PTSD has been around for a long time, as humankind has grappled with the environment and other humans. But the experiences of the military in recent wars again bring it to the fore. And disasters like the Gulf oil spill remind us that PTSD can affect anyone. We take a brief look at post-traumatic stress disorder, as a form of memory not unlike an acid flashback, and new avenues of therapies, including the use of ecstacy (MDMA).
Transcript (edited):
CNS: Howard LaMere here with Dr. Darryl Inaba, and were talking about about posttraumatic stress disorder today. The VA just changed the rules regarding how posttraumatic stress disorder is classified, making it easier for veterans to be treated and receive compensation. Theres another story about the use of Ecstasy as part of the psychotherapy treatment for posttraumatic stress disorder. Another interesting PTSD story focuses on the symptoms, especially in the form of alcohol use, that are surfacing in the Gulf Coast as a result of the oil spill, and hurricane threats that bring on memories of Katrina.
DARRYL: PTSD has always been around and it is much easier to meet psychiatric criteria for PTSD if youre non-military; many people suffer from it for a variety of reasons. People who have been victims of trauma sexual abuse, kidnap victims, the kids in the Chowchilla kidnapping they were put in that little van and buried under the ground, now when they get into elevators they re-experience the trauma and the stress. Yet people at a dance I remember at one of the Hyatt Regency hotels the dance platform was poorly constructed that it dropped and several people were injured – many of those people re-experience that whenever they hear something creak. It is strange that our military, where probably the greatest amount of PTSD exists given the trauma that soldiers experience on a daily basis, uses more stringent criteria for diagnosing it than is imposed on the general population. Im glad President Obama changed the rules so soldiers and veterans can quickly be diagnosed and receive appropriate treatment for that condition.
PTSD, posttraumatic stress disorder is actually a form of memory, just like a flashback on LSD. Its a memory thats formed emotionally rather than classically. There are two ways in which memories are formed. The memories processed through the hippocampus are short-term, they remind you how to drive a car, or that you have a dentist appointment tomorrow. Memories of an emotional event, something thats tied to your emotions – forms a much deeper memory, a much more readily accessible memory a memory that comes back to the person 5 times faster than the hippocampus memory. Its an amygdala memory and it occurs with any kind of trauma, any kind of great emotional situation and interestingly enough, it plays a big part in addiction. We now know that relapse comes about from what we call environmental triggers, or environmental queuing occurs because the brain forms both withdrawal symptom memory and use memory as an emotional memory. And so any time an addict is reminded of their use of a drug or goes through withdrawal their mind is triggered by those memories from what we call memory spikes or memory bumps, but these protrusions on dendrites react a lot more rapidly and a lot more powerfully, recalling the use of drugs and creating a craving to use the drug.
CNS: Thats tied into the fight and flight mechanism.
DARRYL: Exactly. Its part of the old brain. Its part of the non-thinking, automatic, instinctive reactionary brain and that is why it is so powerful. Your response is much quicker than with regular memories. PTSD is hard to treat. But there is hope .pharmacopoeia, I guess you can call it – a whole bunch of different drugs are alleged to help people deal with posttraumatic stress. Sedatives even the cannabinoids . anti-seizure drugs anti-psychotic drugs, anti-depressants. A few years back we started to look at treating flashbacks or what we call environmental craving or triggered craving in addicts with the use of rapid eye movement counseling. While a person is reliving an experience in their mind, treatment helps them control their reaction so they can desensitize, slowly make that memory less important, so it isnt as easy to recall. This form of desensitization occurs while the patients eyes are moving rapidly, much the same as they would during a bad nightmare; it diffuses the stress created by experiencing the memory. There is a lot of movement in regression therapy, having people go back to that moment when the trauma happened, the main experience happened or a multitude or combination of experiences occurred and having them rapidly move their eyes back and forth as they discuss it that eye movement dissipates the stress they experienced from the event. Its kind of surprising that with all these advances, we still have people with posttraumatic stress. Theyve probably taken different medications at one time or another, theyve gotten counseling, regression therapies, rapid eye movement, desensitization, EMDR therapy and still they cant diminish the memory of that trauma.
CNS: That brings me to the question of the use of Ecstasy in this treatment. So talk a little about Ecstasy, MDMA. Originally developed as a psychiatric assist, I believe, but then it was subsequently banned.
DARRYL: Actually Ecstasy is being re-looked at in California at some universities and so forth. They are looking at the use of Ecstasy or methamphetamine MDMA as an adjunct to psychotherapy. It is empathic, it is a consciousness effective drug, a drug that is a methamphetamine derivative but it has a side chain a methylenedioxy side chain that makes it more of a calming stimulant if you will – sort of like a serotonin.
CNS: Seems kind of contradictory.
DARRYL: Seems contradictory, but remember we also use amphetamines to treat hyperactive children, so theres some compliments of how the drug works and where the drug works with the serotonin receptor sites and the norepinephrine receptor sites and the dopamine receptor sites that can have a calming effect. And Ecstasy with its side ring attached to the methamphetamine ring seems to meet that receptor site criterion where people feel much more aware, much more alert, and much more awake without the jitteriness or without the stimulation that usually occurs with the other stimulant drugs. And so it was being developed as an adjunct for depression, as an adjunct of psychotherapy when treating people reliving trauma and PTSD and things like that. It did get sidetracked because it was so abused, but theres still a lot of interest in it and a lot of work being done, used in conjunction with regression therapy…treating people living their trauma. When people are under the influence of Ecstasy, they dont experience the tremendous stress and tremendous pain and tremendous fear that they had during the original event, therefore they are able to go through remembering the experience and hopefully dissipate it. Dr. Anna Rose Childress at the Veterans Hospital of Philadelphia found success giving graded stimulation an addict who has been in recovery a few months to a few years can be stimulated to trigger a response. Dr. Childress mapped out the sensors – the heart measurer, the pulse measurer, EEG measurer, body temperature – she objectively worked it out on a scientific basis so she knows when a person is going to experience craving or a stress reaction and want their drug. When that occurs, she is able to intervene somehow. She does not let the addict leave the room so they cant go off and score the drug and slip and then come back, she holds them there. She uses different techniques to aid addicts dissipate feelings. She has documented this wonderful process called extinction. After 43 visits where the addict experiences increasing amounts of stimulus necessary to trigger their craving for a drug – the threshold of that stimulation has risen to a point that the addict does not experience the physiological reaction of craving. Well, the same thing is used with EMDR and other techniques . maybe Ecstasy is used in combination to help people with PTSD . to raise that threshold so when they are triggered, they wont experience the same reaction.
I remember trying to do this with phobias and fears and it took between 12 to 20 exposures for somebody who is say – very afraid of snakes first picking up pictures of snakes, and then holding up toy snakes, and then holding little worms and things like that until after about 12 visits of gradation and talking through the process or using some way to dissipate the stress, that person who was originally afraid of snakes was holding up a boa constrictor and not reacting. So there is promise. But you dont want to push your luck too far.
CNS: I wouldnt push it, no! Ok, interestingly enough and I just tossed you this right before we started here. But theres an anesthesiologist in Chicago, who applied to the Pentagon to use the drug, SGB, which is used to treat hot flashes in postmenopausal women, apparently an injection into the sympathetic nerve sequence in the neck accomplishes something similar.
DARRYL: Im not sure about that medication, but just the way in which it has to be administered is very invasive and very dangerous. If it is proven to be effective, the method if application would have to be precise because there certainly would be a lot of side effects and dangers. It probably would be a last resort, after a whole bunch of psychotherapies and other medications had been tired. I think the efficacy is around 20% in treating PTSD.
CNS: I think that was in the VA study because of the difficulty in being qualified for treatment.
DARRYL: Oh, that might be. I usually see just the opposite in classic psychotherapy treating people suffering from non-military related posttraumatic stress. Usually the efficacy is about 80 or more there is still that sub-segment of people who do not get relief from traditional treatment, so we need to continue to search for better ways of treating this condition.
CNS: In the VA context they were only seeing the most extreme cases, so that would account for the low number.
DARRYL: Im not sure how they arrived at that figure.
CNS: Well, Im sure we will hear more about this as time goes on because posttraumatic stress goes way back – in this country it goes back to revolutionary times and to settlers afraid of an Indian attack or to Revolutionary War. I mean, it just goes on.
DARRYL: Yes, its had different names but its always been around. I dont know if it has had as high a profile, but today it seems more prevalent. Maybe we are suffering in a more stressful age.
CNS: Just the way weve changed our lives.
DARRYL: it was called other names, war neurosis, flash backs and other names but as you say, I think if take a long look – its probably been around as far back as recorded history.
CNS: Well, interesting topic. If you have any comments, questions, wed love to hear them. Send us an email and well possibly address your topic in a future post.