"Ecstasy" may help PTSD victims get better

NEW YORK Fri Mar 20, 2009 3:11am EDT

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NEW YORK (Reuters Health) - The drug MDMA -- better known as the illegal recreational drug "Ecstasy" -- may help people with posttraumatic stress disorder (PTSD) recover, a Norwegian research team suggests.

They say the effect of MDMA should allow PTSD patients bond more easily with their therapists, take control of their emotions, and re-learn how to respond to past trauma.

People with PTSD "are usually running away from what they experienced as very scary, and then they never have this inhibition learning, this fear-learning," Pal-Orjan Johansen of the Norwegian University of Science and Technology in Trondheim commented to Reuters Health. "When the clients are getting MDMA we believe it is easier for them. It becomes more bearable, it becomes easier to regulate, to be in the situation and not run away."

A couple of small studies in which people with PTSD were given MDMA in addition to standard therapy have had promising results, Johansen and his colleague Teri Krebs, a graduate student in neuroscience at the university, note in their report in the Journal of Psychopharmacology. Meanwhile, three controlled clinical trials of MDMA plus therapy are now underway.

A minority of people will develop PTSD after surviving traumatic events, such as being raped or serving in combat. They will continually re-experience the traumatic event in an intrusive way, while trying to avoid things that will trigger these memories or remind them of the traumatic experience.

Currently, the standard treatment for PTSD is extinction-based exposure therapy, in which a therapist guides the person to revisit the traumatic memories repeatedly, until he or she is able to experience them without fear. However, more than 40% of people still have PTSD after undergoing this treatment.

In their article, the researchers describe three mechanisms for how MDMA might benefit people who aren't cured by therapy alone, and even speed up treatment and make it more effective.

First, they say, MDMA drug triggers the release of oxytocin, the so-called "cuddle chemical," which reduces fear while boosting trust. This could make it easier for PTSD victims to build a strong relationship with their therapist -- which is key to treatment success.

Second, the drug could help re-balance the dysfunctional relationship between two brain regions seen in people with PTSD. These individuals show excessive activation of the amygdala and less activity in the ventro-medial prefrontal cortex (vmPFC).

"The amygdala is the most connected region of your brain, it's doing a lot of stuff, it's really important for emotional regulation and triggering emotional responses to fear," Krebs explained in an interview. In a healthy person's brain, the amygdala and vmPFC are in "constant communication," she added, but in PTSD the overactive amygdala may overpower the vmPFC, making it much more difficult for a person to control their emotional responses to traumatic memories, while making it harder for them to confront these memories.

The opposite occurs when a person takes MDMA, according to Krebs; his or her amygdala activity is dampened down, while the vmPFC becomes more active. This could help a person feel more in control and better able to revisit traumatic memories, the researchers say.

Finally, Krebs and Johansen say, MDMA boosts the release of norepinephrine and cortisol, brain chemicals that are essential for emotional learning. Sedative drugs like Valium are sometimes given to people with PTSD, the researchers note, and these may actually blunt the effectiveness of therapy by completely wiping out the stress response to fearful memories, which is needed for re-learning to occur.

The current report is meant to provide a "framework" for researchers interested in investigating how MDMA might help people with PTSD and other anxiety-related conditions, said Krebs, who with Johansen has received a grant from the Research Council of Norway to investigate the topic. "What we'd really like to see is more research in this area."

SOURCE: Journal of Psychopharmacology, online March 9, 2009.

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