow-up evaluations of the subjects, administered at an average of 41 months post-treatment. We found that, on average, the subjects have actually gotten a bit better over time, demonstrating that MDMA-assisted psychotherapy has lasting benefits.’”

http://www.alternet.org/drugs/151263/ecstasy_as_treatment_for_ptsd_from_sexual_trauma_and_war_new_research_shows_very_promising_results/?page=entire


Info about MDMA:

This paper (note the author disclosure) posits three explanations as to why MDMA may be beneficial to therapy:

1) MDMA increases oxytocin levels, which may strengthen the therapeutic alliance; 2) MDMA increases ventromedial prefrontal activity and decreases amygdala activity, which may improve emotional regulation and decrease avoidance and 3) MDMA increases norepinephrine release and circulating cortisol levels, which may facilitate emotional engagement and enhance extinction of learned fear associations.

While the terms MDMA and ecstasy are often used synonymously, these days they are not the same thing. MDMA used to be the principle component in ecstasy, but now ecstasy can contain a bunch of other things including meth, cocaine, speed, caffeine, etc. and may not even contain any MDMA at all.

Remember, MDMA is illegal. But if you have it and want to get more information on its identity go to PillReports.com which is a global database of "Ecstasy" pills based on both subjective user reports and scientific analysis.


Participating in MDMA therapy:

MAPS (Multidisciplinary Association for Psychedelic Studies) has ongoing clinical trials that you might qualify for if you happen to live near one of their offices.

Talk to your therapist about their opinions. Legally, they can not endorse MDMA use in therapy. However, you may be able to broach the subject as a hypothetical situation as a means of discussing what their response would be if you came to session with MDMA in your system. I do not recommend ever showing up to therapy having taking MDMA without first discussing it with your therapist. It would be very disrespectful to put your therapist in such a compromising situation. Furthermore, one of the points of using MDMA in therapy is to generate a feeling of connectedness in a safe environment; keeping secrets is contradictory to this intention and may have negative impacts on the therapeutic relationship later. If you do decide on MDMA therapy, do let your therapist know at the beginning of the session that you have taken the drug so that they can watch for adverse side effects and properly understand any changes in your behaviour.

All of the above is assuming you have a progressive therapist. It is very unlikely that your therapist will want to be involved in a session with a patient under the influence of an illegal drug. If this is the case, but you still feel strongly that this is the right therapy for you, find a friend whom you feel secure with and are comfortable talking to. Let them know what you are doing and why and ask if they would be okay with supervising and listening during the experience.

Have a plan:

Know yourself. If you think you may be in a vulnerable place where MDMA use could become habitual, take the time to carefully plan out a course of action (if you decide action is even appropriate for you). Make sure you view this as a one time event (do whatever you have to do to make the experience sacred for yourself) and not as an excuse to begin using drugs recreationally.

You may want to find an area near your therapist’s office that feels calm and safe. Since your therapist will probably not give you longer than the usual 1 hour session, arrive at this place well before your session so that you can time when the MDMA begins working with the start of your session. The reason I recommend this is because I think it could be quite distressing being on the bus for a long time with a drug you may have never experienced in your system (and you definitely should not be driving under the influence of any drug).

It is important you feel safe in your setting and that you feel knowledgeable and confident about the experiences you might have.

Do not take an excessive dose. Research studies report experimental doses of 75 - 150mg. Check this site for a dose that might be appropriate for you.

Some research studies have people wear eye masks and listen to relaxing music on headphones. I think this is a good way to relax and prepare yourself for the session ahead. Make yourself a playlist of soothing music that will last the 30 -60 minutes it takes for the drug to take effect.

Have a friend accompany you (maybe not to the session itself, but to be there before and after in case you need emotional support). This should be a person whom you trust, feel safe with, and who is preferably sober.

Bring water and wear comfortable layers. Hyperthermia can be a side effect so you want to ensure you are well hydrated and cool.

Bring comforting objects. Whether during or after your session, you may experience intense emotions. Have some things handy that you can use to soothe yourself (teddy bear, a particular scent, a soft fabric, iced herbal tea, pictures that make you laugh or remind you of good times, art supplies…). If you have a depression emergency kit, you can use that. If you don’t, now is a good time to make one.

Bring a digital recorder. I have never used MDMA and I don’t know how it affects a person’s memory, but for patients with depression (or anyone for that matter), remembering everything that was discussed in therapy can be a challenge. Talk to your therapist/friend about how they feel about recording the session.

Have a place you can go after session while the drug leaves your system. Have ideas of where you can go if you need to feel safe. Also keep in mind places you may like to go if you are feeling well. It may take a few hours for the drug to leave your system so you want to be in an environment that best suits your emotional needs. Since MDMA is supposed to have sensory effects maybe you would like to go for a walk on a sandy beach or have a meal at a restaurant serving foods with interesting flavours and textures.

Potential harmful effects:

Side effects include anxiety and depression when coming off the drug, hyperthermia, visual distortions, nausea, vomiting, jaw-clenching, eye-twitching, and dizziness, as well as depression and fatigue in following days. After frequent or heavy use, some users report bouts of dizziness or vertigo which gradually subside after cessation of use. There have been problems with MDMA users experiencing dehydration, hyperthermia, hyponatremia, exhaustion, blackouts, and a few cases of death generally while using MDMA at clubs or raves.

MDMA has been shown in many studies to be neurotoxic, particularly causing harm to the cells in the brain which produce serotonin. There is evidence that MDMA can cause permanent harm or cell death. These studies have been done using rodents, monkeys, and using laboratory cell cultures. The neurotoxicity seems to be associated with, or magnified by, the increase in body temperature caused by ecstasy ingestion. Here are a few of the many references about this:
http://www.ncbi.nlm.nih.gov/pubmed/1379014
http://www.ncbi.nlm.nih.gov/pubmed/18991870
http://www.ncbi.nlm.nih.gov/pubmed/16884865
http://www.ncbi.nlm.nih.gov/pubmed/12464456
(source)

The following information comes from http://www.erowid.org/chemicals/mdma/mdma_basics.shtml which is a great site full of detailed and thorough information about MDMA (usually I just link to the website, but because this information is important I am reporting in full here).

Contraindications:
• Do not take MDMA if you are currently taking an MAOI. MAOIs are most commonly found in the prescription anti-depressants Nardil (phenelzine), Parnate (tranylcypromine), Marplan (isocarboxazid), Eldepryl (l-deprenyl), and Aurorex or Manerix (moclobemide). Ayahuasca also contains MAOIs (harmine and harmaline). MDMA and MAOIs are a potentially dangerous combination. Check with your doctor if you are not sure whether your prescription medication is an MAOI.
• Avoid taking MDMA if you are currently using the protease inhibitor Ritonavir. This may be a life-threatening combination.
• Individuals with a history of heart ailments, high blood pressure, aneurysm or stroke, glaucoma, hepatic (liver) or renal (kidney) disorders, or hypoglycemia may be at higher risk.
• Avoid strong stimulants in combination with MDMA.
• Avoid high doses and frequent use. Recent studies suggest that the heavier and more frequent the use, the more concerning the long term after-effects may be.
• A small percentage (1-10% depending on race & family history) are "slow metabolizers", who have low levels of a liver enzyme (P450 2D6) which metabolizes many drugs, including MDMA (as well as Prozac, DXM, and many other pharmaceuticals). These people may be more sensitive to MDMA, might require lower doses, and should be cautious.

Onset:

Depending on how much and how recently one has eaten food, MDMA generally takes 30-60 minutes (although sometimes as long as 2 hours) to take effect. Unlike with many other psychoactives, the onset of MDMA is very quick. Often at the point one realizes that perhaps they are starting to notice effects, they are already 'launching' quickly towards the peak. This quick and extremely sharp 'launch' can be unnerving, feeling a bit like it's too quick and hard to know when it's going to end, but the feeling generally only lasts a few minutes until the full effects are reached.

Duration:

The primary effects of MDMA last approximately 3-4 hours when taken orally. For many people there is an additional period of time (2-6 hrs) where it is difficult to go to sleep and there is definitely a noticeable difference from everyday reality, but which is not strong enough to be considered 'tripping'. Many people also experience a noticeable shift in mood for several days after use; for some this is a period of depression while others experience lifted mood.

The Crash:

Some users of MDMA experience a dramatic worsening of mood as the peak effects wear off, often called the "crash". This is often the result of coming down from a wonderful experience, not wanting the feelings to go away, and being sad, scared, or annoyed afterwards. Crashes do not happen after every experience and some users never experience them. One of the primary problems associated with crashing is that some users find themselves redosing in order to stave it off.

Hangover:

Many users report feeling extremely drained the day after MDMA use. This 'day after' effect means for many MDMA users that they need to plan 2 days for the experience: one for the peak experience and one recovery day, with very little planned. Many users also experience some level of post-MDMA depression, often starting on the second day after the experience and lasting for up to 5 days. A small percentage of users report depressive symptoms for weeks afterwards. Alternately, some users report feeling better than normal for a week or so after taking MDMA. The negative after-effects of taking MDMA appear to be worse with higher frequencies of use, higher dosages, and perhaps total lifetime usage.

Further Reading:
http://www.mdma.net/therapy/method.html
http://www.maps.org/research/mdma/
http://www.macalester.edu/academics/psychology/whathap/ubnrp/mdma/table.html
*** http://www.erowid.org/chemicals/mdma/mdma_basics.shtml
http://garthkroeker.blogspot.com/2009/05/mdma-ecstasy-risks-and-benefits.html

Again, MDMA is illegal and I am not endorsing its use, nor am I qualified to. The above is a review of techniques, etc. in documented literature.

3 comments:

  1. This is reminiscent to me of the spiritual healing and awakening effects of Ayahuasca in the Amazon rainforests... a bit like psychologically and emotionally defibrillating your brain, cleansing and reseting thoughts and emotions the same as you would the electricity of the heart.

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  2. There is also a lot of research happening with hallucinogens. Apparently, the drups got a bod reputation in the 70's when people started overusing them recreationally, but they are showing positive results.
    http://www.scientificamerican.com/article.cfm?id=hallucinogens-as-medicine

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  3. MDMA causes a 20fold increase in blood levels of oxytocin, which is now (oxytocin) being looked at as a cure for DEMENTIA. While other sites are trying to say MDMA causes dementia and Parkinsons disease, they are really just advertizements for psychopharmacueticals.

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