[HN Gopher] MDMA-assisted couples therapy investigated in pilot ...
___________________________________________________________________
MDMA-assisted couples therapy investigated in pilot trial
Author : futureguy
Score : 168 points
Date : 2020-12-09 19:57 UTC (3 hours ago)
(HTM) web link (newatlas.com)
(TXT) w3m dump (newatlas.com)
| stakkur wrote:
| I tried this therapy in the late 80s. It didn't work; my
| girlfriend left with the bass player after the party.
| werber wrote:
| My family went through some pretty tumultuous times that created
| a giant rift where there was no communication from my early
| adolescence into early adulthood with one side of my family and
| one night of taking mdma with my closest cousin from childhood
| was able to facilitate a remediation. However when I've taken it
| recreationally without a goal in mind it has been such a painful
| experience in the following days, which isn't every users
| experience, but for myself without meaningful emotional resolve
| the drug left me feeling incredibly depressed. With that being
| said, I hope anyone who wants to experiment with it invests in a
| safety kit ( https://dancesafe.org/product/mdma-testing-kit/ ),
| no matter your intention
| heavyset_go wrote:
| Yeah, MDMA is a heavy 5HT releaser, which is the cause of post-
| MDMA depression after as little as one dose. I wish other
| relatives to MDMA were investigated, too, like bk-MDMA. It
| results in less 5HT release, has the same effects as MDMA, but
| doesn't have a come down with depression as a symptom unless
| abused.
| therealx wrote:
| Interesting. By abused, do you mean prolonged use over many
| days or large one time dosage or both? If the one time use
| definition, can you reach a threshold dose for what one
| considers an mdma experiance and still avoid the bulk of
| depression?
| therealx wrote:
| I just checked erowid and it seems to be a very different
| experiance. Still seems interesting!
| taurath wrote:
| Also supplements are mandatory to prevent a really large
| comedown period - the most important being alpha-liproic acid,
| to avoid neurotoxicity.
| uoaei wrote:
| 5-HTP is a precursor to serotonin and taking it for about a
| week before your experience allows your body to synthesize
| more to replace all the serotonin that gets used during the
| experience.
|
| For more information look into "pre-loading" for MDMA
| experiences.
| com2kid wrote:
| > 5-HTP is a precursor to serotonin and taking it for about
| a week before your experience allows your body to
| synthesize more
|
| Prolonged use of 5-HTP will also cause heart problems, same
| reason fen-phen does. https://en.wikipedia.org/wiki/Fenflur
| amine/phentermine#Adver...
|
| I don't know of any studies of exactly how much is needed
| to cause problems, before taking 5-htp one might want to
| look into that!
|
| I am always rather concerned that 5-htp is available OTC,
| and is even added to energy drinks, when it is known to
| have such harmful effects.
| pvarangot wrote:
| 5-HTP will do nothing to your serotonin levels if you are
| healthy. That's mostly anecdotal evidence from communities
| that are usually looking into using it with more frequency
| that what most experts agree that you should be using it.
|
| It is recommended as post-loading by psychiatrists but also
| based on their anecdotal experience with patients.
| taurath wrote:
| Agree with this. It also must be taken at least 24 hours
| afterwards in order to ensure that you've finished
| metabolizing the MDMA or else the newly available
| serotonin will make the drugs effect more continuous.
| com2kid wrote:
| Fun fact, assuming you meant lipoic not liproic, large doses
| of R-ALA will put someone into a ketogenic state.
|
| From what I understand, ALA is rather unstable and degrades
| quickly, so for accurate dosing using stablized r-ala.
|
| Anyway, about 1000mg and you'll be in ketosis a couple hours
| later!
| taurath wrote:
| Yes, and large doses are not recommended. 100mg every few
| hours while under effect of MDMA.
| pvarangot wrote:
| Supplements are not mandatory even on semi-legal MDMA
| assisted psychotherapy and in research studies. I don't know
| were you got that from. If they are effective or not is also
| a matter of debate, the specific action mechanisms are not
| well understood even in simple models like mice, and all the
| evidence in humans in anecdotal.
|
| They are only recommended and it's usually preloading and not
| postloading.
|
| The most common side effect on people with ASD is anxiety and
| difficulty concentrating, and on people with PTSD it's
| anxiety or depression. They happen in around 50% to 25% of
| the population and they also happen on people taking placebo.
| Here we are talking about people _with an actual serious
| mental condition_ that is leading to chronic social anxiety
| or dissociative episodes even when not under the influence of
| any drug.
|
| That's all data from MAPS sponsored published research
| studies. I'm not sure where you got the idea that supplements
| are mandatory to prevent a really large comedown period, but
| I think you might have confused yourself from reading too
| much anecdotal data, or you have been lied to.
|
| Data gathered from surveys on recreational users point out
| that depression happens only in something like 10% to 15% of
| the population but it's tricky to get conclusions from self
| reported studies.
| taurath wrote:
| Personal experience and the experience of a lot of people
| who have used MDMA, backed up by the studies below. I'm not
| saying you will become depressed. MOST people feel a "fried
| out" feeling the next couple days unless supplementation is
| taken, and that effect is well studied and established.
|
| https://pubmed.ncbi.nlm.nih.gov/10619665/
|
| Here is the basing study - and the neurotoxic effects of
| MDMA being metabolized to MDA in vitro are well documented.
|
| https://pubmed.ncbi.nlm.nih.gov/2457659/
|
| Yes - these are rat models. But it's not like we are
| allowed to test for toxicity in humans at these levels.
| ketamine__ wrote:
| Drug users like to see themselves as experts. It makes them
| feel smart. It's really that simple.
| pvarangot wrote:
| I was also thinking that the person I replied to was
| getting their anecdotal data from drug user groups or
| communities or online "how to trip" wikis, but I
| understand that I'm biased. I was just calling to
| attention that it may be wiser to get your information
| from people actually gathering data in an unbiased way
| and from large populations.
|
| That being said, ketamine__, I do agree with your general
| statement about some drug users thinking their use makes
| them smarter or wiser, it's a common indication of
| addiction though. Specially among people that are highly
| functional among society or in disciplines like
| engineering or the sciences.
| taurath wrote:
| Please see my response above. It is based on, YES,
| experience from communities but also backing from
| scientific studies.
|
| There are NO large population scientific studies on MDMA
| usage. The scientific data that does exist absolutely
| supports supplementation. I am not a current user of MDMA
| nor a "druggie", but I attribute an enormous amount of my
| personal growth to its occasional use in conjunction with
| therapy in my 20s.
| loves_mangoes wrote:
| I'm glad to learn about alpha-liproic acid, and on the same
| theme the beta (and alpha1) blocker Carvedilol taken 1h
| before has been found [0] to reduce hyperthermia and other
| cardiotoxic effects of MDMA without "affecting the subjective
| effects".
|
| This is your threadly reminder to practice harm reduction if
| you plan to take neuro- and cardiotoxic drugs like MDMA =)
|
| [0] https://pubmed.ncbi.nlm.nih.gov/22404145/
| bennysonething wrote:
| Genuine question, is mdma cardio toxic? Thought that was
| cocaine?
| therealx wrote:
| Many drugs are, but youre (I think), thinking of the
| study where they accidently used meth instead of MDMA.
| pvarangot wrote:
| It's not clear it's cardiotoxic even on heavy users. Most
| research points out that it is, but the mechanism is not
| well understood so it may be a correlation as most heavy
| users will not be leading a healthy vascular life.
| cwkoss wrote:
| Note that it is spelled alpha-lipoic acid - no 'r'
| PragmaticPulp wrote:
| Good to see some progress in this area.
|
| As usual, it's important to emphasize that this research is about
| therapy, with MDMA as an additional modulator on top of the
| therapy. In this case, 15 therapy sessions over a period of 7
| weeks. MDMA was only involved in 2 of the 15 sessions. If I'm
| reading the paper correctly, patients received 3 therapy sessions
| before MDMA was introduced and the bulk of reported improvements
| happened prior to MDMA being added. Looking at the graphs, there
| aren't any obvious score increases around the MDMA sessions. In
| fact, I couldn't tell when the MDMA was introduced without
| reading the methodology section.
|
| The study was also limited to 6 couples, with no control group.
| Note that the control group in this case doesn't have to be a
| placebo group, because it's too obvious if someone has taken a
| powerful drug. Instead, the control group would simply receive
| therapy without MDMA and results would be compared. The
| difference would begin to show the benefit of therapy+MDMA over
| therapy alone, which is critically important in these trials. You
| can't just give people 15 therapy sessions and then attribute the
| benefits to 2 doses of MDMA.
|
| People tend to see these headlines and assume that the drug is
| doing all the work, or that they can simply replicate the results
| by taking the drug and seeing what happens. This is usually
| backed up by a couple of random positive anecdotes in the comment
| section while anyone with negative experiences is downvoted or
| dismissed.
|
| Please don't assume you can replicate these results with ad-hoc
| experimentation with street drugs. If you browse Reddit, it's not
| hard to find anecdotes from people who have mistaken the short-
| term effects of these drugs for long-term healing, which usually
| results in them reaching out for more drugs the next time they
| have problems. Once people convince themselves that the drug is
| the easy solution to their problems, they're on their way to low-
| level addiction.
| therealx wrote:
| I actually had long term healing from MDMA, and had no problems
| putting it down at any time. Of course people with addictive
| personalities can get addicted, but thats true of almost
| anything.
| pvarangot wrote:
| It's normal to get the glowy MDMA feeling in a good
| "breakthrough" therapy session or deep conversation with a
| friend. So yeah if you just take a pill and look at the wall
| you'll know, but in a very warm social context or a good
| therapy session you may get the serotonin rush out of a
| placebo.
| ketamine__ wrote:
| > Once people convince themselves that the drug is the easy
| solution to their problems, they're on their way to low-level
| addiction.
|
| What's the difference between this and being prescribed an
| antidepressant? I'd argue there is no difference except that
| self-medicating is much less likely to work.
| jskajakzkjx wrote:
| MDMA induces tolerance and requires dose escalation for
| redosing after the acute effects wear off. It's like benzos,
| heroin, or speed in that respect. At least it will stop
| working eventually so few people would compulsively redose
| every day, but I've seen people who did it every weekend and
| eventually had a very bad time. Antidepressants, on the other
| hand, are designed for daily use (and generally require
| sustained use to be effective). The dynamic where you want
| more so you keep increasing your dose to fight tolerance
| until you end up worse than you started is less of a risk.
|
| I don't mean to attack MDMA. I think it's great, and a lot of
| people could benefit from if. But I think this is a real
| issue if it's easily available outside of a therapeutic
| context.
| sneak wrote:
| > _which usually results in them reaching out for more drugs
| the next time they have problems_
|
| "I hate to advocate drugs, alcohol, violence, or insanity to
| anyone, but they've always worked for me."
|
| -- Hunter S. Thompson
| PragmaticPulp wrote:
| I know this comment was meant to be facetious, but this is
| actually how many people spiral into addiction. Recreational
| drugs feel like they're "working" when they make the person's
| problems temporarily disappear, but in reality the person
| hasn't solved anything. When the problems inevitably return,
| the temptation is to reach for more drugs. Tolerance is real,
| though, so people tend to reach for escalating doses over
| time. The cumulative effects of drug abuse and avoidance
| behavior begin to add up, compounding the original problems
| and digging the person into an even deeper hole.
|
| That's why these successful programs are always therapy-
| first, rather than drug-first. The focus is first on
| identifying and fixing problems, using drugs to potentially
| amplify the therapy rather than avoid the problems.
|
| Sadly, most of these studies lack any control groups (e.g.
| therapy-only) to compare against. If you look at the graphs
| in the study, patients were already reporting massive
| improvements after the first 3 therapy sessions, before
| taking any MDMA at all. Unfortunately, I don't think we can
| draw any conclusions about the MDMA in this study other than
| it didn't appear to make things worse when it was introduced.
| bennysonething wrote:
| I took way to much mdma when I was in my twenties, it
| really messed up my short term memory and I'm pretty
| certain the affects on my memory are still there. At the
| time I think it started to mess with my confidence too. I
| had some great times on it and actually meet my future wife
| on it. Over all I wish I'd never tried it though. It was
| too good. Then after a while the nastier side of it
| outweighed the fun and we stopped doing it.
|
| I can definitely see how it could help couples talk through
| their difficulties and it seems to bond people closer
| together.
|
| As an aside I know a guy who completely fucked himself by
| doing mdma farvto much. It was really sad to meet him after
| a few years, he'd gone from happy outgoing to a paranoid
| mess.
| girvo wrote:
| The other more difficult issue (and was my personal one) is
| when you lean on drugs (opiates in my case) to try and
| solve _unsolvable_ issues.
|
| That's a recipe for addiction, more so than anything else.
| RangerScience wrote:
| IMO the difference between a drug, a medicine, and a
| psychedelic is behavioral more than substantive, although
| different substances do have more or less tendency for
| abuse.
|
| Morphine is a medicine until you take like a drug. MDMA is
| a psychedelic at a rave and a medicine on a therapist's
| couch. By all reports, there's no possible way to abuse
| ayahuasca.
|
| You will have more mileage with someone experienced, and
| more still with a professional, just like you would with
| other therapy practices that you can teach yourself, like
| meditation and yoga.
|
| AFAIK addiction is mostly about a person's life, and not
| the things they ingest. That's why rehab clinic success is
| so heavily dependent on the support network (or lack
| thereof) the person returns to. You have to have something
| to avoid in the first place to turn to substances to avoid
| them.
| tpm wrote:
| Unfortunately (and I am a fan of psychedelics when used
| in the 'right' way) I think it is indeed possible to
| abuse psychedelic drugs, not perhaps in the sense of
| addiction, but it can still be a habit (with negative
| consequences) of sorts for some people, either alone or
| as a part of polysubstance abuse, or be used to
| manipulate people who are more susceptible under the
| influence. I have seen some examples of this.
| pmoriarty wrote:
| _" By all reports, there's no possible way to abuse
| ayahuasca."_
|
| I don't know where you heard this, but this is a highly
| dubious assertion.
|
| I know people who have in fact abused ayahuasca, take it
| compulsively, and have had negative impacts on their life
| from taking it.
|
| There's a long and sad history of various drugs being
| claimed to be harmless or even beneficial, only to have
| it revealed later that they aren't.
|
| Cocaine was such a drug, with Freud being a huge fan of
| it, claiming it as a miracle cure with no potential for
| abuse. In fact it was used to treat morphine addiction.
|
| Heroin was also initially used as a treatment for
| morphine addiction.
|
| The methadone came around, and was used to treat heroin
| addiction. But, surprise! It turns out that just like
| heroin and cocaine, methadone itself can be addictive.
|
| Marijuana was widely hyped as completely harmless, but it
| turns out that some people can get (psychologically)
| addicted to it, abuse it, and suffer negative effects.
|
| Anything (whether drug, activity, object, or food) that
| is highly desirable can be abused.
| RangerScience wrote:
| > I know people who have in fact abused ayahuasca
|
| I am super interested in hearing more details. Can you
| share?
| therealx wrote:
| I haven't heard of it either, but it's mostly a
| proglonged, enhanced DMT trip, and I know people who got
| addicted to DMT, so I could believe it?
| scythe wrote:
| >The methadone came around, and was used to treat heroin
| addiction. But, surprise! It turns out that just like
| heroin and cocaine, methadone itself can be addictive.
|
| That's a little unfair to methadone. It _is_ less
| addictive than heroin and morphine. But users figured out
| how to combine it with other drugs to get a stronger
| high, which led to some recreational abuse. It 's sad
| that these maintenance programs are so widely disparaged
| when they are in fact valuable treatments for opioid use
| disorder supported by extensive medical evidence that are
| underutilized due to popular misconceptions and paranoia.
|
| https://jamanetwork.com/journals/jama/article-
| abstract/18289...
| mseidl wrote:
| I remember reading an article or something that was something
| like "Soldiers with PTSD try MDMA, give rave reviews"
| uoaei wrote:
| Straight from the source: https://maps.org/research/mdma
|
| MAPS does pretty much all of the coordination with the FDA
| and other regulatory bodies for making these studies
| possible.
| pmoriarty wrote:
| _" Note that the control group in this case doesn't have to be
| a placebo group, because it's too obvious if someone has taken
| a powerful drug."_
|
| It's not, actually. I've heard interviews with researchers in
| other MDMA studies saying that there were subjects who were
| absolutely convinced they got MDMA, and acted like they were on
| it, but when the double-blind study was over it was revealed
| that they didn't.
|
| Never underestimate the power of placebos or of the human mind.
| fblp wrote:
| Interesting. Got a link to a study?
| pmoriarty wrote:
| Not off hand. About a year ago I watched and listened to a
| huge number of talks and videos on psychedelics in general
| and psychedelic therapy in particular, and it was at one of
| those that I heard an MDMA researcher mention this.
|
| My best guess is that it was at a video of a talk or
| interview given on the _Aware Project_ [1], or on an
| episode of the _Psychedelic Salon_ [2]
|
| [1] -
| https://www.youtube.com/channel/UC0oErWkP157InE47YAuhzPg
|
| [2] - https://psychedelicsalon.com/
| mattkrause wrote:
| Here's crazy case report of man who "overdosed" on placebos
| given to him as part of a blinded clinical trial.
|
| https://pubmed.ncbi.nlm.nih.gov/17484949/
|
| His blood pressure crashed (80/40 initally, 100/62 after
| several hours of IV fluids) and his heart rate was over 100
| bpm. When he found out the pills he had taken were inert, he
| bounced back almost immediately.
| mjburgess wrote:
| just a panic attack
| mattkrause wrote:
| It's obviously psychosomatic (which is why I brought it
| up) but it's different from a garden-variety panic
| attack:
|
| - Blood pressure tends to shoot up, rather than down,
| during a panic attack. - Four hours would be incredibly
| long; they're usually more like 20 minutes
| crazygringo wrote:
| Wow, that is bizarre. At first I'd say it seems unbelievable,
| but then when you think of people in churches speaking in
| tongues, etc. -- I guess I could see it.
|
| But if you've ever _done_ MDMA you 'd certainly know it was a
| placebo, so it feels like these are people who never had, but
| _imagined_ what they thought it _ought_ to be like.
|
| I'd actually be incredibly curious to hear their description
| of it? Especially since everyone knows what people act like
| when drunk or on cocaine... but I'm not quite sure people
| have as definite an idea of MDMA?
| majormajor wrote:
| > But if you've ever done MDMA you'd certainly know it was
| a placebo, so it feels like these are people who never had,
| but imagined what they thought it ought to be like.
|
| There have been times when the effect of coffee or
| marijauna hits me after a few sips/a bite of an edible,
| which _feels_ placebo-y. But then I 'm aware that it seems
| to be too fast, even as I start to feel it so fast, so
| could that still be a placebo effect?
|
| I don't know, but it confuses me.
| pvarangot wrote:
| The first MDMA experience is usually very surprising, yes,
| but not for everyone. Depending on how you usually regulate
| your serotonin release, getting a very similar feeling to
| that of a run of the mill "roll" may happen if you are just
| very happy or melancholic or introspective. A very deep
| conversation about something that you have been wanting to
| let go for a while or a therapy breakthrough can elicit
| that feeling.
|
| I don't know about this couples therapy thing, but remember
| that in most of this trials researchers are dealing with
| somehow of an "unstable" brain chemistry. Individuals with
| PTSD or ASD tend to dissociate even when sober and to be
| very sensitive to mindset and setting and believing they
| took a pill that is going to make their struggles go away
| while talking with a therapist can be a very warm and
| welcoming setting.
|
| That being said, I also would like to point out that how
| people act on cocaine is usually heavily misunderstood and
| most of the stereotype of someone under the influence of
| cocaine is usually how people act on cocaine+some other
| strong stimulant like pseudo-efedrine. Cocaine was used
| medically for a long while and it's effects are very well
| understood and not similar to the usual "that person is on
| coke" stereotype.
| twic wrote:
| > But if you've ever done MDMA you'd certainly know it was
| a placebo
|
| What's the dose used in the experiment? Similar to a
| recreational dose, or much smaller? If it was much smaller,
| i could imagine people not really being able to tell.
|
| EDIT: The paper [1] says there are two MDMA 'sessions',
| about three weeks apart, and:
|
| > Each partner was given 75 mg MDMA in the first MDMA
| session, and 100 mg in the second MDMA session, with an
| optional supplemental half-dose 1.5 hours later in both
| sessions (participants were informed that the supplemental
| half-doses could prolong the therapeutic window of MDMA
| effects).
|
| I am told that a typical recreational dose of MDMA is 100
| mg. More concretely, an Orange Tesla is ~250 mg, so make of
| that what you will.
|
| [1] https://www.tandfonline.com/doi/full/10.1080/20008198.2
| 020.1...
| jcampbell1 wrote:
| 1mg per lb of body weight is about what is required to
| "roll" for a very infrequent user. I personally think it
| is a pretty ideal drug to use no more than twice per yer
| with a partner, and you sure as hell don't want a
| therapist in the room, as it would waste the physical
| intimacy effects.
| bawolff wrote:
| Its a common joke in teen tv shows, where the main
| character is supposed to obtain alcohol but can't so buys
| non alcoholic beer, but everybody thinks its the real thing
| and nobody notices.
|
| Not sure how based in reality that is, but seems to imply a
| similar effect for other drugs might be real.
| mlyle wrote:
| Clearly you've never seen one of the kegger pranks where
| someone buys a keg of non-alcoholic beer and everyone acts
| drunk :P
| sushisource wrote:
| Indeed. It's something I rarely hear mentioned, but I have
| found valuable about recreational drugs - they teach you a
| _lot_ about how your body works and what certain things
| feel like. A lot like tasting a spice in isolation allows
| you to pick it out in a complete dish.
| tenaciousDaniel wrote:
| I'd bet that that was one of the controls in the study -
| targeting participants who had never used MDMA before.
| Otherwise it would affect the integrity of the placebo
| group.
| zepto wrote:
| Also people who didn't receive a placebo who didn't seem to
| respond at all and claimed to have received a placebo.
| yboris wrote:
| A very related book on the topic: _Love Drugs: The Chemical
| Future of Relationships_ by Brian D. Earp And Julian Savulescu
|
| https://www.sup.org/books/title/?id=27130
| el_dev_hell wrote:
| Note: the below is an anecdote from my life. I have no
| medical/psychological training past a psy 101 class in uni.
|
| I took a fair amount of MDMA in my late teens/early twenties.
| Mostly in nightclubs and music festivals. It was cool at the time
| (great memories and the music 100% was better).
|
| In my late twenties (after 5+ years without MDMA), my partner and
| I decided to roll after getting some MDMA off the dark web. We
| went to a bar, which was my past go-to, and had an OK night. We
| left pretty early and went home.
|
| When we got home, we had 100mg left each and decided to roll in
| the peace of our house. We both dropped a cap and spent the next
| 6 hours having very deep conversations and just caressing each
| other (I especially enjoyed touching her hair).
|
| We didn't have any major issues in our relationship leading up to
| that night, but we did have a bit of friction over our future
| plans. After that one night, our relationship was at least 30%
| more pleasant and we both felt significantly closer to each
| other.
|
| We still have a great relationship 2 years later. Obviously, the
| MDMA isn't the only factor, but it helped to dramatically
| strengthen our feelings towards each other.
|
| One downside was sex. She was very in the mood and I was unable
| to perform on MDMA.
|
| YMMV.
| GordonS wrote:
| Just wanted to say that I appreciate you sharing this
| interesting, personal story!
| ttul wrote:
| 20mg Cialis, just saying.
| tlb wrote:
| The value of a dramatically improved relationship can be
| equivalent to several years of life. Ask anyone who's been in a
| failing marriage. So the value of a therapy that helps fix
| relationships would rank among the great breakthroughs of modern
| medicine.
|
| It's a shame that research has been hampered by the war on drugs.
| Some day our descendants will look back on the prohibition on
| research towards such therapies as one of the great own-goals of
| our species.
| cmehdy wrote:
| Link to the research article:
| https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1...
|
| While studies of this kind are still very hard to make and very
| limited in scope (in this case, uncontrolled and with a very
| small sample size), I'm glad to see that we are lifting the
| unnecessary taboos around things like MDMA so that proper
| research can begin to get done (with 6-8 decades of delay
| compared to what we could have had, but still).
|
| Props to MAPS (Multidisciplinary Association for Psychedelic
| Studies) in the US for paving the way to that change.
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(page generated 2020-12-09 23:01 UTC)