There are studies showing that EMDR with psychotherapy is effective, but it’s far from clear that it offers any advantage over other treatments. My guess is that it works by distraction, or what they call “dual attention.” Our conscious attention is limited, and anything that reduces the amount of attention devoted to the emotional component of memories might be expected to facilitate psychotherapy. I would like to think there is a way to accomplish the same thing without deception and without overblown claims for a “gimmick.”

My problem with PTSD was that the narrative surrounding the incident (a serious bicycling crash) was disjoint: playing the events in my head, I could not get past the feeling in the moments leading up tot he crash, of “I am going to die”, even though intellectually I know I didn’t. The EMDR therapy re-established the narrative thread so that I could observe the feeling I had had, but without re-experiencing it, because I could identify it as part of a narrative which culminated with me being strapped to a spinal board and eventually walking out of the hospital unaided later that day with nothing much worse than a broken rib.

So, I can’t say what the role of the EMDR component was, but it does sound as if it was a proper, evidence-based use of it, in a relevant clinical context. Unfortunately, it’s also apparently being pushed by quacks and charlatans. My contact advised me that the evidence supports its use only where there is a clear and unambiguous diagnosis of PTSD. Importantly, I went in with a healthy skepticism and discussed this with the psychologist, who agreed that it is being oversold in some contexts. And “it worked for me” (those dread words), but it worked in the way the literature says it should and for the condition the literature lists as an indication.

Bear in mind that this was after probably 8-10 sessions with David, a properly trained and eminently qualified psychologist with an honest-to-goodness PhD from a highly regarded department at a respected university and all, and the result was apparent (in reduced flashbacks, reduced nightmares, and reduced panic responses) after just two sessions. That is, normal psychotherapy has only a minor effect, EMDR had a dramatic and immediate effect, and subsequent psychotherapy again only a minor improvement (on a much better baseline).

I hope I am not a dupe! I think we’d all like to know *how* this works, if it really does. As far as I can tell, my experience is fairly typical. So maybe it is just another psychologist’s mind game (David really did not like me using that term, but it’s what they are I reckon).

While these kinds of studies may sound humorous to the average person, it is important to note as Robb does that these medications were originally developed with an eye towards helping mentally ill people.

This is not true with respect to either MDMA or ketamine, although, speaking as someone who has had poor luck in the SSRI/SNRI/atypicals game, I can very much empathize with interest in the latter.

I don’t think a smaller “booster” would be very effective as it is also known to lead to rapid tolerance/diminished effects.

I suspect that you’re thinking of LSD, which is not usefully supplemented outside a narrow window. (Psilocin is a bit more forgiving in this regard. Just sayin’.) MDMA is well known as being boostable to stretch out the effect, which is what one would naively expect from an amphetamine backbone. These guys seem to have made the pharmacokinetics into something of a cottage industry.

Shulgin did have more of a tinkering, exploratory, hobbyist approach but if I remember right he was horrified at the way it ultimately made its way into casual use.

This bit is usually associated with the DOM story.

A persistent problem with media reporting on this trial since 2004 has been that anyone who raises concerns is stigmatized as a mindless anti-drug zealot. This trial set, to my knowledge, the record for IRB shopping. It’s my understanding that Copernicus IRB, the commercial IRB that brought us the Ketek protocol 3014 fiasco, approved the protocol after 8 IRBs rejected it.

The first IRB (Western IRB) to approve the trial had to rescind approval upon further consideration. Thanks to the sponsor’s outrage at FDA regulations for the protection of research subjects, many of these documents are online: http://www.circare.org/im2Feb2004.htm#additional.

As for Dr Mithoefer’s concern about self-medication and the purity of street-grade E, perhaps this same concern could have been extended to research subjects in a MAPS-sponsored trial in Spain testing E for PTSD in rape victims. The trial was terminated when somebody noticed the (sole) physician quit leaving a psych grad student in charge. The source of the “study drug” was the local police impound, which is stupid beyond belief and grossly unethical. IIRC proponents complained the trial was terminated for political reasons.

I have every sympathy for people with treatment refractory conditions but exquisite care must taken in the oversight of research conducted by ideologues. I would also prefer to see sponsors select qualified investigators with relevant experience in conducting clinical trials.

With mental health it can be trickier, as the treatment can consist of multiple components (MDMA + psychotherapy for example) and there is more of a subjective element. Scoring tests are of course used to try to quantify subjective mental health, but I think they are still far removed from objective measures like blood pressure, etc.

So in your case, I’d imagine there would be strong ethical issues (let alone your own concerns) with your going off medication in order to participate. I’m not really sure how the ethical issues are navigated in general for studies with depressed patients potentially receiving placebo and going downhill though. I’d imagine it’s a balancing act of respecting that you are treating real people with the fact that certain design factors are needed to ensure you are getting the most accurate results, with the implication that the more accurate the results, the better you will know how well future people can benefit (or not).

“Why are patients always being treated as an inanimate object with the only results respected being those that can be chemically measured?”

That’s not a fair characterization. Patients are not treated as inanimate objects, but as unreliable witnesses, subject to placebo effects and to misperceptions and misattributions of their experiences.

“expressed concern that publicity about the study might lead some people to self-medicate with ecstasy. PTSD patients should not use the drug on their own, Mithoefer said, because there are risks, such as elevated blood pressure and pulse. Also, ecstasy purchased on the street may not be pure MDMA — or even contain no MDMA at all.”

Yes! Don’t try this at home. – I was never into the recreational pills, but in my younger years I did witness some bad ecstasy experiences at social events that I would not put anyone with PTSD or anyone with a history of being sexually abused through.

On the other hand, a while ago I heard about some research that indicated that retelling of the traumatic experience while the patient was given medication that eliminated the stress response (I’m not sure what drug, maybe benzodiazepines) was beneficial to people with PTSD, while retelling the experience without stress reduction tended to be not beneficial. I don’t know how good the research was. I think I heard about it on RadioLab, which isn’t the most reliable source for medial research interpretation. If I get a chance I’ll look it up.

Anyway, right now the NIMH has an open and ongoing clinical trial on the effect “Special K” (ketamine) may have on major depressive episodes. The problem with these studies as I see it, and I speak as someone desperate for a breakthrough (I have bipolar disorder and have proved to be resistant to at least a dozen antidepressants and a half dozen more anti-psychotics), is the whole nature of a double blind study. I can’t offer myself up for the ketamine study for example, because in order to do the study I’d have to stop taking everything I’m on now. Mind you, I’m still depressed on the existing drugs, but I’m not suicidal like I was earlier in the year, and so to risk going off existing medications to try something new is to risk feeling like killing myself again. Even I’m not “crazy enough” to do that.

OTOH, medications for mental illness are inherently different from those for say, heart disease. A patient can’t tell you if a new statin is doing anything for her heart, but she *can* tell you if a new medication leaves her feeling less suicidal than she did before. Long-term effects can only be monitored by continued study, but I can say with absolute certainty for example, that within a week of first taking Prozac, I felt completely different than I had in my first 21 years of life. Unfortunately, I had to take higher and higher doses (there’s a lot of similarity between street drugs and psych meds) to get that effect, and eventually I had to try other things because it didn’t work at all, but short term, it was astonishing.

Why can’t a new type of study protocol be designed for these sorts of medications, whether they are for PTSD or depression or anxiety? A study that would recognize that double-blinding doesn’t work or is too dangerous and instead takes into account the patient’s on-going opinions instead of playing potentially fatal games by offering something-that-might-help-and-I-know-I’m-on-something and a placebo-that-can’t-help-and-I-can-feel-that-too? Why are patients always being treated as an inanimate object with the only results respected being those that can be chemically measured?

Then again I suppose I could just go with Richard Dawkins on this one and say that any child who was taught there was a hell was undoubtedly more damaged than a combat veteran.

As some of you probably know, MDMA did not start out as a party drug but was originally used by psychotherapists in treating anxiety and other problems before it was classed Schedule I.

I would quibble with the “originally.” My understanding is that Leo Zeff picked up on it (enthusiastically) as a therapeutic agent by way of Shulgin, whose use seems to have been frankly recreational at the outset.

As for the placebo issue, Oehen et al. appear to have used 25 mg + 12.5 mg booster at 2.5 hr versus a full dose of 125 mg + 62.5 mg booster at 2.5 hr. While I’ve never tried the stuff, I’ve read nothing to suggest that it’s “intensely psychoactive.” The effects are perhaps readily apparent to someone who specializes in dosing people with it, particularly given the all-day-long psychotherapy design, but I’m wondering whether some MDMA homologue at closer to full strength might have made more sense.

Alcohol has always been a form of self medication for PTSD – and it doesn’t work long term and has a multitude of very negative side effects. When I have worked with combat veterans, good old exposure therapy (without chronic use of benzodiazepines) seems most effective. I doubt that we will find a simple pill solution for a complex and multifaceted disorder like PTSD (as nice as that would be).

One way that the Vietnam conflict was different than the wars in Iraq and Afghanistan is the lack of drug testing in the Vietnam Era and (as I remember from news accounts at the time), very high availability of alcohol, opiates and marijuana in theater. Was that drug use self-medication? and did that prevent PTSD and suicide in Vietnam era active duty personnel and veterans?

PTSD from war trauma (of multiple different types) is likely to be different than PTSD from sexual assault. The time scale for their occurrence is very different. It is very likely that the time scale for their resolution would be different too.

I am concerned that in their zeal to “fix” the problem of military PTSD and suicide, that non-rigorous or “band-aid”-type “magic bullets” are going to get all the funding and that more science based research and treatments won’t be funded.