• Psychedelic Medicine

PTSD | +60 articles

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James J. Peters VA Medical Center

MDMA-Assisted Psychotherapy for PTSD*

Dr. Rachel Yehuda shares details about an ongoing clinical trial involving MDMA-assisted psychotherapy to treat post-traumatic stress disorder in veterans.

by Justin R. Kulchycki, MS | Psychedelic Science Review | 27 Jan 2022

Dr. Rachel Yehuda has studied post-traumatic stress disorder in combat veterans for decades. In November, her team at the James J. Peters VA Medical Center, in conjunction with MAPS, began enrolling U.S. military veterans in a phase 2 clinical trial for MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD).

The study is centered around an 8-12 week treatment period. During the sessions involving MDMA, the patient has the opportunity to revisit past events and emotions with trained therapeutic staff. Additionally, patients will receive three preparatory sessions before drug treatment and three integrative sessions following drug treatment. These sessions do not involve MDMA administration, and help patients consolidate therapeutic gains.

In addition to its clinical efficacy, Dr. Yehuda is interested in uncovering the molecular mechanisms responsible for MDMA’s therapeutic properties. Although the work is in the early stages, some details are beginning to emerge. She very generously agreed to talk with Psychedelic Science Review about the work her and her team are doing.​

The Conversation

Q: How did MDMA as a potential therapeutic for PTSD first cross your radar?

A: I met Rick Doblin, who invited me to a training session, I was rather skeptical about it. I went to the training session in Israel, and I became very enthusiastic and excited about what I was seeing. Following that experience, I decided it was something that really should be studied.

Q: You have previously shown that PTSD patients have lower cortisol levels. It has been shown that administration of MDMA can increase cortisol levels. Are you and your group looking at that relationship as the primary mechanism that drives the effectiveness of MDMA therapy?

A: I wouldn’t say that it would be a primary mechanism, but it is something that is definitely interesting to know, because PTSD has been associated with lower cortisol levels. Of course, it’s going to be more complicated than that. Not only our group, but other groups are going to be looking at molecular and epigenetic mechanisms that might explain the actions of MDMA, and I strongly believe that these are going to include cortisol related measures.

Q: Speaking of molecular and epigenetic biomarkers, will your team be looking to see if MDMA modulates the epigenome in any way?

A: We have done a study with some collaborators looking at epigenetic changes in connection with the first phase 3 trial (of MDMA-assisted psychotherapy for PTSD). We have written up some results, which are very exciting, and submitted for publication.

Q: Can you share any relevant biomarkers that could be behind the effectiveness of MDMA therapy or is it too soon to tell?

A: I think it’s too soon. We are going to take an approach of looking at biomarkers that either relate to serotonin or relate to markers that are associated with PTSD.

Q: I’d like to get your thoughts on some of the combination therapies that are happening in clinical trials right now. For example, MindMed is using MDMA as an adjunct therapy with LSD. The idea is that co-treatment with LSD and MDMA will mitigate anxiety that can be observed with clinical LSD use.

A: I’m all for getting more information. The barriers are that it is usually very hard to get permission to study one compound, let alone two. But, I think that it’s not uncommon to combine psychedelics in underground use.​

Looking Ahead

As Dr. Yehuda and her team attempt to unravel the molecular mechanisms behind MDMA’s potential therapeutic effects, clinical trials are showing promising results pointing to MDMA as a breakthrough treatment for PTSD. In 2017, MAPS was able to obtain Breakthrough Therapy Designation from the United States Food and Drug Administration (FDA) for MDMA-assisted therapy for PTSD. Securing this status has accelerated the progression of clinical trials using MDMA-assisted therapy for PTSD. The most recent of these trials was published in May of 2021 and demonstrated that MDMA-assisted therapy is both safe and efficacious in patients with severe PTSD.

The ongoing study at the James J. Peters VA Medical Center will compare the effectiveness of 2 versus 3 MDMA-assisted therapy sessions in U.S. military veterans with chronic PTSD. The study is currently recruiting participants, and is estimated to be complete by June 2022.

*From the article (including footnotes) here :
 
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How psychedelic drugs are helping veterans with PTSD*

by Jamie Reno | HEALTHLINE | 19 Nov 2021​
  • More veterans are turning to psychedelic drug-assisted therapy as a treatment for post-traumatic stress disorder as well as other mental health conditions such as depression.
  • Veterans advocates are urging the Department of Veterans Affairs to consider psychedelic drugs such as MDMA as part of the agency’s treatment programs.
  • The advocates say that psychedelics are “misunderstood” and can provide a variety of benefits.
  • They add that the drugs along with therapy can also be used by people other than veterans for mental health conditions.

When Army Ranger Jesse Gould came home from Afghanistan in 2014 after his third deployment, he was suffering, both physically and emotionally.

It took the Department of Veterans Affairs (VA) 2 years to process his disability claim and diagnose him with post-traumatic stress disorder (PTSD).

Gould said that the VA’s treatments for PTSD simply weren’t working for him, and he was losing hope.

So, he began a search for something that could help him.

Ultimately, he discovered psychedelics, a class of psychoactive substances that can alter perception and mood and affect numerous cognitive processes.

These include lysergic acid diethylamide (LSD), methylene dioxin methamphetamine (MDMATrusted Source), dimethyltryptamine (DMT), psilocybin (psychedelic mushrooms), ketamine, and ayahuasca brew.

Gould chose ayahuasca brewTrusted Source, which is made from the leaves of the Psychotria viridis shrub along with the stalks of the Banisteriopsis caapi vine, although other plants and ingredients can be added.

“It saved my life,” said Gould, who in 2017 founded the Heroic Hearts Project, a nonprofit organization pioneering psychedelic therapies for military veterans.

Gould has partnered with the world’s leading ayahuasca treatment centers and sponsored psychiatric applications with the University of Colorado Boulder and the University of Georgia.

He said that he’s now aware of thousands of veterans who’ve been helped by ayahuasca brew.

“In terms of direct connection, we have served over 150, and a clinic we work with has served 450,” Gould told Healthline.

Psychedelics are ‘misunderstood’

Thomas Bandzul, a legislative counsel for Veterans and Military Families for Progress and a longtime veterans advocate, said that what Gould is doing is becoming increasingly more common.

Bandzul explains that the reason so many veterans ultimately land on psychedelics is because they work.

“MDMA, for example, is one of the most misunderstood drugs that have huge potential for doing good,” he told Healthline. “Under controlled circumstances, used under medical professionals’ care, I think this can be, and has been, of great use for the good of people with stress-related injuries."

“Too many of the issues of the past have biased the public against this drug, but I have seen people with PTSD use this as a curative in conjunction with other therapies,”
Bandzul added. “I believe it has great potential.”

How the VA sees it

Despite what some see as growing evidence that psychedelics can positively treat people with PTSD and other psychological conditions, VA officials haven’t given them much attention.

Gary J. Kunich, a spokesman for the VA, told Healthline that the use of psychedelic treatments such as MDMA-assisted psychotherapy and psilocybin-assisted psychotherapy are “not part of the standard of care for treatment of mental health conditions at the Veterans Health Administration (VHA) and is not an approved clinical treatment.“

"The use of psychedelics as part of a research protocol might be permissible," he added, “but this would require Institutional Review Board and Research and Development Committee approval at the local facility.”

He continued, “The Veterans Health Administration’s Office of Mental Health and Suicide Prevention is closely monitoring the developing scientific literature in this area.”

When considering evolving scientific literature around innovative mental health treatments, Kunich said, the VA looks for outcomes from “rigorous and well-designed clinical trials” as well as things such as Food and Drug Administration (FDA) approval or recommendations in clinical practice guidelines.

“When implementing a new, evidence-based mental health treatment, VHA puts safety of veterans first and foremost,” he said.

New clinical trials beginning

While the VA hasn’t endorsed any psychedelics or funded any trials at the federal level, several individual VA hospitals have begun looking at psychedelics as a possible treatment alternative.

“The VA is lagging way behind with regard to psychedelics,” said Rick Doblin, PhD, the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS).

“Most veterans believe that the VA should be the active voice for veterans. If there is some treatment that can help the veteran, they should be first to study it,” Doblin told Healthline. “But that is not the case. The vast majority of the funding has been from private donors.”

Doblin, who received his doctorate in public policy from Harvard’s Kennedy School of Government, wrote his dissertation on the regulation of psychedelics and cannabis for medical use.

His professional goal is to change the public’s perception of psychedelics. He supports the development of psychedelics as prescription medications but also for personal growth for otherwise healthy people.

Not just for veterans

Doblin believes that there are many applications and uses for psychedelics that extend beyond the VA — especially for depression and other psychological issues.
By 2025, Doblin said, we’ll see a ramping up of psychedelic clinics for PTSD, psilocybin clinics for addiction, and more that will go beyond veterans.

“Psychedelics will also play a major role in community-wide addiction treatment," he said. “It will be combined with psychotherapy, as well as for couples, obsessive-compulsive disorder (OCD), phobias, and depression.”

By 2035, he said, “many people will be telling stories about having been to a psychedelic clinic. They will have legal access to these psychedelics.”

First priority is veterans

The VA Loma Linda Health Care System in California has initiated a single-site, phase 2 clinical trial designed to test the feasibility of administering MDMA alongside psychotherapy for combat-related treatment-resistant PTSD.

MDMA will be given in conjunction with structured psychotherapy in three single-dose psychotherapy sessions in a hospital setting over the course of 12 weeks.

The overall objective of the study is to evaluate the risks, benefits, and feasibility of MDMA used in conjunction with manualized psychotherapy, on reduction of symptoms, or remission of PTSD, as evaluated by standard clinical measures, in a VA healthcare system.

“So far, only one veteran has been enrolled and treated at the Loma Linda VA,” Doblin said. “The study is for eight vets. No other psychedelic trials at VAs have been conducted.”

Doblin said that the first veteran has been screened for a trial at the VA facility in the Bronx in New York City but hasn’t yet been treated.

“We just submitted a protocol to the FDA for a group therapy study at the Portland VA, which we anticipate starting about March 2022. There will be psilocybin PTSD trials at multiple VAs, but they haven’t started,” he said.

PTSD expert changes her mind

Rachel Yehuda, PhD, a PTSD expert and a professor of psychiatry and neuroscience, is director of the Center for Psychedelic Psychotherapy and Trauma Research and director of the Traumatic Stress Studies Division at the Icahn School of Medicine at Mount Sinai in New York.

Yehuda told CBS News last week that she was previously skeptical about psychedelics being of any benefit to patients.

“When I first heard about this, I thought to myself, ‘How could this possibly be a good idea?’” she said. “Psychedelics were illegal and designated by our government as being of potential harm and no medical benefit.”

However, in 2016, the FDA authorized phase 3 trials of MDMA, and Yehuda has since changed her view.

Yehuda told CBS that the results from MAPS’ first phase 3 trial “were just astounding.”

“Two-thirds of the people that were treated with a course of MDMA no longer have PTSD,”
she noted.

The FDA now recognizes MDMA-assisted psychotherapy as a breakthrough approach, which could help lead it to full approval.

How safe are psychedelic trials?

Are psychedelics clinical trials safe? Doblin gives an emphatic yes.

“We have medical screening to keep people safe from physical complications,” he said.

“We have lots of preparation and integration sessions, and we administer a suicide severity rating scale at every meeting with a patient to try to keep people safe from psychological complications.”

Doblin said that therapists have a code of ethics and two-person therapy teams. They videotape all therapy sessions, whether they involve medications or not.

“We have monitoring and oversight from our clinical research team to keep the data safe from mistakes,” he explained.

*From the article here :
 
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Why are Vets turning to MDMA-assisted psychotherapy?*
by Amelia Walsh | Psychable | 4 Apr 2022

Mentions of post-traumatic stress disorder (PTSD) date back to 490 B.C. when a Greek Historian named Herodotus mentioned the psychological symptoms experienced by soldiers who fought in the Battle of Marathon.

PTSD has been identified in United States history as early as the Civil War, fought from 1861-1865, and has been referred to using different terms before it became an official diagnosis in the 1970s. During World War I, it was called shell shock, while in World War II it was more common to call it battle fatigue. After the Vietnam war, it has been estimated that at least 25 percent of returning veterans have needed psychological care of some kind as a direct result of the trauma experienced by being exposed to violent warfare.

As the problem of PTSD within the community of current and former members of the military persists, it is becoming all the more imperative to improve methods of treatment. Keep reading to learn about how MDMA-assisted psychotherapy might offer a solution in the coming years.

What is PTSD?

The Department of Veterans Affairs (VA) has defined PTSD as “the development of characteristic and persistent symptoms along with difficulty functioning after exposure to a life-threatening experience or to an event that either involves a threat to life or serious injury.”

Symptoms of PTSD after combat exposure can cause lifelong suffering if left untreated (or unsuccessfully treated) and can include depression, anxiety, hypersensitivity to stimuli, nightmares, emotional detachment, cognitive and memory impairment, difficulty sleeping, and many other debilitating effects. Veterans affected by PTSD often feel disconnected from themselves and people in their lives, and lose interest in activities or communities that used to be sources of joy.

PTSD can cause chronic pain; it is estimated that anywhere from 15 to 35 percent of chronic pain patients also suffer from symptoms of PTSD. 55 to 75 percent of problematic drug or alcohol use diagnoses among veterans are comorbid with PTSD. The depressant properties of alcohol act to help suppress symptoms of PTSD, anxiety, and hypervigilance.

How does PTSD affect Vets?

Because PTSD has a significant impact on a person’s emotions, the condition can make relationships and family life more difficult after exposure to trauma during military service. Many veterans experience difficulties with their marriages and partnerships or find it challenging to relate to their children.

PTSD might make it difficult or impossible to maintain a job, fulfill educational requirements, or hold leadership positions. Activities that may seem straightforward to a healthy individual can be an overwhelming struggle for veterans affected by PTSD, like grocery shopping or social interactions with peers.

When suffering from PTSD, many people isolate themselves to avoid experiences and people that trigger memories of traumatic events. Loneliness and estrangement only serve to deepen the painful experience of living with the condition.

Unfortunately, there is sometimes a stigma associated with mental health issues within the military community which frequently becomes a deterrent for seeking help. Those who do take action are often met with long delays to see a mental health professional in the current Veterans Affairs system, and only individuals who have been discharged on terms deemed favorable by the military are qualified to receive care. Many are fearful that seeking help for PTSD will cost them promotions their security clearance, or make them susceptible to discharge.

What is MDMA-assisted psychotherapy?

MDMA (3,4-methylenedioxymethamphetamine) is a psychoactive substance that is often referred to as ecstasy outside of the clinical setting. It produces both stimulant and mild hallucinogenic effects on the brain by influencing levels of serotonin, dopamine, norepinephrine, and oxytocin. Such neurotransmitters influence mood, energy, emotional openness, bonding, and reduce the fear response, which is elevated in those affected by symptoms of PTSD. This cocktail of neurotransmitters creates a powerful balance of motivation, relaxation, and emotional safety to face and process potentially suppressed (or repressed) painful memories, initiating the road to healing and recovery.

When used in the context of psychotherapy, MDMA can help those living with PTSD release the fear and anxiety of reliving traumatic events, thus allowing them to engage more meaningfully with the therapeutic process. MDMA is administered while a psychotherapy session occurs so that individuals can more effectively benefit during in-person treatment and become better equipped to apply cognitive-behavioral therapy practices in their daily lives afterward.

MDMA does have risks and side effects, in addition to being potentially dangerous for those with certain existing mental and physical health concerns. For more information about MDMA, its effects, and the potential risks, read Psychable’s Beginner’s Guide to MDMA.

How can MDMA-assisted psychotherapy help Vets?

The U.S. Food and Drug Administration (FDA) has designated MDMA as a Breakthrough Therapy for treating PTSD, which helps expedite reviews of clinical trials and create a more direct path to approval if the drug satisfies the requirements in trials. A study sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS) is currently in Phase 3 trials and on track to make MDMA-assisted therapy available by prescription by 2023 should it succeed.

In clinical trials so far, MDMA-assisted psychotherapy has been more effective as a treatment for PTSD than any other type of medication or psychotherapy alone. It differs from traditional methods; as opposed to medications taken daily (and possibly for the remainder of a lifetime), MDMA-assisted therapy occurs only a few times and can provide lasting effects when it is successful. In one study, more than two-thirds of participants demonstrated remission one year after treatment, no longer meeting DSM-V criteria for PTSD.

MDMA-assisted Psychotherapy is currently only available to people diagnosed with PTSD who opt to participate in studies and clinical trials, though this may change in the near future.

The harm reduction of alleviated symptoms, sometimes following just a single treatment, can provide swift relief to a community of people suffering from PTSD for whom the condition prevents ordinary function and enjoyment of life.

The possible impact of making MDMA-assisted psychotherapy more widely available to veterans could be life-changing for some. Current treatment for PTSD requires years of rigorous and difficult psychotherapy and medications that are prone to inefficacy, and there is an immense risk for veterans abandoning the process altogether as a result.

An unfortunate reality is that current and former members of the military affected by PTSD are at an increased risk for suicide, making it imperative to find effective treatments that are more swift and profound than what is currently available. MDMA-assisted psychotherapy seems to offer such hope.

Closing thoughts and resources

PTSD is a serious mental health condition that requires effective treatment and compassionate care. There is an urgent need to offer veterans more innovative solutions, and MDMA-assisted psychotherapy could offer treatment with an improved rate of success.

For more information about PTSD, resources are available from the National Institute of Mental Health and American Psychiatric Association.

If you or someone you know is struggling with symptoms of PTSD, it is important to contact a mental health professional as soon as possible. Do not wait for MDMA-assisted psychotherapy to become widely available, find help now. If you or someone you know feels unsafe or is experiencing suicidal ideation of any degree, call 911 or seek emergency medical attention immediately.

*From the article here :
 
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MDMA Therapy for PTSD looks safe and effective in new trial data

PTSD sufferers who took MDMA along with talk therapy experienced greater relief, according to new data from a clinical trial.

by Ed Cara | GIZMODO | 22 Mar 2022

Follow-up data from a Phase III trial is the latest to suggest that MDMA—also known as ecstasy—could improve mental health when combined with therapy. The study found that MDMA-assisted therapy was better than talk therapy alone in relieving the symptoms of patients with post-traumatic stress disorder, and that this relief remained durable months later. The results from this trial and others will likely pave the way to a formal approval of MDMA by the Food and Drug Administration in the near future.

MDMA, formally called 3,4-methylenedioxy-methamphetamine, is a synthetic drug with both stimulant and psychedelic effects. It can produce feelings of increased elation, empathy, and a distorted sense of time and space. These properties made it a popular club drug, which led to its designation as an illegal substance by the U.S. federal government in the 1980s. But even before then, a small group of psychologists had experimented with using MDMA as a way to boost the effects of talk therapy sessions.

MDMA-assisted therapy has received renewed attention from the scientific world as of late, buoyed by new research and a successful push for the legalization of drugs in general. And in the last few years, the FDA has agreed to consider a formal approval of MDMA for PTSD, pending positive results from randomized, double-blind, placebo-controlled Phase III trials, which are considered the gold standard of clinical research.

Last year, a team led by University of California, San Francisco researcher Jennifer Mitchell published the first results from their Phase III trial of 90 patients with severe PTSD. Compared to placebo, MDMA-assisted therapy was highly effective and well tolerated, they found, even among patients with other relevant health conditions, such as depression and a history of substance use disorder. Specifically, two months after the last therapy session, about two-thirds of patients who took MDMA no longer fit the criteria for active PTSD.

On Tuesday, at the spring meeting of the American Chemical Society, Mitchell and her team reported follow-up data from the study, which showed that these improvements seem to last longer still after the initial treatment.

“MDMA is really interesting because it’s an empathogen,” said Mitchell in a statement provided by the American Chemical Society. “It causes the release of oxytocin in the brain, which creates feelings of trust and closeness that can really help in a therapeutic setting.”

Typically, the FDA requires positive data from at least two Phase III trials to consider approving a new drug. Mitchell and her team are already starting to enroll patients for the second trial, and they plan to continue tracking the long-term outcomes of patients from the first trial. Both are being funded by MAPS, a nonprofit organization that has been shepherding clinical research on psychedelic medicine since its founding in the 1980s. MAPS is also behind the application for the FDA approval of MDMA-assisted therapy, after having obtained an emergency use authorization for its use in 2017.

While legally administered psychedelic medicine is on the rise, there have been challenges and concerns about its use, at least in some contexts. Some advocates have opted to not necessarily wait for FDA approval of treatments like psilocybin-assisted therapy and have instead taken the approach of fighting for the local legalization of these drugs in cities and states, with increasing success. Some researchers have expressed worry about these therapies becoming used by practitioners in these areas without sufficient safeguards, while others have argued that the claimed benefits of these drugs could be inflated.

Should the data from these trials continue to bear out, though, the odds are good that MDMA-assisted therapy for PTSD could be FDA-approved as early as late next year.

 
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Which Psychedelic is Best for Overcoming PTSD? A Conversation with Professor David Nutt

by Wesley Thoricatha | Psychedelic Times

Post Traumatic Stress Disorder (PTSD) is a debilitating condition that countless trauma survivors, soldiers and veterans have to live with every day. Conventional treatments for overcoming PTSD are notoriously ineffective, often involving a slew of powerful prescription drugs that have mountains of side effects yet offer limited relief. Thankfully, psychedelics like cannabis, ayahuasca, ibogaine, and MDMA are starting to offer some PTSD sufferers true relief.

In this continuing conversation with Professor David Nutt, we speak about how we are learning to pair specific psychedelic treatments with certain conditions, and how some of these findings—particularly with PTSD—are welcome surprises. At the end of the article, we’ve also listed resources for anyone wanting to delve deeper into this subject with further interviews, documentaries, and nonprofit organizations that are helping people in need find treatment.

Thank you again for speaking with us, Professor Nutt. Going back to your plans to study psilocybin for opiate addiction, it’s striking me more and more how perhaps any of these psychedelic substances can be used to treat nearly any condition.

No, I don’t quite believe that. Let’s revisit that. I’ve been thinking a lot about this. My current thinking is that they will work for what we call “internalizing disorders,” disorders where people get locked into a line of thinking about a particular aspect of their life, whether it’s depression, thinking negative thoughts… people with OCD get locked into thinking scattering thoughts, and with addiction they’re locked into thinking about booze or the syringe. I’m not sure that psychedelics will work for disorders that are more externalizing—like ADHD, bipolar disorder, schizophrenia. So I think there will be a distinction; I don’t think they will be a panacea.

Right, very true. To better articulate my thought, you heard about LSD being used to treat alcoholism in the 60’s, then you have your new MDMA for alcoholism study, and there’s a forthcoming psilocybin for alcoholism study at NYU. Here at Psychedelic Times we’ve covered PTSD quite a bit, and have heard of course of the MDMA research, plus many accounts of people using ayahuasca and ibogaine for overcoming PTSD, along with psilocybin, ketamine, and so on.

PTSD is an area that is quite interesting and challenging. We did the MDMA study with alcoholics because the vast majority of people who come to our clinics with alcoholism have been traumatized, and they’re drinking to deaden the pain of the trauma. There we are giving MDMA as an adjunct to classic behavioral therapy, or extinction therapy, getting people to relive the trauma and extinguish the emotion. MDMA does that because it dampens the stress centers in the brain and allows people to relive trauma without overwhelming emotion.

I’m also meeting veterans who are going to ayahuasca ceremonies for treating their PTSD, and that was a surprise to me. From first principles I had not predicted that it would work, in fact at one level I thought it might have made it worse, because psychedelics can make anxiety worse. But we’re getting these reports now, and they’re certainly compelling.

So there is another take on PTSD: there is an element of this repetitive remembering of the trauma. You talk to vets and it’s a specific trauma—they continuously see their friends being blown up or shot, and they have this recurrent imagery that they can’t escape from. That might be like an internalizing obsession, and that may well be why psychedelics can disrupt it. It’s an interesting challenge. It may be that psychedelics are better than MDMA because you get the effect from a single dose rather than the two doses of MDMA. The trips are really long and challenging and they last for hours and I think it’s interesting they are often going in groups together, six or eight guys together, and their trip is with those people that they suffered with. I think that might actually be the most optimal way of overcoming the trauma, because they all have shared trauma at the same time, and perhaps can work together as a team in this way.

MDMA is a fundamentally different thing than psilocybin, LSD or DMT. Mechanistically they are fundamentally different. It’s going to be fascinating to see if you can tease apparts between these within one subgroup or another. There’s a lot of exciting research to be done.

Yes it is fascinating. I’ve spoken with many of those veteran groups and the people behind the documentaries and they certainly report huge amounts of healing, and it’s usually done as a community. There’s camaraderie, and a shared healing ordeal experience to overcome the shared war ordeal experience.

Exactly. What a nice way to come out of a war and come back together. And of course there’s so much fragmentation. One of the worst things about war is that you send these young kids out to fight, and the only thing that keeps them sane is their mates. And then usually they come back to their home country and they’re just pushed on to the scrap heap; the togetherness and teamwork just disappears. Everything is broken up and they’re just left alone.

I read a wonderful book by Sebastian Junger called Tribe that speaks exactly to this. He was an embedded war reporter and he speaks on how these are some of the worse experiences in someone’s life, but they are also often the best because at some primal level, depending on your survival with a close group of comrades, watching out for each other and relying on each other and creating those bonds feeds a deep need within us. So it’s not just the trauma of war that makes it hard to come back, it’s the loss of that community and that primal human connection that makes it so tough.

Absolutely. I’ll look that up.

We’re very grateful to Professor Nutt for speaking with us on this subject. You can read our previous conversations with Professor Nutt here and here. If you are interested in learning more about psychedelic treatment for PTSD, check out the following resources:​

Organizations

VETS
Veterans of War
Veterans for Natural Rights

 
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Healing Trip Tales: One Vet’s Ibogaine & 5-MeO-DMT Experience for PTSD and TBI

by JL | Psychedelics Today |

A former NAVY SEAL struggling with PTS and TBI is granted ibogaine and 5-MeO treatment in Mexico by an anonymous donation through VETS, and returns home with more than he could have ever imagined.

Whoever paid for me… thank you.

It was the most profound weekend of my life.

I didn’t expect too much. I guess I anticipated that this would be like most of the other “cutting edge” treatments for my traumatic brain injury and post traumatic stress: pretty cool, it’d help a bit, I’d be grateful, but that’d be about it.

But here I am, two weekends from my treatment, struggling to find the words to accurately convey how transformative this was for me—how transformative it will be for any of us who are willing to let go, really. I keep typing things and then erasing them, thinking I must sound like a crazy person—some wild-eyed zealot who’s just too far-out to relate to. But then I think… this is the most far-out thing I have ever experienced in this life and whatever crazy talk I throw at you won’t be crazy enough to cover what went down.

In other words: I expected a firecracker and I got about six pounds of C4.

I guess I’ll just stop struggling for adjectives and “as ifs” and just tell you my story. Keep in mind please, as I do, that I can’t stand hippie, new age bullshit, and while I grew up in the church, I’m not particularly religious.

So yeah… joke’s on me.


We’re first introduced to the rest of the group via Signal secure text messaging. I’m stoked to see that a classmate of mine from BUD/S, whom I hadn’t seen in almost 20 years, is going to be there, but the other guys I don’t know. Everyone seems a little held back, but that’s to be expected considering the circumstances.

We meet in San Diego on Friday afternoon for lunch, which is to be our last meal for the day, as we need to be in a fasted state for the ibogaine treatment that night. Little did I know that it would be pretty much the last thing I’d eat until lunch on Sunday.

After an uneventful drive of several hours, we arrive at the treatment house in Mexico and everything kicks into gear as a smoothly-functioning operation. The facilitators arrange the spaces, the doctor and his medical staff take urine samples, do EKGs on all of us, start IVs, and lay out some pretty impressive medical support gear for what I imagined to be a fairly low-risk event.

**Quick aside here: when I signed up for this, I thought it would be beneficial, sure, but as I started doing the preparatory work that I was sent by the organization, weirdly, things started coming up. Family issues. Relationships. Parts of me and things I’d seen and done that I’d buried out of shame or disgust. They said, “The medicine would start working before you take it,” and it really did. So by this point, I was open to something a lot more than what it appeared to be on the surface. So back to our story….

Evening approaches, and we gather around the fireplace. There’s an air of solemnity, but I can tell not all of us are bought in. Or maybe just none of us are at 100% yet. Most of us are pretty closed off, if still willing. It’s just kind of a SEAL thing, I guess.

We write down what we want to leave behind, and we take turns burning our paper in the fire. It’s quiet except for the crackle from the flames, and then the doc passes out our ibogaine doses (measured for our bodyweight) in little wooden bowls. It feels like a sacrament.

Solemnly, we take our medicine, and one by one, the facilitators lead us upstairs to be saged and smudged as a cleansing before moving to our mattresses. Curiously, the cleansing has a gravitas and weight to it that crumbles and dismisses all the shallow and thin echoes of spirituality in yoga studios and SoulCycles across Los Angeles. I receive it with humility.

Settling in on our mattresses, it’s dark. Only flickering candles and the fading light from the sun just below the ocean’s horizon remain to illuminate the room. The medical staff move quietly through, attaching heart monitor leads and O2 clips on our fingers and chests. Once they complete their tasks, I pull my eyeshade down over my eyes and lay back to wait.

Hyper-attentive to my mind and body, several times over the next half-hour, I think, “Is this it?… No… not yet…”

And then it comes.

Uber-detailed and realized visions flood my mind’s eye. They’re nightmares in 4K. I’ve never seen anything with the detail and clarity through my physical eyes that I’m experiencing now. I am completely in a dream yet 100% in my body. Unknowable machines possessed with alien intelligence build and fold out of the space like fractals from some dark pit. Strange visions that make no sense. A nightmare buzzing, like the sky is being chainsawed apart, howls with a clearly defined shape (shape?!) above my head. There’s a loud talking, without cadence or expression, just behind my left ear. It never ceases or pauses and I understand not a word. I open my eyes under the eyeshade and immediately I’m in fields of stars. I close them and I’m back in an alien, machine hell. They told us that if it gets to be too much, raise your eyeshade and you can come out of the visions, but I keep my eyeshade on. I want all of what the medicine has for me.

I begin to dry-heave. I feel hands around me, holding me in a sitting position. The retching is violent and back-to-back, four, five, eight times. Soon I’m laying down again, fighting the urge to vomit. The visions add strange, expressionless, soulless people standing and sitting around me. Again, they’re alien; there is nothing human about them. It must be hours that I try to make sense, assign meaning, figure out the visions, until, worn out, I give up. Just let them come, I think, and I let go.

Innumerable hours pass, or is it minutes? I try to move my arm and my leg, and while I can, nothing’s coordinated. It’s as if I’m operating a crane, and while I can pull one lever at a time, I can’t make the arm do anything resembling a smooth or efficient motion. I really need to piss but can’t conceive of trying to stand right now.

At some point during the night, six, seven, eight hours later, the “visionary stage” ceases, my mind quiets, and the literal nightmare I’ve been in ends. I’m in a trance-like state now, apparently what they refer to as the “contemplative stage.”

Bullshit.

All I’m contemplating is how tumbled and empty I feel. I still need to piss but can’t move. Unfocused, I feel like I’ve had a hard reset and I’m in the BIOS of the motherboard. Everything is in two-toned, 8-bit graphics. I pull off the O2 monitor and scrape off the eyeshade. I close my eyes but don’t sleep. At some point, I notice the sun rise.

Several hours later, I look around the room. All of us are glued to our mattresses in various interpretations of a full-body rictus. No movement.

Sometime later in the afternoon, around three or four I’d guess, I get up and make my way to the restroom and then downstairs. I manage to grab a banana off the counter (which takes a couple tries) and slide down to the floor and eat it. Judging from the expressions on the faces of the staff, I must look like shit… and it appears that they’ve seen this before, or maybe even experienced this themselves.

One of the facilitators comes to me, brings me to the couch, and does some “energy work” on me. I’m too worn out to resist the hippie bullshit… and surprisingly, it helps. A lot. Even though they had no meaning to me, I manage to write down my visions (not that I’ll ever forget them), then make it back upstairs to my mattress.

Several hours later, we attempt dinner. I don’t know how much the other guys manage to get down, but I think I get about two spoonfuls. There’s very little movement and lots of agonized expressions around the table.

Back to bed we go in silence, and in the dark of Saturday night or perhaps the wee hours of Sunday morning, my trance fades and I fall asleep.

When I wake on Sunday morning, I feel like a fever broke in the night. You know the feeling: You’re worn out, exhausted, but you know it’s over. The sickness is gone, leaving only relief.

Still weak, but ravenous, I make it downstairs and as my greedy hands begin to shove food towards my mouth, the facilitator kindly tells me that I still need to be in a fasted state for the 5-MeO-DMT, which we’ll be doing in a few hours.

MORE psychedelics?! I honestly don’t feel up for it. I don’t really want any more than what I’ve just experienced, but I’m in this for the whole enchilada (food metaphors? Fuck, I’m hungry) and I’m committed to following the whole program. I can tell I’m not the only one with hesitation though.

As the rest of the guys make their way downstairs, we gather again around the fireplace and the staff talks us through what’s going to happen next. One of the other guys expresses his doubts about the 5-MeO-DMT, and the facilitator reassures us that this is nothing like the ibogaine. It’s complementary, she says, a nice bookend to what we just experienced. “Hope they’re not matching bookends,” I think.

As she finishes with the brief, the two SEALs there helping out (who had gone through this before) offer a few words: “It’s like a deep dive in the ocean. You’re down 150 feet and it’s beautiful and quiet, and the water pressure is intense, and you’re at peace… but then you look over, and there’s a deep, dark abyss. If you have it in you, go down there. That’s where the jewels are.”

I think we all make up our minds at this point to go all the way, no matter what it feels like.

The staff gives us the order we are to go in and I’m number three of five. They tell us to go wait our turn by the pool, and mention it’s helpful to write what we’re feeling, so I grab my journal and head out to find a private spot by one of the fire pits around the pool. I begin to write, awkwardly, my muscles still not in agreement with my head yet, and I manage to stain the top of a clean page with: “I don’t I.” Frustrated that my hand, brain, and intentions all seem to be separate entities, I try again. This time, slowly, I write:
Ibogaine was a nightmare in 4K that I couldn’t stop or wake up from. I could make no sense of it then or now. I think I had expectations for the medicine as much as I tried not to. I have no expectations of 5-MeO. None whatsoever. It will be what it will be.

I start to put the pen down… but pause… and write:

I feel… different

It’s true. Something’s subtly very different. I write again:

I feel… present

Shocked into an introspective silence, I look inward and feel a clean openness in my soul, like all the accumulated and stored entanglements of my life have been quietly discarded, and I now only recognize they had ever been there by their absence.

Kind of stunned, I sit there with myself and savor the feeling. I haven’t felt this… free since I was probably about twelve. And as I rest in this quiet, subtle peace, awestruck… I hear our first 5-MeO guy scream from the house 50 meters away.

Shit.

As my turn arrives, I’m led into the house by one of the SEALs helping out. Up the stairs, I’m smudged and saged again, and led into the room. It’s kind of sacred. Candles. Music. The doctor and facilitators have really set the space and I can feel it. Speaking in hushed tones, they sit me up on the single mattress covered in a spotless white sheet, and almost in whispers, describe what’s about to happen. The doctor shows me the vaporizer, inscribed with a medical caduceus, and the three doses of toad venom I’m about to encounter. “The profound from the humble,” I think, and then I’m inhaling the “handshake dose,” just to familiarize me with the process. Easy enough, and with no effects to speak of, I pull my eyeshade over my eyes and we move on to the first real dose. I inhale again as the doctor instructs me, holding for a count of ten, then exhale and fall backwards as instructed.

Only just as I begin exhaling, the world explodes. Gorgeous fractals in vivid primary colors, more detailed and distinct than anything my eyes have ever viewed fills… my field of vision? No… my field of consciousness. I can barely feel that I have a body. Bliss suffuses all of me (what is “me”?) and all I feel is love. I remember what the SEAL downstairs said—that if you can handle it, go deeper. Since I’m able to have these thoughts, I figure there must be room left, so I clumsily signal for another dose. Halfway in my body, I’m pulled to a sitting position and again feel the vaporizer against my lips. Drawing deeply and holding, I hear the doctor count down from five. Far away, he whispers, “Exhale…”

…and I die.

No, really. I die. And here is where words begin to fail.

I feel my body atomize and it’s GONE. I’m in a blackness that is teeming, but warm. Infinite. It’s gentle, but I sense that the gentleness, while truly the essence of this Consciousness, is not all of it, and the power… there is no word that can convey the awesome power of this place. It is infinite possibility. And I? I am a speck, a tiny ripple, a wavelet upon an Ocean so vast and deep, how could I have ever thought; how could I have forgotten that I am no less separate from this great Consciousness than a wave is seperate from the Ocean? How can a ripple be apart from the sea? I am no longer “me,” but still completely “I.” And I remember what I am.

I feel a scream coming from deep, and it happens—from somewhere I scream, and I hear it as an observer. But here’s the weird(est) thing. Time has no meaning here, and as I hear this scream, I know that this scream is not just from “now.” It’s from five years ago, and 20, and from when I was two, and from when my parents divorced, and from Afghanistan, and from yesterday. The linear time we live in has condensed to a singularity and this scream is from my now, my past, and probably my future.

I don’t know time, space, or have any ties to what I used to know. There is only existence returned from whence I came, and then, at some point in time or space…

…I walk through the Gates of Heaven.

(If you’re still with me, believe me, I know how this sounds.)

Hands around me, bright light more beautiful than anything I have ever seen, and the purest love, acceptance, grace, and right-ness permeates my existence. The greatest feeling I have ever experienced or could possibly imagine is dwarfed by this feeling. I pull my eyeshade off, and with pure wonder and without the slightest insincerity, think, “Are we dead? Are all of you angels?” I lay there on the mattress, alternately weeping with the sorrow of what we’ve lost and laughing with the realization of what we are, and I whisper, “I am born.”


I will never be the same. I wish I could convey more of this experience to you but words are useless. Ibogaine reached deep inside of me and wrapped up all my trauma and sorrow. It wrapped it up in a dark, wet, moldy, wool blanket and when I screamed, it all came out. I walk around every day in awe, feeling this, seeing with new eyes. I didn’t learn anything, I just remembered.

My brain works now too. It’s the strangest thing. Words flow. Thoughts sizzle. Synapses fire and I can discuss, read, think, and elucidate in ways I haven’t been able to in at least 15 years. I feel smart again. All the TBI had made things slow and fuzzy, but these medicines lit up all the lobes, cortices, stems, and folds of my brain and shocked them back into activity (not a scientific analysis, of course). It was starter fluid for my grey matter.

My relationships are healing. My dad and I are reconciling. He’s so happy. So am I.

I’ve been reading everything I can get my hands on regarding this therapy and the history and use of psychedelics (I prefer the newer term, “entheogens” these days—it means to “create the divine within”).

These are not drugs. This is powerful, powerful medicine and it has the potential to do enormous good. These are sacraments that require much of you and will bring you what you need and are prepared for.

It is not the molecule, but the door that it opens.

To my benefactor: thank you. I’m going to do my part to take this newfound remembering and make the world better, and bring it to as many people as I can. And the most unexpected, beautiful realization? The Brotherhood that we fight with, for, and next to—the ones who scar us and scar with us are also the ones healing us. What an amazing thing!!!!

I never thought I’d be signing off like this, but….

Love and Light,

JL

 
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MDMA safe and effective for severe PTSD, study*

by Liam Davenport | Medscape | 14 Apr 2021

Adding MDMA to integrative psychotherapy may significantly improve symptoms and well-being for patients with severe PTSD, including those with the dissociative subtype, new research suggests.

MAPP1 is the first phase 3 randomized controlled trial of MDMA-assisted therapy in this population. Participants who received the active treatment showed greater improvement in PTSD symptoms, mood, and empathy in comparison with participants who received placebo.

"MDMA was extremely effective, particularly for a subpopulation that ordinarily does not respond well to conventional treatment," study co-investigator Bessel van der Kolk, MD, professor of psychiatry at Boston University School of Medicine, Boston, Massachusetts, told delegates attending the virtual European Psychiatric Association (EPA) 2021 Congress.

Growing interest

In recent years, there has been a great deal of interest in the potential of MDMA for the treatment of PTSD, particularly because failure rates with most available evidence-based treatments have been relatively high.

As previously reported by Medscape Medical News, in 2017, the US Food and Drug Administration approved the trial design of Kolk's and colleagues' MAPP1 study after granting MDMA breakthrough designation.

The MAPP1 investigators assessed 90 patients with PTSD (mean age, 41 years; 77 percent White; 66 percent women) from 50 sites. For the majority of patients (84 percent), trauma history was developmental. "In other words, trauma occurred very early in life, usually at the hands of their own caregivers," Kolk noted.

In addition, 18 percent of the patients were veterans, and 12% had combat exposure. The average duration of PTSD before enrollment was 18 years. All patients underwent screening and three preparatory psychotherapy sessions at enrollment.

Participants were randomly assigned to receive MDMA 80 mg or 120 mg, or placebo followed by three integrative psychotherapy sessions lasting a total of 8 hours. A supplemental dose of 40 or 60 mg of MDMA could be administered from 1.5 to 2 hours after the first dose.

The patients stayed in the laboratory on the evening of the treatment session and attended a debriefing the next morning. The session was repeated a month later and again a month after that. In between, patients had telephone contact with the raters, who were blinded to the treatment received.

Follow-up assessments were conducted 2 months after the third treatment session and again at 12 months. The primary outcome measure was change in Clinician Administered PTSD Scale for DSM 5 (CAPS-5) score from baseline.

"Dramatic improvement"

Results showed that both the MDMA and placebo groups experienced a statistically significant improvement in PTSD symptoms, "but MDMA had a dramatically significant improvement, with an effect size of over 0.9," Kolk said.

The MDMA group also reported enhanced mood and well-being, increased responsiveness to emotional and sensory stimuli, a greater sense of closeness to other people, and a greater feeling of empathy.

"Patients also reported having heightened openness, and clearly the issue of empathy for themselves and others was a very large part of the process," said Kolk.

"But for me, the most interesting part of the study is that the Adverse Childhood Experiences scale had no effect," he noted. In other words, "the amount of childhood adverse experiences did not predict outcomes, which was very surprising because usually those patients are very treatment resistant."

"The dissociative subtype of PTSD was first described in DSM-5 and that patients are notoriously unresponsive to most unconventional treatments,"
Kolk added.

In the current study, 13 patients met the criteria for the subtype, and investigators found "they did better than people with classical PTSD," Kolk said. "This is a very, very important finding," he added.

Carefully controlled

In a pooled phase 2 data analysis, 82% of patients reported a significant improvement by the end of treatment; 56% reported that they no longer had PTSD.

In addition, 67 percent of patients no longer met diagnostic criteria for PTSD. These included patients who had crossed over to active treatment from the placebo group.

Eleven patients (12 percent) experienced relapse by 12 months; in nine of the cases, this was due to the presence of additional stressors.

"Overall, there were very few adverse side effects," Kolk noted. "In addition, there were really no serious mental side effects, despite the patients' opening up so much very painful material," he added.

The most common adverse events among the MDMA group were muscle tightness (63 percent), decreased appetite (52 percent), nausea (30 percent), hyperhidrosis (20 percent), and feeling cold (20 percent). These effects were "quite small, and the sort of side effects you would expect in response to an amphetamine substance like MDMA," said Kolk.

"An important reason why we think the side effect profile is so good is because the study was extremely carefully done, very carefully controlled," he added. "There was a great deal of support, and we paid an enormous amount of attention to creating a very safe context in which this drug was being used."

However, he expressed concern that "as people see the very good results, they may skimp a little bit on the creation of the context and not have as careful a psychotherapy protocol as we had here."

"On the right track"

Commenting on the findings for Medscape Medical News, David Nutt, MD, PhD, Edmond J. Safra Professor of Neuropsychopharmacology, Imperial College London, United Kingdom, said the results are proof that the investigators' "earlier smaller trials of MDMA were on the right track.

"This larger and multicenter trial shows that MDMA therapy can be broadened into newer research groups, which augurs well for the much larger rollout that will be required once it gets a license," said Nutt.

"The prior evidence of the safety of MDMA has now been confirmed," he added.

"The study represents an important step in the path to the clinical use of MDMA for PTSD," Nutt said.

*From the article here :
 
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VA approves Ketamine for PTSD

by Billy Cox | Herald Tribune | Jun 30 2019

SARASOTA — This month’s decision by the U.S. Department of Veterans Affairs to offer a psychedelic drug to treat post-traumatic stress disorder while marijuana remains off limits is leaving some stakeholders flummoxed amid the ongoing wave of veteran suicides.

Spravato, derived from the family of anesthetic drugs called ketamine and produced by a division of Johnson & Johnson, will be prescribed to VA clients on a case-by-case basis and administered as a nasal spray.

Ketamine variants have made headlines over the decades for their multiple roles as sedatives, recreational hallucinogens and for their impressive track records for mitigating suicidal depression. The Spravato version, which was approved by the U.S. Food and Drug Administration in March, requires patients to remain under professional observation for two hours following ingestion.

The addition of a new remedy for lowering military suicide rates at a moment when retired and active-duty personnel are killing themselves roughly 20.6 times a day was hailed as a milestone by VA Secretary Robert Wilkie. “We’re pleased to be able to expand options for veterans with depression who have not responded to other treatments,” he said in a statement. “It reflects our commitment to seek new ways to provide the best health care available for our nation’s veterans.”

But for those like Sean Kiernan, an Army veteran who attempted to take his life in 2011, the VA’s simultaneous embargo on marijuana is incoherent.

“Ketamine was the most effective drug I’ve ever taken for suicidal thoughts — but it is not a long-term medicine you should use. I got psychologically addicted to it for four years,” says Kiernan, president of the Weed For Warriors Project, which advocates legal cannabis for veterans, with 12 chapters nationwide.

“The danger with ketamine is the side effects, like on your urinary tract and gall bladder. I’ve had three surgeons telling me I need to have my gall bladder removed. My question is, why are you so willing and eager to accept something that, on the face of it, is the very thing you complain about with marijuana, like THC, which isn’t nearly as strong? This is hypocrisy, and it makes no sense.”

Catch-22 for veterans

The nation has been struggling with that contradiction since marijuana was classified as a Schedule 1 drug with the Controlled Substances Act of 1970.

The Herald-Tribune documented the Catch-22 that many veterans find themselves in and the effort of proponents to change the law last year in its “Warriors Rise Up” project.

Despite the fact that more than 2.5 million Americans are legally using medical marijuana for ailments as disparate as fibromyalgia and cancer, all drugs labeled Schedule 1 are regarded as having no medicinal value. Ketamine is a Schedule 2 substance.

CNN reported in February that the military suicide virus is now beginning to sweep the ranks of America’s elite warriors, with U.S. Special Operations Command counting 22 self-induced fatalities in 2018. Eight SOCOM operators took their lives the year before. Also, in April, the self-inflicted gunshot death of a 68-year-old veteran in a VA parking lot in Virginia brought to 22 the number of veterans who’ve killed themselves at VA facilities in the past 20 months.

For researchers like Brad Burge, however, the willingness of establishment medicine to employ psychedelics for the treatment of PTSD and associated psychological issues bodes well for the future of marijuana. “It is good news,” he says. “It shows that things are changing in the acceptance of these drugs for mental illness.”

Burge is director of strategic communications for the Multidisciplinary Association for Psychedelic Studies. Founded in 1986 by New College alum Rick Doblin, MAPS is establishing scientific and legal foundations for the expanded use of psychedelics and cannabis.

The nonprofit research organization is completing Phase 3 trials on MDMA-assisted therapy. That drug, also commonly known as Ecstasy, is a controversial synthetic stimulant banned in 1985. MAPS is also studying the therapeutic applications of LSD, and it hopes to get funding for investigating Ibogaine- and Ayahuasca-assisted therapy.

Early this year, MAPS completed its first study of medical marijuana on 76 veterans diagnosed for PTSD, and will publish its results before the end of 2019. But until cannabis loses its Schedule 1 status, gaining access to acceptable samples of marijuana for the completion of MAPS’ research will be difficult.

“But things are changing,” says Burge. “The heads of all these administrative bodies have acknowledged there are limitations that shouldn’t be there. They don’t want to be put in the position of obstructing legal research.”

*From the article here :
 
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