denBefore Dawn by Bisbiswas

 

The ketamine craze: Ketamine infusion therapy for depression & PTSD

Ketamine clinics for depression and PTSD are popping up like wildflowers, but is it a poison or a cure?

 

ketamine for depression, PTSD, anxiety

By Katalina Lourdes & Guy

 

Ketamine’s first recorded synthesis was back in 1956. It was approved for use in the US on humans and animals in 1970, and it became the most commonly administered battlefield anesthetic during the Vietnam War. However during the 1980s it emerged on the street and became popular within the rave party and gay scene as a drug to get high on.

Though not widely used recreationally in the US, over the past decade ketamine has become UK teenagers’ “drug of choice”. Maybe they’re self-medicating… but the consequences of ketamine addiction can be serious. (You can read about the recreational or dark side of ketamine in Guy’s essay, at the end of this article. With over 20 years of street experience, I advise that you read what he has to say before going out and buying or trying street ketamine.)

2020 saw ketamine hit the headlines again as a successful treatment within clinics for patients suffering from treatment resistant depression.

Is ketamine really a psychedelic? Coined by Humphry Osmond (a British psychiatrist who gave Aldous Huxley his first dose of mescaline in LA in 1953, inspiring him to pen The Doors of Perception) the word psychedelic means “soul-revealing”, or “mind-manifesting” in Greek. Those words could certainly be used to describe Huxley’s essay. Many ketamine users would say “soul-revealing” is also descriptive of their experiences.

Ketamine is also a horse tranquilizer. It’s sometimes called a “dissociative” psychedelic hinting at a sense of disconnection, often from others, their environs, or users’ own bodies—but who knows? Perhaps they’re connected to something else. So the trip is quite different from something like mescaline or LSD, yet as with classic psychedelics like LSD, psilocybin, or ayahuasca,ketamine infusion therapy has shown promise as a treatment for depression, PTSD, OCD, anxiety, and even addiction.

Unfortunately ketamine is a lot more dangerous, and not nearly as effective as our beloved tryptamines (LSD, psilocybin, & DMT – including its derivatives & analogs & of course ayahuasca, the magical Amazonian brew). While ketamine may almost instantly resolve treatment-resistant depression, and even suicidality – which is undeniably a good thing – the relief may only last a week.

Ketamine treatment usually involves multiple infusions, and are often combined with psychotherapy. Ketamine infusion therapy that includes psychotherapy tends to be more successful. Still, in some cases a patient may need to get weekly or monthly infusions for years. So, while ketamine is a very effective short-term depression treatment, it’s not exactly a cure. As with other psychedelics, the trick might be to change your depressive habits – including your habits of thought – in the immediate aftermath, while your brain is still maleable from the experience.

It’s worth noting that a few magic mushroom and ayahuasca trips will trigger longer-term neuroplastic changes, accompanied by deep insights and lifestyle changes that can dispell depression for years.

(Clearly, we’re advocating that you give tryptamines a try before you get yourself in a k-hole. However if you still want to know more about ketamine – how it works and about its potential to treat depression, anxiety, addiction, & OCD, read on.)

 

Ketamine poison or remedyMoonlight Circus by BisBiswas

 

The ketamine market

 

Despite its risk of abuse, because of its anesthetic and pain-relieving applications, ketamine is a Schedule 3 substance in the US, as opposed to Schedule 1 like magic mushrooms, LSD, or MDMA. That makes it a lot easier to conduct research on ketamine, and means doctors can use it off label.

So ketamine clinics have been proliferating across the US (and now also the UK) and news of it as a panacea is still lighting up the marquees. Of course it will cost you a pretty penny. Since the treatment is experimental and not approved by the FDA, it’s not covered by insurance.

But the ketamine itself is cheap for the clinics. At just 0.1 – .5mg/kg per infusion, generic, medical grade ketamine costs doctors less than a dollar per patient, but of course, they charge you around $400 for the visit. Don’t worry, you can get a discount by buying a package (get eight shots in two months for the low price of $3,000!).

 

“As if the medical industry needed a boon,” I mumble through my depressed fog as I walk across town to the clinic to start a new round of ketamine infusions for $400/pop. My brain lost its plasticity, became rigid again this month after learning that my mother is facing bankruptcy as a result of medical debt. The house will be foreclosed on, and my thoughts are darkened with the certainty that I will never have my own home, and will be forever a victim of the rental market, paying my own and my mother’s rent to BlackRock til the day we die. I better work harder so I don’t lose my job, I think. After the ketamine shot, everything will be okay. For a week or so.

 

Most clinics offer ketamine in conjunction with therapy, but of course that’s extra. Many also offer ketamine infusions as a standalone treatment. The company MindBloom has quickly become a chain, and claims to be making ketamine infusion therapy as affordable as a visit to the psychiatrist.

MindBloom began offering ketamine treatment as telemedicine during the pandemic – sending packages of ketamine through the mail. I suppose the patients insufflated their powdery parcel as they connected with a nurse over Zoom. What could go wrong?

The startup was recently accused of negligence. Apparently it paid for its “low prices” by cutting and underpaying staff, and didn’t have enough trained therapists to ensure positive outcomes, among other oversights.

Still, if you’re going to use ketamine, any clinic should be safer than street ketamine, because the risk of addiction if you’re using it regularly on your own is high.

 

What is ketamine like?

Mentally it’s not for the faint hearted; it’s a powerful tranquilizer and the trip is intense, introspective and psychedelic. As a street drug, ketamine can be quite moreish on a low dose so it’s very easy to go over on the second line… and then you may end up in a “K-hole”, coming around a few hours later with no memory of what happened.

The comedown is spacey and empty, leaving you feeling a bit down.

 

Ketamine therapy for depression

 

We’ve known for at least 20 years that ketamine relieves depression. Since then, several studies have found ketamine therapy to reduce depressive symptoms in patients with treatment resistant depression, or those who have failed to respond to traditional antidepressants. 

Ketamine is also promising for those at risk of suicide; it has been found to significantly lower suicide ideation.

Ketamine is also fast-acting – most patients experience near total relief of depressive symptoms within one to 24 hours of treatment. On the down side, the antidepressant effects of ketamine typically wear off within one week to one month, so it’s not a cure.

It seems that as a long-term treatment, patients need to receive injections weekly or monthly, though by combining ketamine infusions with psychotherapy their effects may last longer.

 

Ketamine infusion therapy for PTSD

 

People who have been through a traumatic event, or repeated or chronic events, can develop PTSD or chronic C-PTSD. Common symptoms include depression, flashbacks, anxiety or panic, and nightmares. However PTSD can also manifest in difficulty concentrating, cognitive impairments, loss of interest and detachment, emotional dysregulation, and reckless behavior. 

Since these symptoms are also common in those suffering from neural lesions or traumatic brain injury, a group of researchers theorized that PTSD may also be caused by a lack of synaptic connectivity.

They write:

“It is well established that chronic stress causes neural atrophy and decreases the number of synapses within cortical and limbic circuits implicated in the regulation of mood, cognition, and behavior. Glutamate synapses are the dominant form of synaptic connectivity in these circuits.”

 

So they hypothesized that ketamine could treat PTSD based on how it is thought to treat depression – building the strength of synapses by increasing brain-derived neurotrophic factor (BDNF), the number of AMPA receptors, and the number and strength of dendrites, the branches at the receiving ends of neurons.

Now that theory is being tested. A study just published in the American Journal of Psychiatry found that a two-week course of six ketamine infusions significantly improved symptoms of PTSD, and the effects lasted for nearly a month. Research on humans is still limited, but at least one other study has found similar results. More research has been done on rats, suggesting that ketamine can help us forget bad memories.

 

Ketamine and OCD

 

Since glutamate is thought to play a central role in the obsessive thought patterns characteristic of OCD, ketamine has been investigated as a possible treatment. A 2013 study found that treatment with ketamine had rapid and stable results, reducing symptoms of OCD in half of participants for at least one week.

 

Ketamine and addiction

 

Ketamine is itself addictive, so it seems an unlikely candidate to treat addiction. However a study from 2019 found that one ketamine treatment plus five weeks of mindfulness-based therapy resolved cocaine addiction in 44% of participants for at least six months, while all of those who received only the therapy (the control group) continued using.

 

Ketamine for anxiety

 

Though the effects aren’t as pronounced as they are for depression, a few studies have also found ketamine to be somewhat effective in treating anxiety. In one study, ketamine was found to reduce social anxiety but not generalized anxiety compared to placebo.

Generally ketamine is a sedative, however another study found that experiencing anxiety during ketamine infusions for depression was associated with poor outcomes. So the first word of advice to those seeking ketamine treatment for depression might be: relax. Let the experience wash over you.

A second word of advice? If you’re having ketamine treatment, take magnesium supplements along with it. Ketamine and magnesium are thought to work in similar ways , and a recent study found that supplementation with magnesium enhances ketamine’s antidepressant effects.

 

How does ketamine work?

 

As the main excitatory neurotransmitter in the brain, glutamate binds primarily to NMDA receptors. We need glutamate and NMDA receptors, because they are the main pathway for all learning and memory – but if your memories and learned habits are negative or unhealthy, your existing pathways, or thoughts, may need to be temporarily forgotten, those neural circuits weakened or broken.

Moreover, overactivation or “excitability” of NMDA receptors is implicated in chronic stress and anxiety, and can weaken neurons and cause cell death. The result is neural atrophy, a loss of neuroplasticity, and depression.

As an NMDA antagonist, ketamine temporarily blocks glutamate from binding with NMDA receptors, preventing activation of downstream neurons – interrupting, and causing us to temporarily forget those depressive thoughts.

Is having a break from all that we know what allows our brain to reconfigure itself after a ketamine experience? Momentarily forgetting the bad, are we then able to make new connections and create space for more positive thoughts?

Or is it that ketamine enhances neuroplasticity?

Or could it be both?

Neuroplasticity – something lacking in depressed subjects – is the prevailing theory. The blockage of NMDA receptors sets off a series of chemical processes that increase levels BDNF in the brain, a key protein for the growth of new neurons. BDNF levels are stunted in depressed subjects. People with depression also have more glutamate in the brain than healthy subjects, and their NMDA receptors are overactivated.

A healthy brain is plastic. That is to say, its dendrites are strong, with plenty of dendritic spines. Its synapses are dense, making it easier for neurons to connect. BDNF also supports the growth of new neurons.

By increasing BDNF levels, ketamine stimulates deteriorated parts of the brain to grow. The resulting neuroplasticity helps us to learn and form new thoughts.

Blocking NMDA receptors also causes glutamate to activate more AMPA receptors, the other main glutamatergic receptor. In situations of chronic stress, AMPA receptors are underactive and there are fewer of them at synapses. However AMPA receptors are key to synaptic plasticity; they stimulate short-term and long-term potentiation, or the creation of new neural pathways.

ketamine and depression
A healthy synapse versus one under chronic stress, as in when NMDA receptors are overactivated

Neuroscientists believe ketamine’s antidepressant effect to be achieved by both increasing the number of AMPA receptors and by stimulating BDNF in the brain, fostering the growth of new neurons and dendrites, and strengthening synapses. All of this increases neuroplasticity, or how healthy and flexible our brains are, which is thought to play a key role in the antidepressant effects of all psychedelics. 

This is a general overview; the exact mechanism by which ketamine relieves depression is still being investigated.

A recent study discovered that the antidepressant effects of ketamine may be through one of its metabolites, hydroxynorketamine.

Serotonin may also play a role. A 2020 study found that ketamine treatment increased binding with serotonin 1B receptors in the hippocampus of depressed patients.

 

 

 

city budget cuts and mental health services

  

Accessing treatment in a deteriorating system

 

By Angel V.

I was diagnosed with Borderline Personality Disorder about six months ago. Before that I’d had a diagnosis of bipolar one, a severe form of bipolar where rapid cycling and suicidal ideation are particularly common. Borderline personality disorder, or BPD, makes it difficult for someone to control and regulate their emotions, affecting interpersonal relationships, basic day to day functioning, and employment.

Finding treatment and therapy for both of these diagnoses is difficult. Even under the best of circumstances.

Before covid, my options were limited. Most people choose to go on a waitlist and wait for the type of therapy that is known to work best with borderline personality disorder, Dialectical Behavior Therapy, to become available. This type of therapy works best in a group setting and takes the form of a course wherein a person is taught better coping mechanisms, based on a practice of mindfulness.

I’ve been waitlisted for almost a year now.

Covid made treatments like this near impossible. People can meet in Zoom chat rooms, but scheduling can be difficult. And it requires a full group doing the full 6 to 12 week program in order to work.

 

mental health budget cuts

 

Cutting mental health budgets, militarizing the police

Part of the problem lies with state funding. Without people who are experienced in this type of treatment, who can facilitate the group, the number of groups that are available dwindles.

Funding for programs in Chicago and throughout Illinois was cut years ago.

Under Republican Governor Bruce Rauner, the state decided to allow mental health services to receive little or no funding during sweeping budget cuts. True to form, it was the most at need that received the least assistance under the new budget.

Psychiatric care for many programs were reduced drastically or eliminated completely as a result. In Chicago, a city of over eight million people, these budget cuts, and the reduction in services that they cause, have had deep and lasting effects.

Under Democratic Mayor Rahm Emanuel, many of the city’s major providers were shuttered because of lack of funding. Unsurprisingly, the first providers to go were the ones in predominantly Black and Latino neighborhoods.

The money that should be going to mental health services and clinics is going instead toward policing and prisons.

The 2021 budget allocates nearly $1.7 billion dollars toward police spending. This is nearly 40% of the corporate fund, the largest of funds of the city’s spending plan.

As seen during the Black Lives Matter Protests, the city’s police force is better equipped than some military forces. In addition to full riot gear, tear gas, batons, rubber bullets, police have availed themselves the use of the Long Range Acoustic Device, or LRAD, a sonic weapon intended to disperse protesters using an ear splitting deterrent tone, capable of causing permanent hearing damage. Use and operation of these weapons is not cheap. Spending suggests the city would rather deal with the problems that having an unhealthy population cause then preventing the problems by providing services.

 

A history of cuts to mental health services

Cutting health services is a hallmark of Republican budget strategies: As soon as he took office as governor of California, Reagan decided to slash funding for health services. The number of people suffering from mental health issues in the prison system effectively doubled as a direct result of this action.

Private board and care facility operators capitalized on former patients who needed assistance. There was money to be made providing spaces and services for the mentally ill. Those who didn’t end up in prison ended up in one of these facilities, or eventually on the street if their symptoms were severe enough and they were not receiving proper treatment and medication.

Later as president, Reagan decided to cut funding for health services again, reducing federal spending for mental health and pushing the responsibility for funding services onto the states.

This fiscal strategy of intentional neglect continues today. As recent as last year, 45’s proposed budget for 2021 included $2.9 billion in cuts to the National Institute of Health and another $708 million to the CDC, this during a pandemic.

In January, the senate overrode a veto to pass a $740 billion defense budget while denying us our $2,000 survival checks. The Democrats still haven’t delivered.

National policy affects people who are suffering from mental illness personally.

Shortly after I was diagnosed with bipolar one, I was prescribed lithium to help with manic episodes and to regulate depressive cycles. I was on lithium for a year before switching to depakote after finding out lithium can damage the liver and kidneys.

Under the Affordable Care Act, also known as Obamacare, I qualify for Medicaid.

Without insurance, I would be paying hundreds of dollars for my medication. 

Even with medication, day to day functioning is a challenge. Trying to explain the necessity of taking medication to someone who doesn’t struggle with mental health issues is difficult and adds to the challenges that neurodivergent people face.

I am in constant fear of losing my insurance because of a change in the administration.

 

Change is possible: cities making progress

Forward-thinking cities have taken matters into their own hands. In 2018, Denver residents passed a measure that would allow for a .25% tax increase that earmarked funds for mental health treatment. Among a rash of suicides and overdoses, Denver wanted to see its citizens receive access to better mental health services. 

Other parts of the country have taken similar steps with positive results. In 2008, King County Washington saw a .1% increase in funding for behavioral health services. Within three years, they witnessed a drop in psychiatric hospital admissions of 29%, with a 35% drop in jail bookings.

The major problem with programs like this is how people access them. A lack of standards means that people might have trouble finding them, and without regulation there is a good chance that those most in need will slip through the cracks.

In Chicago, this has been a big part of the problem as well as limited services. People who are computer literate and who understand how to navigate bureaucratic systems are still left daunted by a confusing and complicated, time consuming, frustrating system.

For those who do not have the time, patience, and wherewithal, it’s easier to find other ways of coping with mental health issues.

 

 

volunteer at an animal shelter

 

10 fun things to do if you’re depressed

By Cane Kelly

 

The past year has driven most of us to live like angry tigers pacing tiny cages. Isolation isn’t natural and has serious side effects, but one can also cultivate a healthy solitude. Knowing yourself isn’t an easy process and it’s easy to get intimidated by the outside world and its standards and materialistic focus.

This article is for anyone. Even if you have a partner, invest in yourself. Trying new things alone is key to keeping your independence and understanding emotions as they pop up in your life. We learn through new experiences, and this helps to keep our brain young and happy. Living with purpose and open-mindedness makes life a lot more interesting than following someone else’s lead. 

If your’re depressed, try dating yourself. Dating yourself is fun. There’s no compromising – you get to choose what you do. It’s healthy for people in relationships too. Being in the constant company of your partner can be overwhelming and creates a dependence that’s bad for your mental health. 

Before I got married, I spent a lot of time by myself. I made continual efforts to entertain myself and explore who I am. I still date myself. Covid-19 changed my normal patterns. I try to visit a new place alone a few times a year. I haven’t been anywhere this year, and I’ve got a bad case of cabin fever.

 

traveling alone

 

While I’m eager to explore places like Romania and Greece, we have to be careful because the crisis isn’t over yet. A few of these suggestions require a little investment but rediscovering and reconnecting with yourself is worth every cent.

 

Go to the movies alone

This seems like a no–brainer. People watch television by themselves all the time but taking a weekday trip to the movies is fun. Most people don’t show up for the first showing of any film. Some theaters won’t care if you slip into a second movie if you buy concessions. I’ve spent entire days lost watching movies. 

go to the movies alone

 

Learn how to bake

I have mixed feelings about baking because it is technical. The quality of your tools, like measuring cups, scales, and other items will determine how well your efforts turn out. I’ve made some real stinkers because I wasn’t precise with the measurements.

A few years ago, I tried to make Red Velvet Cup Cakes, but I was sloppy with the chemistry and they turned out as dense as baseballs. My poor husband ate one with a smile on his face. That’s true love.

learn to bake

 

Meet a new city alone

I must admit traveling alone is my favorite thing in the whole world. You may want to wait a little while as the pandemic finally comes to an end but exploring a new place – even the next town closest to you might have something unexpected to find. The United States is an enormous place with people as different as Europe. It takes an estimated 40 hours of driving to get from one coast to the other. The drive is scenic particularly if you skip the big highways and take the smaller roads. Don’t freak out if you get lost. That is part of the adventure.

visit a city on your own

 

Check out your local cemetary

I’m from Lexington, Kentucky and our city cemetery is the most beautiful part of the entire city. There are mean ducks that might try to run you off if you get too close to the water or forget to bring grapes or other types of fruit. Bread is bad for ducks and other wildlife. I love cemeteries and I make visiting these monuments to past generations a priority when I visit a new city.

 

Volunteer 

There are endless opportunities to help others. The United States has a serious issue with homeless cats and dogs. Thousands are put to sleep every week because they aren’t enough homes for them all. Digging in and helping an animal rescue will make you feel good about yourself and you will be helping creatures that could die without you.

If helping animals isn’t your thing, then volunteer at a homeless shelter or any number of organizations that desperately need your help. From spending quality time with kids to digging in and helping feed those who sleep on the streets, there are endless opportunities to help out and you get a big dose of serotonin for your efforts.

 

Take yourself out to dinner

You might have to sit at the bar if the restaurant is full, but most bartenders are excellent listeners and offer advice and understanding. Alternatively, bringing a novel to dig your teeth into as you try a flight of beer or wines is a great way to spend an evening. You end up making new friends or at the very least hear some juicy details about someone else and their experience. You might feel a little uncomfortable at first but try to embrace the discomfort and watch and adventure unfold as you try something new.

 

Go to an aquarium

You must check out the ratings for any animal attraction. Don’t spend your hard-earned money on places that mistreat any creature. Ethical animal attractions might cost more than their less reputable counterparts, but do you want to see dolphins in tiny takes living like prisoners? No. Do your research before visiting any animal attraction.

 

Learn to grow veggies from table scraps

As the climate crisis rages forward it is crucial to embrace a circular economy. Green onions, potatoes, leeks, and herbs are foods you can grow on a window ledge. All you need to do for potatoes has cut them in half after they have grown a few eyes. Cut them in half and deposit them in deep soil. You will have potatoes by winter!

This is easy and quick to do, but if you have more time on your hands, you can start a larger veggie garden. Gardening reduces stress and negative emotions, it gives you a sense of responsibility and you get to nurture something and see it grow and thrive.

gardening with table scraps

 

Treat yourself to a spa day (or organize one at home)

A spa day is a luxury and if you do a little internet digging you might be able to grab a deal that makes the treatment more affordable. Or you could plan a spa day at home. A bath bomb, essential oil, bath salts, and a few candles and a pumice stone can change your bathroom from an ordinary experience into something truly relaxing, and you can add a face mask or even mix brown sugar and coconut oil for a more natural approach to getting a glow to your skin.

Take your time and pay attention to your feet. A proper foot rub is an easy way to improve your health and help you sleep. Magnesium flakes also can offer an extra element making bedtime a breeze. Magnesium is best absorbed through the skin which means if you have a deficiency, this is a great way to resolve the issue.

Get naked, paint your toenails, do yoga. Go crazy taking care of yourself. A full day dedicated to relaxation is a great way to get in touch with yourself and renew your mind and body.

 

 

Go to a show or a musical performance

Did you know you are more likely to make new friends and acquaintances when you’re all by yourself? Don’t be afraid to push to the front of the crowd and dance your pants off. This is another exhilarating situation, particularly if you are passionate about the music or play you are watching!

take yourself out

 

Bonus tip! Take a long walk!

Self reflection should shadow selfies. Understanding yourself and your emotions can be a complex issue to tackle and take hours or days to process. Being human is hard! Taking time to  breathe and think. If people made it common practice to be careful with their words and intentions even when speaking to themselves is becoming a focus throughout many health and wellness experts. 

Compassion for others is important, but compassion for yourself is more crucial than anything you can do for others because if you’re bullying yourself, then you need to readjust and pull that focus of care on you’re on well-being.

take a walk

  

 

 

how to stay healthy in the pandemic

 

How to be happy during the pandemic

By Lea

 

How can we stay mentally healthy during the pandemic? Better yet, how can we stay healthy with terrible pandemic management?

The healthiest thing I’ve done is stop watching the news, because it’s just bad news and viral boredom.

If there’s a good thing to be found in the pandemic, it’s that it’s exposing the insanity of our human society.

As technology advances, humanity regresses.

It seems that rather than stopping the pandemic, they want to keep it around, with vaccine shortages and spoiled vaccines. Here in Portugal, there are restrictions that don’t make sense and don’t seem to work, but they keep them in place anyways.

Why? Well… the measures don’t stop the virus, but they do kill small businesses. They don’t stop the virus, but end up causing more diseases. 

This is because health is not only physical, it is also economic, social, emotional, relational, spiritual, creative, and psychological. It is the balance of all these aspects of a human being.

This apparent disorganized handling of the pandemic makes me think of what Muadmar Gaddafi said in his 2009 speech at the UN:

Capitalist companies produce viruses so that they can generate and sell vaccinations. That is very shameful and poor ethics. Vaccinations and medicine should not be sold.”

Does anyone really win here? Yes, billionaires have added trillions of dollars to their pockets, however finding a “winner” now is like finding a winner in wars. Everyone is harmed, just some more than others.

We can find different theories to explain what is behind the virus, because although it has long ceased to seem like it, humans are rational beings. We simply cannot go against our nature, we need to give explanations, whether they are correct or not.

Below are some tips – based on what I’ve personally learned in my life – for how to be happy during the pandemic.

First, I want to emphasize that we cannot speak of our mind as something separate; it is linked to a physical, emotional, and social body. Therefore, if we want to speak of mental health, we must speak of health in all these areas.

We could say that our emotions have gone through an earthquake. Yes, the floor has moved, and now we have to relocate internally and externally.

A sense of humor

how to stay happy during a pandemic

Despite this upheaval, if we want to preserve our mental health, a sense of humor is an antidote to losing it. How can we maintain a sense of humor? By not letting ourselves be bombarded by the news, for one.

Create

By the way,  how is it possible that the same three or four news items pass through the 24 hour news cycle on repeat?

The world has eight billion people, and we are by nature creative. Are we losing our nature? If so, what are we, or what are we becoming?

Break some rules

Another antidote is to join the circus breaking some – just some – of the rules to survive. Because if you’re wondering if mental health is possible in over a year of confinement, the answer is no, of course it’s not! Humans are social beings. Contact with others is a necessity even for the least sociable among us. If we lose it, our balance falters.

 

Exercise

Another tip for emotional health, valid at any time, is physical exercise, and this is much better outdoors. I say this from experience, and it’s scientifically proven.

Eat more fruits and vegetables

Another good piece of advice – which no one has asked me but I’m sure you’ll gladly accept if you try it out – is a good diet. By this I mean less flour and sugar and more fruits and vegetables. Where else can you get vitamins and minerals? It’s the fuel for this vehicle called the body.
If you put the best fuel in your car, please remember to do it with your physical body; your emotional and mental body will also thank you.

Start practicing meditation

how to be happy in a pandemicIt’s a good time to practice meditation. We have time, since most of us don’t have to commute to work right now. You don’t need that much time, anyways. At first five minutes a day will be more than enough, and as you advance in the practice, you’ll be able to add minutes. (By this I mean: take advantage of starting to do it now, since many of us don’t know what to do with so much time at home. But don’t stop doing it when the pandemic ends.)

This is something that helps our psychic health, because it’s an important activity for our internal or spiritual world, which we have long forgotten, at least in the West.

Learn something new

Is there anything that you’ve thought about for a long time but never found out how to do? The internet can help you in that search, especially in the pandemic, since we spend so much time at home.

Think positively

Another tip to fight the pandemic and get away with it is to be attentive to our thoughts.

Careful! Depression begins with a sustained use of inappropriate or negative thoughts. Those thoughts are like opening a window in the daytime and seeing only darkness. So, also take care of the thoughts that feed your being. Thoughts can allow or give rise to certain sensations and feelings, this is another reason to choose them consciously.

Get into nature, and nurture your imagination

What happens when we stay indoors without giving ourselves the opportunity to be in open spaces, such as the mountains, the countryside, or the beach?

This absence of distant horizons leads us -if we are not aware- to the absence of distant goals. We stop dreaming, and dreaming is what gives us life or at least, the desire to live and continue.

So what we cannot do physically, let’s at least close our eyes and make it real in our imagination, because everything we do has to pass through our mind beforehand. Even what we say “arises”; it arose because you were open for that to arise.

 

 

 

mdma as a cure for ptsd

 

MDMA-assisted psychotherapy & PTSD: Revising our pasts

 

By Katalina Lourdes

 

MDMA, or ecstasy, is what you take before you go clubbing, right? Or, during your therapy session – which it looks like we may all need after Covid. And by then MDMA-assisted psychotherapy may actually be available.

MDMA isn’t a classic psychedelic like LSD. It doesn’t exactly alter your reality (though it might be able to change your past). The drug, which makes you feel happier, confident, and more empathetic, was synthesized in 1912, but wasn’t used until the 1970s, when it enjoyed a brief therapeutic career. In the 1980s it was sold on the street as a party drug, and was swiftly criminalized in 1985.

On the street, ecstasy is seldom pure MDMA; it’s usually cut with other drugs like amphetamine. It’s true that it’s not as harmless as classic psychedelics like LSD or psilocybin, and overdose or heavy, long-term use can have serious consequences. Its use at raves have earned it a negative reputation in the press, but pure MDMA – when used sparingly – is relatively safe, and less addictive than most illicit drugs.

Anyways, now that psychedelics are becoming more acceptable, the media is changing its mind and shedding light on MDMA’s seemingly magical powers to alleviate – if not cure – PTSD. And these days, there’s more trauma than ever.

The more we talk about PTSD, the more it shows up. One could even say we live in a traumatized society. Around 10% of people in the US are estimated to have PTSD at some point in their lives, and about 3.5% of the population in any given year. But those are the official estimates.

PTSD as a diagnosis was created to describe the symptoms of Vietnam War veterans. However we’re now learning that not only war, but everything from bullying, to living in poverty, to racism, to having Covid can cause PTSD. It’s also common in first responders like paramedics, who have to witness traumatic events on a daily basis. Whether or not we catch the “disease” depends less on the objective event as it does on the person, how they experience it, and the support they receive immediately afterwards.

Oppressed groups such as racial minorities and people in poverty are more likely to experience long-term stress and traumatic events. And those who don’t know they have PTSD are at greater risk of being retraumatized. This can lead to its new, stronger variant, C-PTSD (trauma is also mutating).

The only currently approved treatments for PTSD are SSRIs and psychotherapy, in particular exposure therapy. In exposure therapy, the patient recalls the traumatic event(s) in safe contexts over time. This is supposed to promote “fear extinction”, or an unlearning of the fear response. It turns out patients don’t tend to like remembering their traumas over and over again, and it has high dropout rates. Neither antidepressants nor exposure therapy are very effective in treating PTSD, with only around half of patients responding.

MAPS, an organization founded in 1986 to promote the research of psychedelics, has been at the forefront of MDMA research. MAPS decided early on to focus on MDMA because it’s the drug that best lends itself to therapy, and it had the potential to treat PTSD, which has no strong treatment alternatives. They’ve been trying to conduct research with veterans since 1990, with no luck because of the stigma, despite the huge need; over one million veterans are on disability for PTSD.

“The real motivation, why I’ve kept going for so long, is that humanity as a whole is, I would say, massively mentally ill,” said MAPS founder Rick Doblin in an interview.

 

Towards an understanding of PTSD

More people with anxiety, depression, and even addictions are realizing that these problems are often rooted in trauma. This was the approach of early psychoanalysts, that psychological problems sprang from childhood trauma (though people like Freud created weird theories around it, like “this person is anal retentive because they experienced a trauma during the very scientific phase of potty training”).

Behavioral psychology and medical explanations have dominated since the mid-20th century, because it’s more profitable to treat human beings like lab rats than traumatized subjects. Acknowledging the sources of trauma would also mean addressing the deep inequities in our society. However the popularity of people like the doctor Gabor Maté, who says that all addiction is rooted in trauma, has helped bring trauma theory back.

And now that we now know a lot more about the brain, there’s some biological understanding of how PTSD works (and MDMA, too).

PTSD changes our brain structure. As we revisit the memory or it’s cued in our environment by a “trigger”, our bodies secrete stress hormones like adrenaline and cortisol to respond to the threat, and our bodies reactivate the fight, flight, freeze, or fawn response. Our hippocampus measures and regulates cortisol, but too much wears it down, and so it shrinks. Meanwhile, cortisol continues to signal the fear center of the brain, the amygdala, which grows as we maintain a state of hypervigilance. The pre-frontal cortex, which is responsible for thinking and can rationally tell your amygdala to calm down, also shrinks as the amygdala grows. So people with PTSD have a smaller pre-frontal cortex and hippocampus, which translates to deficits in thinking, learning, and memory, and a larger amygdala, making them more sensitive to fear. 

Of course this hypervigilant state was meant to respond to real threats in our environment, but PTSD is usually maladaptive, playing traumatic memories or their reminders and fear responses on loop.

It’s worth noting that memories aren’t only visual. As a study of traumatic experience notes:

“Episodic memory can present itself in parts… [it] might appear as an inner vision, a sound, or just a hint – a brief sensation in the belly or a strong pain in the chest.”

 

MDMA-assisted therapy offers hope

“We know from brain scans of PTSD patients that PTSD changes people’s brains, and MDMA can change it back in almost the exact same way,” said Doblin. 

“So, where PTSD increases activity in the amygdala (the fear processing part of the brain), MDMA decreases activity in the amygdala. PTSD decreases activity in the prefrontal cortex (where we think logically), MDMA increases activity in the prefrontal cortex. PTSD makes people feel isolated, alone, mistrustful, but MDMA builds trust and connection.”

MDMA increases the availability of the neurotransmitters serotonin, norepinephrine, and dopamine, while releasing hormones including oxytocin, cortisol, prolactin, and vasopressin.

This neurobiological cocktail puts subjects in an ideal therapeutic state. It provokes a sense of peace and safety, makes them more introspective and open, and more trusting in their relationship with their therapists.

And in combination with psychotherapy, it appears that MDMA heals trauma in about two-thirds of cases.

It wasn’t with veterans, but MAPS was finally able to conduct their first study in 2008. It was such a success that the FDA granted MDMA-assisted psychotherapy Breakthrough Therapy Designation in 2017, fast-tracking the research. 

In 2020, MAPS aggregated the follow-up data for six phase 2 trials of MDMA-assisted psychotherapy. All of the trials were conducted similarly, with participants undergoing eight psychotherapy sessions, two of which lasted eight hours and involved MDMA. 

At treatment exit, 56% of participants no longer met the criteria for PTSD. However in the one year follow-up this number had increased, and 67% of participants no longer met the criteria, while over 90% had a clinically significant reduction in symptoms. These are magical numbers. A follow up of an older study is even more promising, suggesting that the benefits of MDMA treatment for PTSD canlast at least 3.5 years.

MDMA-assisted psychotherapy for PTSD is now in phase 3 trials, which are expected to be completed in 2022, and the therapy could be approved by the FDA as soon as 2023.

In case the government wasn’t sold on the benefits, MAPS produced a separate study estimating that making MDMA-assisted psychotherapy available to just 1,000 patients with PTSD would reduce general and mental health care costs by $103.2 million over 30 years. So for a million veterans, it would save $103.2 billion.

 

Positively changing our memories

MDMA & PTSD

MDMA-assisted psychotherapy is thought to treat PTSD through memory reconsolidation. It increases the connectivity between the hippocampus and amygdala, which may indicate a heightened capacity to emotionally process fear-related memories.

It turns out that when we recall memories, they become malleable. There’s a small window in which they “reconsolidate”, and we can modify and update them. The events themselves may not change, but the way we remember them, and especially the feelings we have associated with them, do.

We do this all the time. For example if you once looked back on a fun experience with a partner fondly, but then found out that partner cheated on you, you might remember that same experience differently – perhaps with sadness, anger, or a sense of betrayal.

When we recall trauma memories and our adrenal receptors in the amygdala are activated, those memories are reinforced from a place of fear. Continually recalling the same memories with the same emotions may be what underlies the long-term nature of PTSD.

MDMA therapy is like the opposite of that. The key is reconsolidating memories in a positive state. First you enter a safe, happy state of mind, and only then do you recall memories with your therapist, process them, and reconsolidate them.

MDMA allows us to visit the ghosts from our pasts from a place of empathy or compassion. Without fear, we can see through them and give them new meanings. We can make peace with them, and lay them to rest.

Can you use MDMA to treat yourself? You can try, but I wouldn’t recommend it. You’ll need the psychotherapy help you to integrate your experience and process your trauma, but to pick up the pieces of your life that trauma has left in its wake.

Doblin says the end goal of the MAPS project is “mass mental health”. If phase 3 trials are successful and MDMA-assisted psychotherapy is approved by the FDA, MAPS will focus on researching group therapy for PTSD, as well as other indications for MDMA.

Because MDMA is thought to stimulate prosocial behavior, MAPS is also studying MDMA-assisted psychotherapy as a treatment for social anxiety in autistic adults. It’s also being investigated for couples therapy and addiction.