Ecstasy (Molly) for PTSD?

From the New York times comes news of possible use of Ecstasy for Post-Traumatic Stress Disorder, PTSD. In our new book, Healing the Brain, we take a close look at PTSD, what it is and how it affects people of all ages. 

F.D.A. Agrees to New Trials for Ecstasy as Relief for PTSD Patients

By DAVE PHILIPPS NOV. 29, 2016

C.J. Hardin, a veteran who served three tours in Iraq and Afghanistan, at a memorial in North Charleston, S.C. He is a patient in the study of MDMA, also known as Ecstasy, as a treatment for post-traumatic stress disorder. Credit Travis Dove for The New York Times

CHARLESTON, S.C. — After three tours in Iraq and Afghanistan, C. J. Hardin wound up hiding from the world in a backwoods cabin in North Carolina. Divorced, alcoholic and at times suicidal, he had tried almost all the accepted treatments for post-traumatic stress disorder: psychotherapy, group therapy and nearly a dozen different medications.

“Nothing worked for me, so I put aside the idea that I could get better,” said Mr. Hardin, 37. “I just pretty much became a hermit in my cabin and never went out.”

Then, in 2013, he joined a small drug trial testing whether PTSD could be treated with MDMA, the illegal party drug better known as Ecstasy.

“It changed my life,” he said in a recent interview in the bright, airy living room of the suburban ranch house here, where he now lives while going to college and working as an airplane mechanic. “It allowed me to see my trauma without fear or hesitation and finally process things and move forward.”

 

Based on promising results like Mr. Hardin’s, the Food and Drug Administration gave permission Tuesday for large-scale, Phase 3 clinical trials of the drug — a final step before the possible approval of Ecstasy as a prescription drug.

If successful, the trials could turn an illicit street substance into a potent treatment for PTSD.

Through a spokeswoman, the F.D.A. declined to comment, citing regulations that prohibit disclosing information about drugs that are being developed.

“I’m cautious but hopeful,” said Dr. Charles R. Marmar, the head of psychiatry at New York University’s Langone School of Medicine, a leading PTSD researcher who was not involved in the study. “If they can keep getting good results, it will be of great use. PTSD can be very hard to treat. Our best therapies right now don’t help 30 to 40 percent of people. So we need more options.”

But he expressed concern about the potential for abuse. “It’s a feel-good drug, and we know people are prone to abuse it,” he said. “Prolonged use can lead to serious damage to the brain.”

The Multidisciplinary Association for Psychedelic Studies, a small nonprofit created in 1985 to advocate the legal medical use of MDMA, LSD, marijuana and other banned drugs, sponsored six Phase 2 studies treating a total of 130 PTSD patients with the stimulant. It will also fund the Phase 3 research, which will include at least 230 patients...

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Should kids play football? No.

In this excerpt from the Dana Foundation's blog post by Dr. Guy McKhann, he looks at the choice faced by parents regarding letting their kids play football. We cover this topic in our new book, Healing the Brain.


“Don’t Let Kids Play Football” is the title of a New York Times OpEd column by Bennet Omalu. Dr. Omalu gets credit for being the first to recognize the distinctive neuropathology associated with repeated head injuries in an NFL player. Omalu was on call when an autopsy was needed for former Pittsburgh Steeler Mike Webster.

Not being a football fan, Omalu was one of the few adult males in Pittsburgh unfamiliar with Webster, a star center for 17 seasons. Some time after Webster’s retirement in 1990, he gradually began to deteriorate mentally, first with depression and paranoia, then gradual loss of cognition, so that at the time of his death, he was essentially demented. Because of his football notoriety, his troubles were documented in the local newspapers.

Omalu realized that he was seeing a very unique pathology. The gross brain appeared normal, but when he cut into it and made stained sections, he noted the marked accumulation of the protein tau. Tau, in the form of tangles, is one of the hallmarks of Alzheimer’s disease, as is the accumulation of another protein, beta amyloid, in the form of plaques. In Webster’s brain there were very few amyloid-containing plaques and the tau accumulation was in a different distribution than what one would see with Alzheimer’s. Omalu and his colleagues published two papers in the journal Neurosurgery: one on Webster and another on fellow Steeler Terry Long. They described their findings, suggesting that repeated head injuries might be associated with this pathology. All hell broke loose. The NFL powers that be were not happy that their sport might be associated with brain damage. Several physicians involved with NFL teams wrote the journal asking that the papers be withdrawn. (Withdrawing a paper rarely happens, and is done when there is clear misconduct such as fraud). The papers were not withdrawn.

Deciding that challenging the powerful NFL was an impossible task, Omalu left Pittsburgh and became a medical examiner in California, out of the limelight. However, Dr. Ann McKee, a well-regarded neuropathologist in Boston, picked up the slack and let the world know she and her colleagues were available to do the neuropathology on athletes, and military personnel, with head injuries. She was joined by a neurosurgeon, Robert Cantu, and Chris Nowinski, a former Harvard football player and professional wrestler, who became concerned about his own history of head injuries. Chris has become the liaison between the Boston investigators and the athletic world, active in obtaining permission and access for the Boston group to do autopsies.

As of September 2015, they’ve analyzed the brains of 91 former NFL players and found the distinctive pathology in 87 (96 percent).

The clinical course in the others is much like that of Mike Webster: exposure to a series of head injuries over years, a period of normal functioning after retirement, and gradual decline in cognitive functions. What’s going on in these brains? We really don’t know. However, one possibility is that the accumulation of tau is initiated by head trauma. Even after the trauma stops, the accumulation continues until tau reaches a level that is toxic to nerve cells. This process may take years and might be exacerbated by the person’s use of alcohol or drugs.

So should kids play football? I have nine grandchildren. My youngest, twin seven-year-old boys, are into gymnastics and swimming, so they’re not at risk of head injuries (though they enjoy pummeling each other). The others are into soccer, lacrosse, mountain climbing, and cross country skiing. What would I tell them? I think that there is a lot of hand-waving about the susceptibility of the developing brain. In some instances the younger brain is more resistant to injury. An eight-year-old can survive and make a remarkable recovery from a stroke, while a similar stroke in an 80-year-old would be devastating. However a diffuse injury (one that is spread more widely), associated with a head injury, may have effects on brain development.
I don’t know where to draw the line regarding age. I suggest that prior to age 18 kids play less violent forms of football, like touch or flag football, to significantly reduce the chance of head injury.

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Was Nancy Reagan right?

Nancy Reagan championed her "Just Say No" program in the '80s, drawing praise and criticism. In one way she was right. For an addicted brain, saying no is incredibly difficult. However, for a non-addicted brain, saying no may be the only effective prevention option. Read this excerpt from Healing the Brain.

III. PREVENTING DRUG ABUSE: THE BEST STRATEGY

Why is adolescence a critical time for preventing drug addiction?

As noted previously, early use of drugs increases a person’s chances of developing addiction. Remember, drugs change brains—and this can lead to addiction and other serious problems. So, preventing early use of drugs or alcohol may go a long way in reducing these risks. If we can prevent young people from experimenting with drugs, we can prevent drug addiction.

Wikimedia Commons

In high school, teens may encounter greater availability of drugs, drug use by older teens, and social activities where drugs are used.

Risk of drug abuse increases greatly during times of transition. For an adult, a divorce or loss of a job may lead to drug abuse; for a teenager, risky times include moving or changing schools. In early adolescence, when children advance from elementary through middle school, they face new and challenging social and academic situations. Often during this period, children are exposed to abusable substances such as cigarettes and alcohol for the first time. When they enter high school, teens may encounter greater availability of drugs, drug use by older teens, and social activities where drugs are used.

At the same time, many behaviors that are a normal aspect of their development, such as the desire to try new things or take greater risks, may increase teen tendencies to experiment with drugs. Some teens may give in to the urging of drug-using friends to share the experience with them. Others may think that taking drugs (such as steroids) will improve their appearance or their athletic performance or that abusing substances such as alcohol or MDMA (ecstasy or “Molly”) will ease their anxiety in social situations. A growing number of teens are abusing prescription ADHD stimulants such as Adderall® to help them study or lose weight. Teens’ still-developing judgment and decision-making skills may limit their ability to accurately assess the risks of all of these forms of drug use. Using abusable substances at this age can disrupt brain function in areas critical to motivation, memory, learning, judgment, and behavior control.  So, it is not surprising that teens who use alcohol and other drugs often have family and social problems, poor academic performance, health-related problems (including mental health), and involvement with the juvenile justice system.

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Gay youth, health, and Trump

President Lyndon Johnson set up the Kerner Commission in the late 1960s to investigate the underlying causes of nationwide riots (Newark, Washington, DC, Los Angeles, Detroit, etc.). The commission's stunning conclusion was that America was two societies, separate and unequal, increasingly moving apart. As I began to talk to varied audiences with A Thousand Moms, I realized that a similar gap existed today with the gay community. Despite important successes, e.g., marriage equality, mainstream America didn't know about the LGBT community and rather than learning from an increased public awareness of LGBT issues, they remained profoundly unaware of gay life and the severe and unique stresses that can attend it--except in extraordinary circumstances. 

A Thousand Moms' mission is to educate parents, teachers, social workers, counselors, clergy, and the concerned layperson so that in an optimum world, they can support LGBT youth with a deeper understanding of a group of people seemingly from a completely different world. I wrote Healing the Brain: Stress, Trauma and LGBT/Q Youth because I had the training to do it--15 years as an editor to the world's top neuroscientists at the Dana Foundation--and access to my partner Fred's experience in child development. I was also peeved that my previous employer, in its massive reference on the brain, mentioned gay people only once. The reference blithely said that people attracted to the same sex seem to commit suicide in larger numbers and we don't know why. (Or care.) 

So this book is about the brain, but really about surviving extraordinary stress and trauma and protecting our heath. I have been given many accolades for the book, the best one calling it pioneering. But kind words have not translated into wide interest and in this world of self-publishing, the task of getting the word out has been very difficult. Therefore I am now circulating sample chapters so people can get a feel for the book and make an informed decision about getting a copy. Many books on LGBT life get called reference books or "a contribution to the literature," which means being put on a book shelf to die quietly. I am determined not to let that soft bigotry stop this important information from reaching people who can help LGBT youth--and adults--and make a real difference in our lives. We have a public health crisis in the gay community, still and perhaps worsening. And come a new administration that promises rollbacks, not progress, we are going to need education, awareness, and support more than ever. Please take a look at this sample e-book and share it. 

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Gay youth need support post-Trump

What's a gay youth to do faced by an increasingly hostile social environment brought on by the Trump election? The Southern Poverty Law Center has documented a rise in hate crimes against all minorities since the election and the LGBT community is included. We look at how gay youth can find a supportive hand in this climate in our new book, Healing the Brain.

Finding Support

Coming out is one of the most stressful periods in a gay teen's life.

In a best-case scenario, the teen's parents might have suspected their teen's sexual orientation, and are happy and accepting of the declaration. But in the worst case, the teen's parents might cut off financial support, reject the teen, and kick him or her out of the household.

In “Homophobic Teasing, Psychological Outcomes, and Sexual Orientation Among High School Students: What Influence Do Parents and Schools Have?” published in The School Psychology Review, anti-gay teasing was found to have negative mental health outcomes in gay teenagers who lack supportive school and home environments. Researchers Dorothy L. Esperage and others examined 13,921 high school teenagers, of whom 932 were “questioning” their sexuality, and an additional 1,065 identified themselves as homosexuals.

While all teenagers will experience negative outcomes when parents are unsupportive, for gay teenagers, this effect can be particularly strong, leading to greater instances of depression. The study stated that questioning and openly homosexual students were more likely to report depression, suicide attempts, and drug use when their parents rejected their sexuality.

But gay students who received support were less likely to report these negative outcomes, even if they experienced victimization in school environments. Family acceptance of homosexuality led to higher self-esteem, more support against victimization, and reduced depression among the participants. Since each family scenario differs on a case-by-case basis, the teen should decide if coming out to his or her parents would cause more harm than good. If so, the teen must identify individuals in the teen's life who will be accepting and supportive of the teen's decision to come out. For some teenagers, this might be an aunt, uncle, or sibling, while others find support in school counselors or close friends.

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Trump's low road to the White House

The human brain has developed over millenia. Like a non-stop power plant, the brain added new structures to basic ones (controlling basic functions like breathing). The crowning achievement is the cortex, the largest brain structure, where higher thought and reasoning take place.

Scientists have learned that sensory input, e.g., sounds, do not have to travel to the cortex to induce fear. Impulses need only travel to a primitive brain structure called the amygdala. 

When FDR delivered his first inaugural address, he appealed to reasoning, though his topic was the fear of a nation shattered by the Great Depression. Like dictators and demagogues through history, Donald Trump goes straight for the lower brain with pointed, uncomplicated messages that require little thought. For example, his nicknamesl for nearly all of his opponents (Low Energy Jeb, Little Marco, Crooked Hillary) make for instant recognition and easy identification--and great ratings for cash-starved cable media. Wash, rinse, repeat.

Trump echoes right wing talk radio hosts, who offer short, immediate solutions that fit neatly into a brief format. No exhausting engagement of the thinking brain required. Fear is our most powerful emotion and when Donald Trump boasted he knew how to win this election, like ad men from Madison Avenue, he knew what worked: the low road to the White House. Hillary Clinton and the Democrats had a long, arduous path to the thinking brain to overcome the power of fear and other powerful emotions.

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Heterosexism and the holidays

Thanksgiving marks the start of the trifecta of holidays that spike anxiety in LGBT youth and adults of all ages. In this excerpt from Healing the Brain, we look at the invisible but all-too-real phenomenon of heterosexism, the feeling of gay people that they must give deference to a straight-majority culture.

Despite, or in some cases because of social progress in marriage equality and other matters, pervasiveness of alienation in the lives of the current generation of gay youth is well established. Nevertheless, little is definitively known about the strategies these youth use to cope with stigma and discrimination based on their sexual minority status. Lesbian, gay, bisexual and transgender youth face an array of daunting challenges in addition to many of the developmental stressors facing straight teens.

One of the most difficult stressors gay youth face is heterosexism. This term describes the acculturated and pervasive (intentional or non-intentional) concept that denies, denigrates, and stigmatizes any non-heterosexual form of behavior, identity, relationship, or community. The experience of being stigmatized is at the root of a range of health problems faced by sexual minority adolescents including increased depression, suicide risk, and other mental health disorders. Few researchers have examined the emotional consequences of day-to-day encounters with heterosexism, but many have noted the challenge of maintaining a positive sense of self in the face of chronic negative feedback based in heterosexist attitudes. Recent research has revealed elevated levels of social anxiety in sexual minority adolescents, as well as associations between social anxiety and increased risky sexual behavior.

Forms of heterosexist experiences vary widely, ranging from casual anti-gay remarks to severe physical violence or total social exclusion. Youth encounter heterosexism in diverse settings, including home, school, church, parks, and on the street. Sources of heterosexism were equally wide-ranging, including family members, schoolmates, friends, and religious leaders.

Few researchers have examined the emotional consequences of day-to-day encounters with heterosexism.

Heteroterosexist attitudes by family appeared to be especially stressful for gay youth, in part due to these youths’ emotional and financial dependence on their families. The holiday season, the period between Thanksgiving and New Year’s Day, accounts for many family disruptions over the issue of a child’s sexulity. Youth see this period and the typical gatherings of their nuclear family as an opportunity to begin talking about their true selves. Not coincidentally, this time of year is when the highest incidents of family disruptions occur. Large cities such as San Francisco and New York see an influx of gay youth fleeing their homes and ultimately seeking social services. Relatedly, when television covers an LGBT matter, be it marriage equality or the trauma of the Orlando, FL mass killing at a gay bar, conflicts ensue in families. In 2011, when New York State passed marriage equality, the Ali Forney Center of New York reported a 40 per cent increase in drop-in rates at its youth shelter in New York.

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