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MDMA heads to Phase 3 trials for helping PTSD
A new study shows success in a series of Phase 2 trials.
- A new study in Psychopharmacology shows MDMA has a 50 percent efficacy rate for PTSD victims.
- A series of six controlled, double-blind studies moves research to Phase 3 trials.
- Combined with psychotherapy, MDMA could be a potent force in treating one of the our most challenging problems.
Over 8 percent of Americans will suffer from post traumatic stress disorder (PTSD) at some point in their lives, which is double the global average. Considering the current world population, that means roughly 308 million people will experience short-term or chronic PTSD from a variety of triggers: war, sexual assault, bullying — an entire list of invasive assaults. We're simply not equipped to handle such cognitive and emotional overload.
Which is why treatments are so badly needed. Last year, the Multidisciplinary Association for Psychedelic Studies (MAPS) published a study in The Lancet Psychiatry showing a 68 percent efficacy rate in PTSD symptom reduction; patients in that trial no longer needed ongoing treatment. It was another step on a decades-long battle to remove MDMA from Schedule 1 by proving its therapeutic value.
Now a new study, this one published in Psychopharmacology on May 7, combines the research of six Phase 2 studies on MDMA in order to move the research onto Phase 3. The tortoise-like approach that MAPS has taken since its 1986 founding has been critically important in opening a dialogue about the value of psychedelics. Of course, governmental oversight of these substances has not exactly been progressive.
But there is forward movement. As Michael Pollan notes in his opus on this topic, How to Change Your Mind, given the lack of continual efficacy and troublesome side effects of current pharmacological treatments, governmental agencies are now taking a hands-off approach to substances like psilocybin and MDMA. In fact, research is being requested.
How MDMA and psychedelic drugs can assist mental health
"I… learned about the unique effects of MDMA and why it was used in couple's therapy prior to being placed on Schedule 1 list. Using a drug only a few times to enhance therapeutic processing to resolve underlying issues that cause PTSD symptoms seemed like an approach worth investigating."
MDMA increases the amount of serotonin, dopamine, and noradrenaline neurotransmitters in certain regions of the brain. Though ecstasy became victim to a bad public image in the '90s for being associated with kids at raves not drinking enough water while dancing all evening, little attention was paid to dosage and environment. As with many mind-altering substances, fear mongering usurped a levelheaded, rigorous clinical approach to better understanding how these drugs can benefit us.
The six trials included in this study were conducted between 2004–2017. A total of 103 volunteers took part. Participants underwent two or three 90-minute psychotherapy sessions prior to ingesting MDMA to establish a baseline for their conditions. This was followed by two to three supervised MDMA (or placebo) sessions. Volunteers remained overnight; a 90-minute "integration" session followed.
In total, half of the volunteers no longer met the clinical criteria for PTSD after their MDMA sessions. This is compared to 23 percent in the placebo group. This remained true after a year of follow-ups, which is especially important given that many pharmaceutical treatments require daily usage to remain effective.
Researchers are not certain why substances in the serotonin-producing family "reboot" people's psychological condition. One speculative idea is perspective. For example, LSD has shown efficacy in treating addiction issues. While on the psychedelic journey, a new worldview is introduced. When the subjects realize how their addictions destroy their bodies, they vow to change after the journey is over. Something about the realization coupled with neurochemistry makes the changes stick.
A dose of MDMA in the office of Dr. Michael Mithoefer, a psychiatrist, who has studied the use of MDMA as a treatment for PTSD in Mount Pleasant, SC, USA on August 24, 2017.
Photo by Travis Dove for The Washington Post via Getty Images
For some reason, psychedelics offer, at least in parts of the population, a "wake-up" powerful enough to reorient their relationship to reality. MDMA appears to have a similar function: experiencing the "bliss" associated with the substance, volunteers integrate the experience deeply enough to shift their outlook. The trauma of the past no longer holds as much power over them.
How this correlates on a neurochemical level remains to be seen. Yet as the study authors note, the efficacy of these Phase 2 trials is dependent upon MDMA and psychotherapy. Taking the substance but not being offered professional guidance might not prove as effective in long-term integration regardless of chemical interactions. As has long been espoused in the psychedelic community, set and setting are equally important factors in the experience; drugs alone will not do the trick.
Minor side effects were recorded during the sessions, including anxiety, dizziness, jaw clenching, nausea, and lack of appetite. Still, given the overwhelming and profound nature of the experience, the team notes that MDMA has "a low potential for abuse." None of the volunteers reported craving more; a number of respondents said they did not find pleasure, and that it was "rather difficult therapeutic work delving into their traumatic memories."
As Feduccia says of the research, the road ahead is long. But this is an important step in overturning decades of misinformation about substances like MDMA and their therapeutic potential. If Phase 3 trials hold up, an entirely new — and more importantly, sanctioned — line of treatment could open up.
"It has taken many decades to reach this point for MDMA drug development," she says. "We are seeing a shift in public opinion as scientific evidence builds support for use of MDMA and psychedelics for treating mental health conditions. These are exciting times we live in, and could very well likely be on the cusp of a new paradigm for psychiatric medicine."
Andy Samberg and Cristin Milioti get stuck in an infinite wedding time loop.
- Two wedding guests discover they're trapped in an infinite time loop, waking up in Palm Springs over and over and over.
- As the reality of their situation sets in, Nyles and Sarah decide to enjoy the repetitive awakenings.
- The film is perfectly timed for a world sheltering at home during a pandemic.
Richard Feynman once asked a silly question. Two MIT students just answered it.
Here's a fun experiment to try. Go to your pantry and see if you have a box of spaghetti. If you do, take out a noodle. Grab both ends of it and bend it until it breaks in half. How many pieces did it break into? If you got two large pieces and at least one small piece you're not alone.
But science loves a good challenge<p>The mystery remained unsolved until 2005, when French scientists <a href="http://www.lmm.jussieu.fr/~audoly/" target="_blank">Basile Audoly</a> and <a href="http://www.lmm.jussieu.fr/~neukirch/" target="_blank">Sebastien Neukirch </a>won an <a href="https://www.improbable.com/ig/" target="_blank">Ig Nobel Prize</a>, an award given to scientists for real work which is of a less serious nature than the discoveries that win Nobel prizes, for finally determining why this happens. <a href="http://www.lmm.jussieu.fr/spaghetti/audoly_neukirch_fragmentation.pdf" target="_blank">Their paper describing the effect is wonderfully funny to read</a>, as it takes such a banal issue so seriously. </p><p>They demonstrated that when a rod is bent past a certain point, such as when spaghetti is snapped in half by bending it at the ends, a "snapback effect" is created. This causes energy to reverberate from the initial break to other parts of the rod, often leading to a second break elsewhere.</p><p>While this settled the issue of <em>why </em>spaghetti noodles break into three or more pieces, it didn't establish if they always had to break this way. The question of if the snapback could be regulated remained unsettled.</p>
Physicists, being themselves, immediately wanted to try and break pasta into two pieces using this info<p><a href="https://roheiss.wordpress.com/fun/" target="_blank">Ronald Heisser</a> and <a href="https://math.mit.edu/directory/profile.php?pid=1787" target="_blank">Vishal Patil</a>, two graduate students currently at Cornell and MIT respectively, read about Feynman's night of noodle snapping in class and were inspired to try and find what could be done to make sure the pasta always broke in two.</p><p><a href="http://news.mit.edu/2018/mit-mathematicians-solve-age-old-spaghetti-mystery-0813" target="_blank">By placing the noodles in a special machine</a> built for the task and recording the bending with a high-powered camera, the young scientists were able to observe in extreme detail exactly what each change in their snapping method did to the pasta. After breaking more than 500 noodles, they found the solution.</p>
The apparatus the MIT researchers built specifically for the task of snapping hundreds of spaghetti sticks.
(Courtesy of the researchers)
What possible application could this have?<p>The snapback effect is not limited to uncooked pasta noodles and can be applied to rods of all sorts. The discovery of how to cleanly break them in two could be applied to future engineering projects.</p><p>Likewise, knowing how things fragment and fail is always handy to know when you're trying to build things. Carbon Nanotubes, <a href="https://bigthink.com/ideafeed/carbon-nanotube-space-elevator" target="_self">super strong cylinders often hailed as the building material of the future</a>, are also rods which can be better understood thanks to this odd experiment.</p><p>Sometimes big discoveries can be inspired by silly questions. If it hadn't been for Richard Feynman bending noodles seventy years ago, we wouldn't know what we know now about how energy is dispersed through rods and how to control their fracturing. While not all silly questions will lead to such a significant discovery, they can all help us learn.</p>
The multifaceted cerebellum is large — it's just tightly folded.
- A powerful MRI combined with modeling software results in a totally new view of the human cerebellum.
- The so-called 'little brain' is nearly 80% the size of the cerebral cortex when it's unfolded.
- This part of the brain is associated with a lot of things, and a new virtual map is suitably chaotic and complex.
Just under our brain's cortex and close to our brain stem sits the cerebellum, also known as the "little brain." It's an organ many animals have, and we're still learning what it does in humans. It's long been thought to be involved in sensory input and motor control, but recent studies suggests it also plays a role in a lot of other things, including emotion, thought, and pain. After all, about half of the brain's neurons reside there. But it's so small. Except it's not, according to a new study from San Diego State University (SDSU) published in PNAS (Proceedings of the National Academy of Sciences).
A neural crêpe
A new imaging study led by psychology professor and cognitive neuroscientist Martin Sereno of the SDSU MRI Imaging Center reveals that the cerebellum is actually an intricately folded organ that has a surface area equal in size to 78 percent of the cerebral cortex. Sereno, a pioneer in MRI brain imaging, collaborated with other experts from the U.K., Canada, and the Netherlands.
So what does it look like? Unfolded, the cerebellum is reminiscent of a crêpe, according to Sereno, about four inches wide and three feet long.
The team didn't physically unfold a cerebellum in their research. Instead, they worked with brain scans from a 9.4 Tesla MRI machine, and virtually unfolded and mapped the organ. Custom software was developed for the project, based on the open-source FreeSurfer app developed by Sereno and others. Their model allowed the scientists to unpack the virtual cerebellum down to each individual fold, or "folia."
Study's cross-sections of a folded cerebellum
Image source: Sereno, et al.
A complicated map
Sereno tells SDSU NewsCenter that "Until now we only had crude models of what it looked like. We now have a complete map or surface representation of the cerebellum, much like cities, counties, and states."
That map is a bit surprising, too, in that regions associated with different functions are scattered across the organ in peculiar ways, unlike the cortex where it's all pretty orderly. "You get a little chunk of the lip, next to a chunk of the shoulder or face, like jumbled puzzle pieces," says Sereno. This may have to do with the fact that when the cerebellum is folded, its elements line up differently than they do when the organ is unfolded.
It seems the folded structure of the cerebellum is a configuration that facilitates access to information coming from places all over the body. Sereno says, "Now that we have the first high resolution base map of the human cerebellum, there are many possibilities for researchers to start filling in what is certain to be a complex quilt of inputs, from many different parts of the cerebral cortex in more detail than ever before."
This makes sense if the cerebellum is involved in highly complex, advanced cognitive functions, such as handling language or performing abstract reasoning as scientists suspect. "When you think of the cognition required to write a scientific paper or explain a concept," says Sereno, "you have to pull in information from many different sources. And that's just how the cerebellum is set up."
Bigger and bigger
The study also suggests that the large size of their virtual human cerebellum is likely to be related to the sheer number of tasks with which the organ is involved in the complex human brain. The macaque cerebellum that the team analyzed, for example, amounts to just 30 percent the size of the animal's cortex.
"The fact that [the cerebellum] has such a large surface area speaks to the evolution of distinctively human behaviors and cognition," says Sereno. "It has expanded so much that the folding patterns are very complex."
As the study says, "Rather than coordinating sensory signals to execute expert physical movements, parts of the cerebellum may have been extended in humans to help coordinate fictive 'conceptual movements,' such as rapidly mentally rearranging a movement plan — or, in the fullness of time, perhaps even a mathematical equation."
Sereno concludes, "The 'little brain' is quite the jack of all trades. Mapping the cerebellum will be an interesting new frontier for the next decade."
What happens if we consider welfare programs as investments?
- A recently published study suggests that some welfare programs more than pay for themselves.
- It is one of the first major reviews of welfare programs to measure so many by a single metric.
- The findings will likely inform future welfare reform and encourage debate on how to grade success.
Welfare as an investment<p>The <a href="https://scholar.harvard.edu/files/hendren/files/welfare_vnber.pdf" target="_blank">study</a>, carried out by Nathaniel Hendren and Ben Sprung-Keyser of Harvard University, reviews 133 welfare programs through a single lens. The authors measured these programs' "Marginal Value of Public Funds" (MVPF), which is defined as the ratio of the recipients' willingness to pay for a program over its cost.</p><p>A program with an MVPF of one provides precisely as much in net benefits as it costs to deliver those benefits. For an illustration, imagine a program that hands someone a dollar. If getting that dollar doesn't alter their behavior, then the MVPF of that program is one. If it discourages them from working, then the program's cost goes up, as the program causes government tax revenues to fall in addition to costing money upfront. The MVPF goes below one in this case. <br> <br> Lastly, it is possible that getting the dollar causes the recipient to further their education and get a job that pays more taxes in the future, lowering the cost of the program in the long run and raising the MVPF. The value ratio can even hit infinity when a program fully "pays for itself."</p><p> While these are only a few examples, many others exist, and they do work to show you that a high MVPF means that a program "pays for itself," a value of one indicates a program "breaks even," and a value below one shows a program costs more money than the direct cost of the benefits would suggest.</p> After determining the programs' costs using existing literature and the willingness to pay through statistical analysis, 133 programs focusing on social insurance, education and job training, tax and cash transfers, and in-kind transfers were analyzed. The results show that some programs turn a "profit" for the government, mainly when they are focused on children:
This figure shows the MVPF for a variety of polices alongside the typical age of the beneficiaries. Clearly, programs targeted at children have a higher payoff.
Nathaniel Hendren and Ben Sprung-Keyser<p>Programs like child health services and K-12 education spending have infinite MVPF values. The authors argue this is because the programs allow children to live healthier, more productive lives and earn more money, which enables them to pay more taxes later. Programs like the preschool initiatives examined don't manage to do this as well and have a lower "profit" rate despite having decent MVPF ratios.</p><p>On the other hand, things like tuition deductions for older adults don't make back the money they cost. This is likely for several reasons, not the least of which is that there is less time for the benefactor to pay the government back in taxes. Disability insurance was likewise "unprofitable," as those collecting it have a reduced need to work and pay less back in taxes. </p>