Pubdate: Tue, 20 Nov 2012
Source: New York Times (NY)
Copyright: 2012 The New York Times Company
Author: Benedict Carey


Hundreds of Iraq and Afghanistan veterans with post-traumatic stress 
have recently contacted a husband-and-wife team who work in suburban 
South Carolina to seek help. Many are desperate, pleading for 
treatment and willing to travel to get it.

The soldiers have no interest in traditional talking cures or 
prescription drugs that have given them little relief. They are 
lining up to try an alternative: MDMA, better known as Ecstasy, a 
party drug that surfaced in the 1980s and '90s that can induce pulses 
of euphoria and a radiating affection. Government regulators 
criminalized the drug in 1985, placing it on a list of prohibited 
substances that includes heroin and LSD. But in recent years, 
regulators have licensed a small number of labs to produce MDMA for 
research purposes.

"I feel survivor's guilt, both for coming back from Iraq alive and 
now for having had a chance to do this therapy," said Anthony, a 
25-year-old living near Charleston, S.C., who asked that his last 
name not be used because of the stigma of taking the drug. "I'm a 
different person because of it."

In a paper posted online Tuesday by the Journal of 
Psychopharmacology, Michael and Ann Mithoefer, the husband-and-wife 
team offering the treatment - which combines psychotherapy with a 
dose of MDMA - write that they found 15 of 21 people who recovered 
from severe post-traumatic stress in the therapy in the early 2000s 
reported minor to virtually no symptoms today. Many said they have 
received other kinds of therapy since then, but not with MDMA.

The Mithoefers - he is a psychiatrist and she is a nurse - 
collaborated on the study with researchers at the Medical University 
of South Carolina and the nonprofit Multidisciplinary Association for 
Psychedelic Studies.

The patients in this group included mostly rape victims, and experts 
familiar with the work cautioned that it was preliminary, based on 
small numbers, and its applicability to war trauma entirely unknown. 
A spokeswoman for the Department of Defense said the military was not 
involved in any research of MDMA.

But given the scarcity of good treatments for post-traumatic stress, 
"there is a tremendous need to study novel medications," including 
MDMA, said Dr. John H. Krystal, chairman of psychiatry at the Yale 
School of Medicine.

The study is the first long-term test to suggest that psychiatrists' 
tentative interest in hallucinogens and other recreational drugs - 
which have been taboo since the 1960s - could pay off. And news that 
the Mithoefers are beginning to test the drug in veterans is out, in 
the military press and on veterans' blogs. "We've had more than 250 
vets call us," Dr. Mithoefer said. "There's a long waiting list, we 
wish we could enroll them all."

The couple, working with other researchers, will treat no more than 
24 veterans with the therapy, following Food and Drug Administration 
protocols for testing an experimental drug; MDMA is not approved for 
any medical uses.

A handful of similar experiments using MDMA, LSD or marijuana are now 
in the works in Switzerland, Israel and Britain, as well as in this 
country. Both military and civilian researchers are watching closely. 
So far, the research has been largely supported by nonprofit groups.

"When it comes to the health and well-being of those who serve, we 
should leave our politics at the door and not be afraid to follow the 
data," said Brig. Gen. Loree Sutton, a psychiatrist who recently 
retired from the Army. "There's now an evidence base for this MDMA 
therapy and a plausible story about what may be going on in the brain 
to account for the effects."

In interviews, two people who have had the therapy - one, Anthony, 
currently in the veterans study, and another who received the therapy 
independently - said that MDMA produced a mental sweet spot that 
allowed them to feel and talk about their trauma without being 
overwhelmed by it.

"It changed my perspective on the entire experience of working at 
ground zero," said Patrick, a 46-year-old living in San Francisco, 
who worked long hours in the rubble after the Sept. 11, 2001, attacks 
searching in vain for survivors, as desperate family members of the 
victims looked on, pleading for information. "At times I had this 
beautiful, peaceful feeling down in the pit, that I had a purpose, 
that I was doing what I needed to be doing. And I began in therapy to 
identify with that," rather than the guilt and sadness.

The Mithoefers administer the MDMA in two doses over one long therapy 
session, which comes after a series of weekly nondrug sessions to 
prepare. Three to five weeks later, they perform another 
drug-assisted session; and again, patients engage in 90-minute 
nondrug therapy before and after, once each week.

Most have found that their score on a standard measure of symptoms - 
general anxiety, hyperarousal, depression, nightmares - drops by 
about 75 percent. That is more than twice the relief experienced by 
people who get psychotherapy without MDMA, the Mithoefers said.

The couple works as a team, sitting with the patient for as long as 
the altered state lasts. "It's very much a nondirected therapy," Dr. 
Mithoefer said. "We're with them for 8 to 10 hours, usually, and we 
alternate between having them talk to us and having them focus on the 
trauma. Part of what we're trying to do is help the person stay with 
the memory even if it's difficult."

For many people, the experience in treatment is emotionally vivid, 
Dr. Mithoefer continued. The drug does not produce a "high," but it 
usually brings some tranquillity.

Studies of people taking MDMA suggest that the drug induces, among 
other things, the release of a hormone called oxytocin, which is 
thought to increase sensations of trust and affection. The drug also 
seems to tamp down activity in a brain region called the amygdala, 
which flares during fearful, threatening situations.

"The feeling I got was nothing at all for 45 minutes, then really bad 
anxiety, and I was fighting it at first," said Anthony, the Iraq 
veteran, who patrolled southwest of Baghdad in 2006 and 2007 amid 
relentless insurgent harassment and attacks with improvised explosive 
devices. "And then - I don't know how to put it, exactly - I felt 
O.K. and messed up at the same time. Clear. It was almost like I 
could go into any thought I wanted and fix it."For instance, he could 
think and talk about an attack that occurred in a town near Baghdad, 
in which Iraqis posing as allies - and who had been armed by the 
American military - turned their guns on American troops, killing 
several. The unit could not quickly evacuate its wounded because of 
weather conditions. Anthony's rage and grief were so overwhelming 
that he had to suppress them and did so for years.

"The military does a great job of turning you into a soldier, of 
teaching you how to control your reactions, and it is hard to turn 
those habits off," Anthony said.

He said he no longer struggled with post-traumatic anxiety or guilt, 
more than a year after undergoing the MDMA-assisted treatment. In the 
new report, the Mithoefers write that they found 80 percent of the 
patients treated in the early 2000s reported that much or all of the 
initial benefit they achieved on this standard test persisted a year 
to five years after the therapy ended.

If the results among veterans are anywhere near as powerful and 
lasting, researchers said, it is likely that the government would be 
willing to pay for a larger trial.

"That is really what we're aiming for, and we're doing it carefully," 
said Rick Doblin, the executive director of the Multidisciplinary 
Association for Psychedelic Studies, which financed the MDMA study. 
"After all this cultural turmoil, the split between the military and 
the psychedelic community, it would really be something if we could 
come together and use some of these drugs to help people."

This article has been revised to reflect the following correction:

Correction: November 20, 2012

An earlier version of this article described incorrectly the office 
arrangement the Mithoefers use to conduct therapy sessions using 
MDMA. They hold the sessions in an office in a converted house, but 
they do not conduct the sessions in their home office.
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