MDMA-assisted therapy for PTSD

[AcceptingUncertainty]

I'm glad the FDA—and the U.S. government generally—are slowly changing course re: research on psychoactive drugs. We still have a long way to go, but at least there's some movement in the right direction.

Re: MDMA-assisted psychotherapy for PTSD, Wikipedia's summary at MDMA § Research seems accurate to me:

Parrott, author of the review you cited, is also the same researcher whose animal research was retracted because they mislabeled heroin samples as MDMA samples and concluded something akin to the hole in the head myth about MDMA use.

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[Ollie123]

Parrott, author of the review you cited, is also the same researcher whose animal research was retracted because they mislabeled heroin samples as MDMA samples and concluded something akin to the hole in the head myth about MDMA use.

I thought that was Ricuarte?

Update: It was Ricuarte - Retraction | Science

Either way, not really sure what that incident has to do with more recent work on the topic.

 

[AcceptingUncertainty]

I thought that was Ricuarte?

Update: It was Ricuarte - Retraction | Science

Either way, not really sure what that incident has to do with more recent work on the topic.

Thanks for the correction.

 

[cara susanna]

I'm glad the FDA—and the U.S. government generally—are slowly changing course re: research on psychoactive drugs. We still have a long way to go, but at least there's some movement in the right direction.

Re: MDMA-assisted psychotherapy for PTSD, Wikipedia's summary at MDMA § Research seems accurate to me:

I found a review from the National Center for PTSD on MAPS for PTSD and they also think that the research needs to better justify why this is needed, given that people tend to do so well in evidence-based therapies for PTSD without these drugs.

 

[WisNeuro]

I found a review from the National Center for PTSD on MAPS for PTSD and they also think that the research needs to better justify why this is needed, given that people tend to do so well in evidence-based therapies for PTSD without these drugs.

Ecstasy and ESA dogs for everyone!

 

[tr]

I found a review from the National Center for PTSD on MAPS for PTSD and they also think that the research needs to better justify why this is needed, given that people tend to do so well in evidence-based therapies for PTSD without these drugs.

Can you post link? I'm surprised at this since as far as I know, current EBTs don't get anywhere near 50%+ remission after 2 sessions as the MAPS studies documented? Are you frequently seeing people that no longer meet criteria for PTSD after 2 sessions of PE/CPT?

 

[cara susanna]

Can you post link? I'm surprised at this since as far as I know, current EBTs don't get anywhere near 50%+ remission after 2 sessions as the MAPS studies documented? Are you frequently seeing people that no longer meet criteria for PTSD after 2 sessions of PE/CPT?

https://www.ptsd.va.gov/publications/rq_docs/V30N3.pdf

They aren't making any claims about 2 sessions though, it'd be the full course.

 

[tr]

https://www.ptsd.va.gov/publications/rq_docs/V30N3.pdf

They aren't making any claims about 2 sessions though, it'd be the full course.

Thanks, that was an excellent and thorough review. I don't see where they say medication assistance for psychotherapy is not justified. They did say it needs to overcome 'floor effects' of benefit from psychotherapy alone, which is universally true - once a standard of care exists, clinical trials need to show superiority to that, not to placebo. MDMA seems to do that based on the Phase 2 trials and the authors say at the end that if the Phase 3 trials are successful, it is likely to be the first form of MAP to influence clinical practice.

 

[cara susanna]

Thanks, that was an excellent and thorough review. I don't see where they say medication assistance for psychotherapy is not justified. They did say it needs to overcome 'floor effects' of benefit from psychotherapy alone, which is universally true - once a standard of care exists, clinical trials need to show superiority to that, not to placebo. MDMA seems to do that based on the Phase 2 trials and the authors say at the end that if the Phase 3 trials are successful, it is likely to be the first form of MAP to influence clinical practice.

The floor effect is what I was trying to capture in my comment, but it has been a few days since I read it.

 

[goatcrossing]

How would pharmacologically-assisted therapy stuff like this work if it's rolled out into practice? Psychologists administering this in their own practice? Or more psychiatry's domain?

 

[WisNeuro]

I would assume psychiatry, I can only imagine the liability if you were doing this outside of a medical context.

 

[tr]

I would assume psychiatry, I can only imagine the liability if you were doing this outside of a medical context.

I would think it would have to be a team effort. I think the protocol typically includes two specially trained therapists trading off in extended sessions (4h I think).

It sounds pretty demanding for the therapists and probably something that should be handled by a group. In theory the therapists could be psychiatrists but given market realities it seems unlikely that a lot of psychiatrists are going to undergo the specialized training to provide this kind of therapy. I'd guess it would be more like prescribe and collaborate. There would almost certainly be a REMS program for anyone wanting to be the prescriber for this kind of therapy.

 

[WisNeuro]

Seems terribly expensive unless it was only mandated for treatment resistant forms of some disorders.

 

[goatcrossing]

I would think it would have to be a team effort. I think the protocol typically includes two specially trained therapists trading off in extended sessions (4h I think).

It sounds pretty demanding for the therapists and probably something that should be handled by a group. In theory the therapists could be psychiatrists but given market realities it seems unlikely that a lot of psychiatrists are going to undergo the specialized training to provide this kind of therapy. I'd guess it would be more like prescribe and collaborate. There would almost certainly be a REMS program for anyone wanting to be the prescriber for this kind of therapy.

I'm a college student looking at either taking the psychologist or psychiatrist path, and while it's not the be-all-end-all, I would like to leave the door open to do some of this in a future practice if it ends up approved. Psychopharm + therapy with such intense subjective effects just seems like very interesting work. It sounds like you're saying that it'd be unlikely for a psychiatrist to be in a position to do this, much the same as normal therapy: their time's just too valuable, just evaluate & prescribe, and let (master's level?) therapists carry it out? Is that right?

Have heard a lot of ambivalent advice about which way to go, so any insight is appreciated.