mdma as a cure for ptsd

 

MDMA-assisted psychotherapy & PTSD: Revising our pasts

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.

 

magnesium for depression, anxiety, and stress

 

How magnesium relieves anxiety, depression, and stress

Magnesium is fundamental to many processes in our bodies; it plays a role in over 300 biochemical reactions necessary for our physical homeostasis. It supports the cardiovascular system, endocrine system, and digestive system. It prevents the hyperexcitability of neurons that results in anxiety, stress, and cell death. For this reason it’s also being investigated as a preventative treatment for neurological diseases such as Alzheimer’s, Parkinson’s, and stroke. Magnesium also reduces the risk of heart disease, lowers blood pressure, and reduces the frequency of migraines.

Magnesium deficiency is extremely common

magnesium for depression, anxiety, and stress

Most people aren’t getting enough magnesium – it’s estimated that about 68% of all adults in the US are deficient in this essential mineral.

Why? Most processed foods are stripped of their natural magnesium. For instance, refined flour contains only 16% of the magnesium found in whole wheat. So much pasta, so little Mg! 

Water treatment facilities also tend to filter magnesium out of our drinking water. Poor diet is strongly linked to magnesium deficiency, and other factors like excessive alcohol intake and stress can also deprive our bodies of much needed magnesium.

Magnesium deficiency can cause anxiety, depression, weight gain, fatigue, insomnia, irritability, muscle cramps, diabetes… the list goes on.

Several studies have established magnesium’s efficacy in treating depression and anxiety. In one recent study, daily use of magnesium significantly reduced symptoms of depression  and anxiety within just two weeks.

Magnesium deficiency, stress, and neural atrophy

So how does magnesium work? Because magnesium is so vital to so many processes, its role in relieving depression is multi-faceted. However one way is by regulating the HPA (hypothalamic-pituitary adrenocortical) axis – our body’s main stress response system, which controls the secretion of our stress hormones. 

A second way magnesium may act to curb anxiety is by preventing glutamate from excessively binding to NMDA receptors. Glutamate is the main excitatory neuro-transmitter in our brains, and anxiety provokes an overactivation of NMDA receptors. Over time, these neural pathways become reinforced, and chronic overactivation of these receptors causes the death or atrophy of complementary neurons, resulting in neurological dysfunction. Long term, the cell death caused by NMDA overactivation causes a loss of neuroplasticity, and even  brain damage.

Don’t freak out – you can reverse this process and grow new brain cells. However, this neuronal death and atrophy causes key areas of the brain to shrink, a core physiological feature of depression. The hippocampus, which is responsible for learning and memory, is 10-20% smaller in patients with stress-related disorders like major depression and PTSD.

Have you ever heard it said that a depressed person has “stopped growing”? Well, this may be more than figurative – the hippocampus is also where all new neurons are born (perhaps thousands a day in healthy adults), so damage to neurons in the hippocampus may also limit our ability to form new neurons. If our ability to create new brain cells is stunted, it can affect our entire brain, literally limiting our ability to learn and grow. The prefrontal cortex, the area of the brain responsible for planning, cognition, creativity, self-expression, and social behavior, also tends to be smaller in people suffering from depression.

Magnesium may also support serotonin production, and increase the availability of GABA, the inhibitory neurotransmitter that relaxes us.

New neurons, neurogenesis and neuroplasticity

In short, magnesium deficiency can lead to excess anxiety and stress, which can in turn cause neurons and areas of the brain to atrophy, a central feature of depression. The good news is that you can reverse a lot of this damage by stimulating the growth of new neurons, which is called neurogenesis. Since all new neurons are born in the hippocampus, learning is a great way to stimulate neurogenesis. Exercise is also a classic way. Sex is said to help, too, by way of relieving stress.

Another experimental class of treatments, psychedelics, increases neuroplasticity and may even stimulate neurogenesis. Psychedelics reverse depression-related neuronal atrophy by stimulating the growth of dendritic spines and synapses in existing neurons. These are the very ends of neurons, where they communicate with other neurons. More and stronger synapses mean new connections and neural pathways, which translates to new ideas, thoughts, creativity, and growth.

Your brain will also need magnesium in order to create nucleic acids, which are essential parts of neurons and all living cells.

What type of magnesium should I take?

As with many supplements, absorption is a factor. Magnesium comes in many forms. Look for supplements with magnesium glycinate or magnesium chloride, which are thought to be among the most easily absorbed by the body.

Of course, mental health is complex; biological mechanisms interact with social,  environmental, and historical factors. However nourishing your mind and body by getting enough magnesium is an excellent place to start to feel better. 

 

community gardening therapy

 

30 individual and collective ways to heal trauma

 

By Tina Phillips, MSW

 

 

Overcoming trauma is a process. Trauma, or post-traumatic stress disorder (PTSD) can be caused by an event or an emotional experience in which a person felt a threat to their life and safety.

PTSD and in the event of chronic or repeated traumas, C-PTSD, can present itself as emotional distress, distrust of others, fear and anxiety, and emotional dysregulation. It can also cause depression, flashbacks, and avoidance.

There are both individual and collective ways to heal trauma. Some individual ways to heal from trauma are self-care, therapy, art, journaling, and using workbooks.

Collective ways to heal trauma may include group support, volunteer work, social support, and even activism. Activism and community advocacy can help us have hope for the future, and empower us to take action now that can improve our own lives and help our communities.

Both individual and collective methods are worthwhile endeavors. No solution is one size fits all, and it can take experimenting with different techniques and coping skills, and combining them to fit each individual. 

 

“Developing an inner refuge where we feel loved and safe enables us to reduce the intensity of traumatic fear when it arises.”  

Tara Brach

Individual methods

pet therapy

 

Individual methods of overcoming trauma can help us to feel our feelings and understand our experiences instead of numbing and avoiding them. These tools can help us embrace and process emotional pain and how it shows up for us in our bodies. Feelings can include shame, negative thinking, flooding and repeated thoughts, and low self-esteem. 

In addition, these methods can foster self-compassion and build a relationship with ourselves, allowing us to get to know ourselves better by opening up buried wounds of the past. Some individual ways to help heal trauma are to get moving and exercise. Don’t isolate, use stress reducing techniques, take care of basic health needs such as getting proper nutrition and sleep, and seek professional help if necessary. 

 

“There is no timestamp on trauma. There isn’t a formula that you can insert yourself into to get from horror to healed. Be patient. Take up space. Let your journey be the balm.”

Dawn Serra

Some stress reducing techniques that heal trauma

 

Deep breathing and progressive muscle relaxation

Deep breathing helps more oxygen get to your brain and triggers the parasympathetic nervous system, promoting relaxation. It also connects one to their own body and brings awareness to the rhythmic sound of your breath, bringing centered calmness. In addition, when we tighten a muscle and then release it, it causes deeper relaxation in that muscle. This can promote relaxation in the entire body if done one muscle group at a time. The body is connected to the mind, and thus this causes relaxation in the brain as well.

 

Using soothing scents, sights, sounds, or touch

five senses grounding trauma PTSD

 

Scent can help us relax, via our limbic system, which connects to emotion and memory. Relaxing smells can lower stress levels, promote soothing feelings, and help invoke positive memories.

Pleasing visuals can have a calming effect, helping us to destress and bringing us comfort. This can be as simple as looking at pictures of landscapes, ocean, animals, nature, or going outside and looking at nature.

Listening to music, the ringing of bells, the sound of ocean waves or rain, binaural beats, and guided meditation can all help reduce anxiety, decrease stress, tap into good memories, focus the mind, and promote enjoyment and positive feelings.

Touch can soothe us, make us feel connected, and increase well-being. Touch has been proven to lower heart rate and blood pressure, lower stress, and increase oxytocin. From a hug to a massage, touch comes in so many forms. Even a weighted blanket can help ease our anxiety and help us fall asleep. There are so many ways to bring touch into our lives and collect its benefits.

 

Grounding activities

People with PTSD can dissociate, or have the sense of not being themselves or in their body. In this case, grounding helps bring us back into our body and the present and feel our feelings. It can be as simple as lying on the floor, or anything that slows us down or engages us physically such as meditation, dancing, or going for a walk. When people are experiencing panic attacks or flashbacks, grounding is also used as a tool of distraction, drawing awareness away from anxiety by focusing on a cue which engages the five senses.

 

Mindfulness practice

Mindfulness practice is about bringing awareness into the present moment. It’s a way we can observe ourselves without judgement and getting overwhelmed. When practicing mindfulness people bring awareness into their bodies, feelings, and thoughts and try to bring them into balance.

Mindfulness is about paying attention. Not to the past or the future, but right here and right now. Mindfulness can promote stress reduction, help anxiety and depression, and quiet the mind so it becomes more focused and calm.

 

Meditation

 

Meditation promotes deep relaxation, focuses attention, reduces stress, increases awareness, reduces negative thoughts, can boost imagination and creativity, and increases tolerance and patience. There are so many different kinds of mediation and various methods – despite popular belief that it looks one way, and that way is hard. Learn more about it and you may find one that is right for you.

 

 

Workbooks

Workbooks are a great way to get the tools that therapy teaches you without the price tag. They range in price, but for around $15, you can get a workbook that will teach you about depression or anxiety and techniques on how to reduce them.

 

Art

Art, for example painting, beading, knitting/crocheting, adult coloring books, drawing, collaging, photography, origami, mosaics, etc., can all be healing.

Art helps us make more connections in the brain and connects our minds to our bodies. It helps us tap into our creativity and get in touch with our feelings, and it can help promote enjoyment, rhythm, and soothing feelings.

art to heal trauma

 

Journaling

journaling to heal trauma

Journaling is a cost effective way to put your traumatic experiences down on paper. Writing is a creative expression that can help our brains process information, reduce stress, and even boost our immune system. Writing can help us tap into the meaning of our experiences and see our own growth from them, as we re-read and reflect on our story. It’s also a great way to vent, without anyone else having to listen to it or react. It’s a way for you to get it all out with privacy.

 

 

Get in nature  

Nature can reduce negative feelings such as anger. Nature reduces stress, and promotes positive feelings such as joy. Nature tends to help both body and mind, and has been proven to reduce blood pressure, relax muscles, lower heart rate, and lower stress hormones. Nature can be soothing, help us feel connection, bring us balance and calm, and help us feel more resilient and focused. Nature can even distract us from our pain.

 

Video games 

It may surprise some, but studies show video games can be an effective way to treat trauma. Video games have a mindfulness-like effect, as well as a soothing effect through repetitive tapping and button pushing. They can also provide social connection, be used as a tool of distraction from painful symptoms, and help create meaning. Video games can be affordable and played in the privacy of one’s own home.

 

Get a pet 

It’s been proven that stroking the soft fur of a pet can increase our levels of oxytocin. In addition, having a pet can decrease stress levels, lower blood pressure, lower risk of a heart attack, and help ease depression, anxiety, and stress. A lot of these benefits come from playing with, walking, feeding, and petting a pet. Pets can help us get out of bed because they need us. (The secret is, we need them, too.)

 

ASMR (Autonomous Sensory Meridian Response)

ASMR can help people relieve bad moods, create soothing feelings, reduces chronic pain, and helps reduce stress, depression, and anxiety. ASMR can also help people to relax, fall asleep, and uplift their mood.

 

Join in person support groups, peer support groups, Facebook support groups, or other online support groups

The great thing about support groups is that you’re surrounded by other people who are going through the same thing you are. It instantly decreases your feeling of being alone or isolated. You are validated by others who confirm your experience and reflect back your own experience. This brings comfort and builds social bonds. Many groups are also easily accessible and affordable or free. Peer support is really a great way to help others as well, and feel like you’re giving back in return for advice and support you received from others.

 

Go to therapy

Therapy helps people process the trauma they have been through. Therapy also teaches a person about trauma and how it could be showing up for a person. Therapy helps a person talk about their traumatic experiences, and helps guide them to express their feelings in healing ways. Therapy can help you develop a narrative which is compassionate and accurate based on how trauma shows up for you and how it affects the brain.

Therapists provide psychoeducation, teach therapeutic techniques and tools, and use therapeutic techniques to treat trauma and reduce symptoms such as depression, anxiety, hyper-vigilance, or flashbacks. Therapy can help people regain a sense of power, increase self-esteem, help with daily functioning, teach people healthy coping and self-soothing skills, and help them develop resilience. Therapy can also help reduce stress, negative feelings, and self-harm. There are many types of therapy, and some may work better than others for you depending on your situation and needs.

 

Reading or listening to podcasts

reading therapy for PTSD
Ashwagandha for stress and anxiety

Herbs, supplements, & alternative medicine

 

Collective methods to heal from trauma

volunteering

 

Collective methods of healing trauma are also a creative way to channel our feelings and look outside ourselves for connection. Activism can help people share their feelings, empower themselves, receive validation, and create purpose and meaning for those who may feel they have lost their way.

These collective methods focus on helping others and giving back, building community ties, and fostering healthy relationships. These tools can help one process grief and loss, decrease loneliness and isolation, create safety trust, and build resilience. Furthermore these methods can help create positive change, can be transformative for the individual and society, and help a survivor take their power back.  

 
“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.”
Elisabeth Kübler-Ross

 

Some systemic solutions that help heal trauma

 

Building social support networks

Traumatic experiences can isolate us, or cause us to self-isolate. However human relationships are extremely important for mental health and having a sense of belonging and support. Trauma survivors can help heal by finding social support through support groups, spending time with their friends and family, becoming part of spiritual communities, and building positive relationships  with coworkers.

 

Volunteering

Volunteering is a great way to make social connections, to build community, to help yourself feel positive feelings, and create purpose and meaning. Volunteering can also be fun, be good for building work experience, and helps increase leadership skills.

 

Writing for an audience 

Writing for an audience can help one express deeply held experiences in order to help others feel less alone and isolated. It can also help others to find techniques and ways to improve their own lives. This can be very fulfilling and also healing for the writer, whose lived experience can both be written about and expressed, and also read by many people, helping bring meaning and purpose, resilience, and courage to both the writer and the audience.

 

Advocacy

Advocacy work helps us raise awareness of our own cause. It helps us when we speak up for others who feel voiceless, helps us build resilience and courage and promote these in others, helps us use lived experience to fight for better policies and treatment for others, helps break down stigma, and be effective in promoting better wellbeing for people like us. Advocacy helps us feel less powerless, as we see the benefits of our work demonstrated in tangible outcomes and improved lives. 

 

Join a community garden

community gardening to heal traumaCommunity gardens make cities more beautiful and grean, and provide fresh and healthy food for the communities they’re in. If you already know how to garden, you can start to grow your own food, while meeting and teaching others. And if you don’t know how to garden, you can learn! The other gardeners will give you free tips, and many community gardens even offer classes. Learning, socializing, and eating healthy foods are all ways to nourish your brain and help heal trauma.

 

Restorative and Transformative Justice programs or circles 

Transformative Justice is a framework communities can use to address violence and abuse outside of the criminal justice system. It’s an approach that seeks to create accountability, safety, and healing within communities harmed by trauma, without perpetuating violent reactions or behaviors.

 

Movementand community building

Some people’s experiences of mental health treatment has itself been traumatic. This can be because of the stigmatization that comes with some mental health diagnoses, misdiagnosis, or experiences of forced institutionalization or dehumanization in psychiatric care. There are networks and communities of mental health survivors that critique the mental health system and advocate for it to be more patient-led. Joining one can give survivors a voice and be a source of social support, especially for those who have been traumatized by psychiatric institutions.

 

Join a union

Economic disempowerment is a major contributor to mental health problems. Unions are a way to address disempowerment at the workplace and declining wages. Unions can build a community of solidarity at your work, uniting workers to fight for higher wages and better working conditions. A union will also support you if you’re being harassed on the job, and educate you as to your rights at the workplace.

unions for PTSD

 

Join or start a coop

Coops are a way to bring power back into our own hands and the hands of our communities. There are several different kinds of coops (and collectives). Worker coops are businesses that are owned and operated by the people who work there, so they tend to have better working conditions and serve the needs of their communities more than traditional hierarchical businesses. Consumer coops, like many local grocery stores, are owned by the people who shop there, and often have gathering spaces or offer events and services to the community. Having strong communities and socializing is good for our mental health, and can help us build support networks and overcome isolation and trauma.

 

We are working through trauma and towards healing both as individuals and as a collective. It takes many shapes and forms.  It’s up to us to design the toolkit that works best for us throughout our journey. Hopefully this has inspired you as a jumping off point to do some healing work of your own. 

Before 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

 

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 anaesthetic 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. We’ll get to the recreational, or dark side, of ketamine later.

2020 saw ketamine hit the headlines once more as a successful treatment within clinics for patients suffering from treatment resistant depression. As with classic psychedelics like psilocybin, ketamine infusion therapy has shown promise as a treatment for depression, PTSD, OCD, anxiety, and even addiction.

 

Ketamine poison or remedyMoonlight Circus by BisBiswas

 

Despite its risk of abuse, because of its anaesthetic 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 use it in clinical trials, and means that doctors can use it off label.

It’s because ketamine has approved medical applications that ketamine clinics are now able to proliferate across the US (and now also the UK), and news of it as a panacea is lighting up the marquees. The irony, of course, is that ketamine is much more dangerous than psilocybin, and probably less effective – or at least, its effects are shorter lived.

Ketamine clinics, like the company MindBloom, offer ketamine injections or infusion therapy, sometimes in conjunction with psychotherapy, Since the treatment is experimental and not approved by the FDA, it’s not covered by insurance – though some clinics are making ketamine infusion therapy as affordable as a visit to the psychiatrist.

 

How does ketamine work?

Ketamine is an NMDA receptor antagonist. NMDA receptors are activated by glutamate, the main excitatory neurotransmitter in the brain.

Overactivation or “excitability” of NMDA receptors is implicated in chronic stress and anxiety, and eventually leads to neural atrophy, a loss of neural plasticity, and depression.

As an NMDA antagonist, ketamine temporarily blocks glutamate from binding with NMDA receptors, preventing activation of downstream neurons (which we might experience as negative thoughts if we’re depressed). Glutamate is the most abundant neurotransmitter in the brain, and it’s especially involved in learning and memory and the formation of long-term neural pathways (known as long-term potentiation, or LTP).

The prevailing theory is that a series of chemical processes are then set off that increase levels of brain-derived neurotrophic factor (BDNF), a key protein for the growth of neurons, which is stunted when NMDA receptors are overactivated.

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 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 found 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.

 

What is ketamine like?

The ketamine high isn’t exactly like that of classic psychedelics such as LSD or psilocybin. It’s dissociative, so it can make you feel disconnected from your body as well as your regular thoughts and emotions. Users report feeling like they’re floating, with changes in perception and dreamlike states.

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 spacy and empty, leaving you feeling a bit down.

 

Ketamine infusion therapy for depression

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

Ketamine is fast acting, known to relieve depression almost instantaneously. It’s also promising for those at risk of suicide; ketamine has been found to significantly lower suicide ideation.

Most patients experience near total relief of their depressive symptoms within one to 24 hours of their treatment. On the down side, the antidepressant effects of ketamine typically wear off within 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 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 which plague 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 can itself be addictive, so it seems an unlikely candidate to cure addiction. However one study in 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 only received the therapy (the control group) continued using.

 

Ketamine & esketamine 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.

A couple of studies found that esketamine significantly reduces both depression and anxiety in chronically ill patients.

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: just relax.

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 to treat depression, and a recent study found that supplementation with magnesium enhances ketamine’s antidepressant effects.

 

A look at recreational ketamine use across the pond (or, the case against ketamine)

 

ketamine craze: cure or poison?

 

In England, where ketamine is widely used as a party drug, people are seeing the dark side of ketamine, as young men in their 20s are starting to have bladder problems. This is because ketamine breaks down the wall of your bladder over time.

If you develop a habit and regularly take a lot of street ketamine, you will fairly soon start running into some serious problems, as tolerance grows rapidly. In the beginning it’s fairly cheap, selling at around 20 pound a gram in the UK — that’s enough to get you well and truly munted for up to five hours. And if you start using at the levels given to sedate animals like elephants and horses, your problems will deepen as your usage goes up and tolerance builds.

The obvious drawbacks are the onset of adverse physical effects after heavy or long-term use of ketamine. These are worse than most other street drugs; primarily the rapid destruction of your bladder and urinary function. It’s sad to see teenagers that have been caning k for a few years simply pissing their pants and having seriously painful stomach cramps.

People’s experiences are individual and specific, so whilst Jill who had a little dabble here and there for a few years managed to walk away unscathed and actually benefited from her experiences, Jack spent way too much money and is having a tough time trying to stay off it whilst suffering psychosis, kidney, and bladder problems. You can never know another person’s capacity to say no or have an understanding of how other drugs, medications, and personal traumas are affecting another person’s ability to make positive decisions.

Other associated problems may include scenarios such as where a person on ketamine walks into a busy road oblivious to their surroundings. Unfortunately it is also used by rapists, gay and heterosexual. Finally, it is illegal in most jurisdictions, so you could do hard time if caught dealing or importing–situations many addicts fall into whatever drug they are on to either fund usage or settle mounting drug debts.

An alcoholic who drinks hard liquor morning noon and night could develop cirrhosis of the liver, slurred speech, and a switchy personality, and whilst some may quietly destroy themselves others may be easily manipulated into violence and vicious cycles of low self-esteem, prison, and toxic relationships.

The recent studies have found that ketamine infusion therapy can immediately alleviate a person’s suffering who is suicidal, however the studies also show that after a period of two weeks the person is likely to be back in the same state of depression, so there is no long term gain.

Popular street drugs are popular because they give you a rush or cause an intoxicating effect, and a good experience will give you confidence to try it again. I suppose what I’m hinting at is that making a career out of ketamine will end up doing you serious harm physically and emotionally. While a short course may have benefits, it comes with no recommendations from my end.

 

Es/ketamine: don’t try this at home

There you have it, folks. While some psychedelic drugs may be safe to experiment with yourself for therapeutic purposes, ketamine is not one of them. Ketamine infusion therapy as an occasional treatment in a clinic may be safe, but it’s definitely one of those “Don’t try this at home” drugs.

And as for esketamine: since ketamine itself can’t be patented, pharmaceutical companies had to slightly change it in order to profit from ketamine therapy. Thus, esketamine is basically just a patented version of ketamine, though it’s said to be a bit weaker. And since most studies of ketamine have been by infusion, and since it’s slightly different chemically, it may be less effective in treating depression. And did we mention that ketamine’s addictive? Yeah, don’t get prescription ketamine.

 

What is trauma? Recognizing the causes, signs, and symptoms of PTSD & C-PTSD

By Tina Phillips, MSW 

 

“Vulnerability is our susceptibility to be wounded. This fragility is part of our nature and cannot be escaped. The best the brain can do is to shut down conscious awareness of it when pain becomes so vast or unbearable that it threatens to overwhelm our capacity to function.”

~ Dr. Gabor Maté

When Alyssa came out of an abusive relationship, she was relieved, and thought things would get better. But she didn’t feel like herself; just because it was over, it didn’t mean she was okay. Like many who have been in abusive relationships, she had become isolated from friends and family. She even moved away so her abuser couldn’t find her, but still, everything put her on alert. She didn’t understand her feelings or recognize the symptoms of PTSD; after all, it was over, wasn’t it?

Moving and starting a new job with undiagnosed PTSD led to chronic stress. The only way she knew to deal with her hyperarousal, episodes of panic, and depression was by drinking. It was only after a breakdown that she received medical attention, connected with a network of survivors, and began to recover. Even though the traumatic event was over, Alyssa was still in survival mode. Recovering from trauma can be an ordeal in itself. It takes time to heal, and it’s hard to do it alone.

 

What is trauma?

Trauma is a natural emotional response to an event or an emotional experience by a person that felt a threat to their life or safety. Examples of such events can range from childhood abuse and neglect, to military combat, to sexual assault, or even poverty and chronic stress. These experiences can be jarring for a person’s brain, stress hormones, and create a feeling of being overwhelmed and not in control. These events can be a one time experience or could be over a period of time, which can result in post-traumatic stress disorder (PTSD)orComplex PTSD (C-PTSD).

 

Symptoms of PTSD & C-PTSD

PTSD can present itself as emotional distress, distrust of others, fear and anxiety, and emotional dysregulation. Childhood is one of the worst times to experience trauma, and can affect a person life-long and have consequences on overall healthlater in life.  Repeated or long-term trauma, especially during childhood, is more likely to cause C-PTSD.

C-PTSD manifests with most of the same symptoms of PTSD, but usually in greater severity. People with C-PTSD are more likely to experience prolonged feelings of low self-esteem, shame, isolation, emotional dysregulation, difficulty in relationships, and sometimes feelings of intense anger or shame. They’re also more likely to be revictimized. 


Emotional dysregulation

Emotional dysregulation can throw a person off from interacting with the world around them. The “inability of a person to control or regulate their emotional responses to” input around them, causing exaggerated or inappropriate emotional reactions, especially when triggered. This can cause trouble with relationships, create barriers for daily functioning, and can contribute to anxiety and depression. Barriers in daily functioning could mean one is distracted by intrusive thoughts, bombarded by reliving their trauma or being reminded of it when stressed or emotionally hurt by others, paralyzed by anxiety and fear, overwhelmed from demands in their life, and unable to properly care for themselves. This may mean the struggle to keep themselves well fed, get enough sleep, shower, go to work or school, do chores, maintain relationships, or seek help.

Triggers 

Triggers are when things happen to us that remind us of our trauma. It can send us into an emotional shut down. It can be anything that elicits our symptoms. Furthermore, during emotional dysregulation people often become hypervigilant, experience hyperarousal, and can disassociate. Some also have flashbacks and nightmares, where they relive their trauma. 

Hypervigilance

Hypervigilance causes people to be on guard and scan their environment looking for danger, that may not really be there. It’s an exaggerated response by the nervous system that has been hurt by trauma.

Hyperarousal 

Hyperarousal is when the central nervous system is firing and keeping one awake and alert to be prepared for an impending attack. Often there is no real danger, but our minds and bodies are tricking us into thinking there is. 

“Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.”

~ Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Dissociation

Dissociation is when you lose touch with yourself and anything around you. It’s almost like daydreaming, except it’s often more like a fog you get lost in that shuts down the world outside your inner reality. This is our brain’s way of coping with overwhelming stress, and is a defense mechanism. 

Somatization

Somatization is when a psychological stressor manifests itself in physical symptoms. Examples include upset stomach, nausea, vomiting, headaches, muscle aches and weakness, and fatigue. 

“The bodies of traumatized people portray ‘snapshots’ of their unsuccessful attempts to defend themselves in the face of threat and injury. Trauma is a highly activated incomplete biological response to threat, frozen in time. For example, when we prepare to fight or to flee, muscles throughout our entire body are tensed in specific patterns of high energy readiness. When we are unable to complete the appropriate actions, we fail to discharge the tremendous energy generated by our survival preparations. This energy becomes fixed in specific patterns of neuromuscular readiness. The person then stays in a state of acute and then chronic arousal and dysfunction in the central nervous system. Traumatized people are not suffering from a disease in the normal sense of the word- they have become stuck in an aroused state. It is difficult if not impossible to function normally under these circumstances.”

~ Peter A. Levine

 

Stress response as an evolutionary adaptation 

There is an evolutionary function for the trauma response causing intense bouts of stress. This response is the body’s natural reaction to perceived threats of harm. Back in the savannah days our ancestors did have very real threats to their lives, such as large, predatory animals. Later, warfare or raiding was a reality between some tribes and villages. Though violent attacks are no longer imminent threats for most of us, now we have a leftover stress response that can be out of proportion to our everyday modern life. “[If you’re] a normal mammal, you had better turn on the stress response or else you’re dead. But if you get chronically, psychologically stressed, like a Westernized human, then you are more at risk for heart disease and some of the other leading causes of death in Westernized life,” says  Robert Sapolsky, a professor of biology and neurological sciences at Stanford University. In fact when we are under stress our bodies secrete hormones such as cortisol, and blood rushes to our vital organs to keep us alive in case of an attack, causing physical symptoms we associate with anxiety– tight chest, tingling/cold hands, sweat, dry throat, gastro-intestinal upset, back and headaches, and rapid heartbeat. But now instead of real physical threats to our lives, most of us have everyday stressors and trauma throughout our lives that can come back to torment us over and over.

Furthermore, mental health issues such as depression, anxiety, PTSD, and other mental conditions that come about in part due to stress and trauma, end up being risk factors for real physical diseases. We may be susceptible to certain conditions biologically, but it’s our social environment that elicits those traits to be expressed. The social environment is that which we live in, and can involve social interactions, family structure, schooling, political and cultural factors, a community in which a person grew up, relationships a person has, and any abuse or trauma they endured throughout their life, particularly in childhood. The reason childhood is such a large factor is because the human brain is still developing at this time and the trauma will shape the brain, causing patterns a child learned in order to survive their abuse into potentially life-long conditions, both physical and mental. 

 

Capitalism causes trauma 

“It is the economic and political system under which we live—capitalism—which is responsible for the enormously high levels of mental-health problems which we see in the world today.” 

~Iain Ferguson

It has been demonstrated and bared out in data that existing in a capitalist society doesn’t help most people psychologically. In fact, “research since at least the 1930s has consistently documented that mental illnesses are more common among those with lower levels of income, education, and occupational prestige.” 

The economic system we live under is exploitative, oppressive, and leads to stratification, political and cultural polarization, and isolation. There are a lot of “have-nots” these days. Millions can’t pay their rent, and are being threatened with losing their homes. When the stock market goes up, it just means that CEOs get more money, while income inequality and costs rise, and wages stay flat. So many young adults are now saddled with student loan debt, but don’t have high paying jobs and suffer without affordable housing, healthcare, or other social safety nets.

Some work themselves to the bone, yet they just aren’t making it, and are forced to live with their parents or several roommates, and delay starting families. For others, job insecurity means housing or food insecurity, and can in itself be a source of enormous stress, leading to states of hyperarousal similar to that in PTSD. People with less control over their jobs have higher rates of mental health issues like depression, especially when the jobs are also demanding. We too often don’t have enough time off or benefits to adequately take care of our mental or physical health, and many people have to work more than one job to survive.

People can’t wait until the weekend, but when the weekend hits it’s all chores, errands, caring for loved ones, and catching up on sleep. When Monday hits it starts all over again, leading to burnout and for many, mental distress. It is soul crushing. If we’re in poverty because we’re unemployed or can’t find a job that pays enough we’re more vulnerable to further traumatic events; we’re more likely to suffer from violence and abuse, not to mention extremely stressful situations such as homelessness or incarceration. All of these situations can be traumatizing, and the ways people may try to cope can lead to more problems, such as when people try to self-medicate and become addicted to substances. #ba6db5

Too many of us find ourselves where we’re overworked, in poverty, or both. Businesses seek to maximize their profits at our expense, and then discard us when the toll on our health leads to a crisis. Our economic system isn’t working for most people, causing more problems than it solves, and in many cases causing mental health issues, which we’re made to feel inadequate for. In so many ways, capitalism is just plain bad for our mental health. In this sense, trauma is often systemic.

 

Racism, oppression, and trauma

Furthermore, racism, sexism, homophobia, and other forms of oppression intersect with capitalism, and America has a long history of exploiting people to extract wealth such as through slavery, imperialist occupation, wars, policing, and colonization. There is also historical trauma. For example, Black people may experience Post-Traumatic Slave Syndrome (however there is also criticism of this theory, as some argue it presents Black culture as dysfunctional, instead of locating problems in continued institutional and everyday racism, as well as an economic system which denies people their basic needs). The point is that the legacy of slavery and racism may cause intergenerational, even epigenetic trauma, that causes both mental and physical health issues to be passed down to the next generation. Low-income Black people in the US have a rate of PTSD higher than combat veterans; some studies have estimated that 20-30% of people in these communities meet the criteria for PTSD. Given this we have every incentive to fight for a better world and do away with white supremacy, racism, and capitalism, which is a root cause of trauma.

 

Trauma isn’t always obvious

Though they may not pose direct threats to our lives, experiences of psychological abuse, such as bullying, neglect, isolation, exclusion, harassment, mistreatment in the workplace, racism, and other forms of oppression are responded to by our brains in a similar way to physical pain, and when acute or chronic, can result in PTSD or C-PTSD. Emotional abuse that takes place in childhood, repeatedly, or over time is more likely to cause PTSD, and factors such as having a support network play a role. While victims of violent situations may understand they’ve undergone trauma, in these less obvious circumstances, trauma may go unnoticed or misdiagnosed. 

People can experience PTSD or C-PTSD for months, years, or even decades if left untreated. Since symptoms can look like depression, anxiety, or Borderline Personality Disorder, and because some people block out certain traumatic events from their pasts, many go undiagnosed or misdiagnosed for years. Recognizing PTSD and the source of trauma can help survivors and those around them to better understand their thoughts and behavior, seek support and treatment, and begin to recover.

 

What can we do?

“The greatest damage done by neglect, trauma or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child will continue to interpret the world and her situation in it. All too often these ill-conditioned implicit beliefs become self-fulfilling prophecies in our lives. We create meanings from our unconscious interpretation of early events, and then we forge our present experiences from the meaning we’ve created. Unwittingly, we write the story of our future from narratives based on the past…Mindful awareness can bring into consciousness those hidden, past-based perspectives so that they no longer frame our worldview.”   ~ Dr. Gabor Maté 

Given how common and frequent trauma is in our society, how overwhelming it can be and difficult to overcome, what can we do about it? There are individual solutions and systemic solutions. Both are needed, and both have potential to aid mental health and help heal trauma. Individual solutions may be more immediate in relieving symptoms of trauma, while systemic solutions may take longer, but have longer-lasting impacts for society as a whole.

Now that we’ve looked at how to recognize trauma, it’s causes and it’s symptoms, it’s time to look towards solutions. There are so many ways to heal ourselves, be there for others, and transform our society. I go into some detail on them in 30 individual and collective ways to heal from trauma.