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vivien’s Article : MDMA-Assisted Psychotherapy

The first article talked about the utilization of 3,4-methylenedioxymethamphetamine, also known as MDMA, Ecstasy, or Molly, and how it can be beneficially used in therapy (Figurasin & Maguire, 2022). Especially in patients suffering from post-traumatic-sress disorder, also known as PTSD. Promoting arguments for the use of MDMA in therapeutic settings have been provided by studies conducted on 103 participants who had displayed symptoms of PTSD for over 15 years despite treatment. Compared were participants in the placebo group and the MDMA group and how well they reacted to talk therapy and PTSD-specific tests afterward. The studies showed a significant negative correlation between the usage of MDMA and PTSD-related symptoms, leaving 56% of participants that have used MDMA in the trials and 23% of the placebo group falling out of the clinically diagnosable realm of PTSD by the end of the trials. The question of why MDMA works remains a mystery for the most part, however, Robert Koffman, a senior consultant for integrative medicine and behavioral health at the National Intrepid Center of Excellence, explained that the drug has quite the opposite effect compared to the symptoms displayed in PTSD. While PTSD symptoms include increased activity of the amygdala (anxiety and alertness) and a decrease in activity in the hippocampus (emotional numbness and increased distrust), MDMA has the exact opposite effect, by decreasing the activity of the amygdala and stimulating the hippocampus. This made people not only more likely to talk about their trauma but simultaneously made them build up trust and comfort far easier and faster, which then helped them to work through it in a less aroused and anxious manner. However, Koffman also doubled down on the fact that these positive results of MDMA are only possible in a professional therapeutic setting, taking the drug alone without talk therapy won’t have the same effect (Gleason, 2021).

What I found super interesting were the results of the study in general. 56% of people who suffered from post-traumatic stress disorder for over 15 years despite treatment displayed clinically insufficient symptoms for PTSD after the trial and after 12 months it was even 67% of the participants. This is truly stunning considering all the pain and insufficient treatment concepts these people have tried and were still unsuccessful in reducing their symptoms. However, maybe that was exactly the reason why. Maybe these people had such a blockade of panic and stress related to their individual traumas that all approaches were too triggering for them. Thus, having a drug that reduces that trigger threshold and increases feelings of trust and openness might just be the gap that separated them from working through their trauma in a bearable and effective way.

References

Figurasin, R., & Maguire, N.J. (2022). 3,4-Methylenedioxy-Methamphetamine Toxicity. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK538482/

Gleason, P. (2021, May 28). Looking to the Future of MDMA-Assisted Psychotherapy. Psychiatric Times. https://www.psychiatrictimes.com/view/future-mdma-…

Karan’s Article: The article I chose was “Looking at the Future of MDMA-Assisted Psychotherapy.” Before reading the article, I could only imagine the amount of draw backs to using MDMAs during therapy sessions. My thoughts were of possible addiction or potential health consequences. MDMA has been linked to hypertension, feeling faint, anxiety attacks and possible seizures (National Institute on Drug Abuse, n.d.)

I found it interesting that MDMA actually produces the opposite effects of PTSD. PTSD causes the unwanted replaying of traumatic memories. This can occur through thoughts or nightmares. Some sufferers of PTSD are triggered by certain things that remind them of the traumatic event (Mayo Clinic Staff, n.d.) MDMA causes an increase in the release of neurotransmitters such as serotonin, dopamine and norepinephrine (T & Gans, 2020).
My only concern about the use of MDMA for Psychotherapy, would be the effect on the brain and body. MDMA/Ecstasy/Molly can cause an increased heart rate, hypertension, confusion, fluctuation in body temperature as well as other (possibly more serious) side effects (Stoneridge, n.d.). While I think MDMA can be beneficial for individuals suffering with PTSD, I believe that it should only be administered for a specific period in a very controlled medical setting.
References
Mayo Clinic Staff. (n.d.). Post-traumatic stress disorder (PTSD). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/pos…
National Institute on Drug Abuse. (n.d.). MDMA (Ecstaty) Abuse Research Reports. Retrieved from National Institute on Drug Abuse: https://nida.nih.gov/publications/research-reports…
Stoneridge. (n.d.). How Does MDMA Affect The Brain? . Retrieved from Stoneridge: https://pronghornpsych.com/how-does-mdma-affect-th…
T, B., & Gans, S. M. (2020, July 13). The Effects of Ectasy or MDMA on the Brain. Retrieved from VeryWellMind: https://www.verywellmind.com/what-does-mdma-do-to-…Sabin’s Article: I believe that psychotropic medications are overprescribed, and one medication I would like to focus on is Xanax and the benzodiazepine drug category. From 2003 through 2015, the prescription of benzodiazepines doubled. Half of those prescriptions were made out in outpatient medical centers such as family medicine. Ideally, benzodiazepines were prescribed for anxiety, lack of sleep, and seizures. But a study further investigated the outcome of benzodiapaines being prescribed for chronic conditions such as back pain and many other chronic diseases. The alarming aspect of this study was that not only did the prescriptions for benzos double, but family medicine and primary care were seeing an increase in visitations double the visits for benzodiapine prescription refills. These visiations exceeded visits to a psychiatrist( Chatterjee, 2019).

Primary care providers can benefit from more education in prescribing these medications, especially the risks involved. Prescription for these sedatives can cause physical dependency in patients and increase their long-term use. These sedatives have opioid-like symptoms such as decreased breathing and altered mental status. According to the CDC, “the overdose mortality rate involving benzodiazepines for women between the ages of 30 and 64 has increased by 830 percent between 1996 and 2017” ( Chatterjee, 2019, para7). Since primary care providers are the front-line provers, especially in locations where there aren’t many specialties like rural areas, they are burdened with prescribing pain and sedative medications like benzodiapaines. I agree with this article, especially about primary care providers not having the proper training to prescribe benezodiazipines.

From a personal experience, I have worked in family medicine in the past, triaging patient phone calls and working with primary care providers. Patients would be on xanax for months on months, and the pharmacy would track them to ensure they are not requesting more xanax than the 30-day supply that is on automatic refill. People can be on Xanax for years, with prescriptions refilled every 30 days. Many patients are taking xanax for back pain, and they will refuse referrals to pain management or any apecilaty because those specalitites will ween them off xanax and implement alternative therapies suited for the pain condition. It’s worrisome when patients say they have insominia and are prescribed xanax when they actually suffer from a diagnosis of sleep apnea and prefer the xanax over the losing weight or wearing oxygen to address their underlying cause for the lack of sleep. I felt that family medicine providers use xanax as a band-aid because they are so overwhelmed and not adequately trained. Often ive witnessed patients refuse to see a psychiatrist because of the stigma of being medically diagnosed with a mental health condition that would require psychologist/ psychaitray intervention. I believe psychiatry should be able to see these patients because they are well versed in how the medication should be used appropriately. They can also investigate the patients underlying health problems and if they require a sedative.

Chatterjee, R. (2019, January 25). Steep Climb In Benzodiazepine Prescribing By Primary Care Doctors. The Northeast Public Radio. https://choice.npr.org/index.html?origin=https://w…