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MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

nature.com

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Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#91

Post by hinkley »

Aurornis wrote: post #68
hinkley wrote: post #28

Earlier quoted context omitted.

If you start with people who know what MDMA feels like, I suspect you're sunk for the reasons you state. But if for instance the placebo were niacin... niacin makes most people feel funny. If you don't know what MDMA or a niacin flush feels like, you might just know something is happening but not what. And then you test people who don't experience niacin flush with or without a placebo to make sure that niacin isn't…

Blinding isn’t just about the patients - It’s about the therapy providers as well. We would like to think they’d provide the same treatment regardless of what the patient received but over-eager researchers tend to get more excited about the active group and provide them more attention and enthusiasm. Niacin isn’t a great placebo these days because it’s not the 70s any more and people going into these studies will pr…

Isn’t that why many psychiatric experiments engage in some misdirection?

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#92

Post by tmpX7dMeXU »

d1lanka wrote: post #67
rexpop wrote: post #40

Earlier quoted context omitted.

Many people have had bad trips on MDMA. I don't know where this reputation comes from, but it's common to have extremely intense and unpleasant emotions, sensations, or thoughts. Anxiety, agitation, muscle tension, sweating, and/or chills are all documented effects of the drug. For a dozens of anecdotes, just search "MDMA bad trip".

Meh. What's your source? Yes, those things can of course happen, but they're very rare and in the minority. It is absolutely NOT common to have a "bad" experience with a drug that is chemically designed to make you feel incredible via serotonin depletion.

OK. Firstly, people in academia don’t even talk like this (“what’s your source!”). Secondly, you’re fighting anecdotes with anecdotes, which is fine, except you’re trying to pull the ladder up after you.

You’re coming across as an MDMA fanboy and the way that you’re approaching the conversation will have if anything a negative impact on “the cause”.

MDMA wasn’t ‘designed’ to do anything. It happens to do something. I’m surprised that you’re even phrasing it this way because MDMA fanboys tend to obsess over the lore of its discovery.

I have been present for bad MDMA trips. One of these people has C-PTSD (putting aside the controversy about its existence), and had a C-PTSD-related bad trip, which seems highly highly relevant to this topic.

I’ve done a bunch of MDMA. I’m certainly going to do a bunch more throughout the rest of my life. I’m not going to kid myself about it being perfect. I’m not going to kid myself about the fact that over a large enough population even “improbable” adverse reactions are meaningful. Nerds that do drugs are so often insufferable because they’ll try to intellectualise what’s essentially “God I love drugs and they’re great!”

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#93

Post by tmpX7dMeXU »

Alupis wrote: post #53
singingfish wrote: post #51

Earlier quoted context omitted.

aah research impeded by morality police, understand now, thanks

That may not necessarily be the reason. It could simply be until recently nobody believed there could be positive medical uses for MDMA specifically. Not all recreational drugs have legitimate medical uses, or are better than existing medically prescribed drugs. After our current opioid crisis, it's not unreasonable to assume research on opioid medical usage will decline or stop - outside what has already been studie…

Hah. People have believed in this for some time. MAPS has been around for a while. What you mean is, not the right people, and now we are back to morality policing.

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#94

Post by tmpX7dMeXU »

Alupis wrote: post #33
mountainriver wrote: post #7

Overall seems positive, some interesting pieces: > The only measured exploratory covariate with a significant interaction with treatment was lifetime history of SSRI use, which was associated with improved efficacy of MDMA-AT (P = 0.02; Supplementary Table 5). Covariates significantly impacting the main effect were sex assigned at birth and baseline Beck Depression Inventory (BDI)-II score; female sex assigned at bir…

> That being said, for people with severe PTSD this is surely a godsend. This seems a bit of a premature statement. The long term usage affects of MDMA use can be very costly, and I suspect long term use of something that provides artificial "feel good" emotion will have a tremendous downside for people who are already struggling with normality. > sex assigned at birth... female sex assigned at birth As an aside - in…

Please don’t paint your obvious naivety re gender as scientific enlightenment. This is real populist Ben Shapiro reasoning and I’d really hope that this community is above it. The reality is that esp. when we are talking about mental health it is important to be specific about the nature of a sex/gender breakdown. Could it be a question of hormones? Socialisation? The author/s are using concise language in a scientific publication and because of your naivety and typical software developer undeserved sense of transferable expertise, you are claiming it as superfluous, when it isn’t. Please consider that maybe you are wrong, and not everyone else.

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#95

Post by InSteady »

randomNumber7 wrote: post #81
BurningFrog wrote: post #42

Earlier quoted context omitted.

> I would not take this every day for a month... From the article: The treatment period consisted of three 8-h dosing sessions, in conjunction with therapy, spaced approximately 1 month apart.

Thank you and sorry for not reading carfully enough. It's still a pretty heavy dosage. Most sane ravers would take less with more time in between. But I guess if you stop after 3 sessions it is ok. They gave everyone the same dosage without considering the body mass. Then 120mg as initial dosis for someone who has no tolerance is a crazy kick (considering body mass of ~80kg).

Taking multiple "points" (100mg doses) in a single session is extremely common among enjoyers of MDMA.

People don't really build tolerance to MDMA when they use it responsibly.

This is a phase 3 clinical trial, aka the last and most rigorous phase before potential FDA approval. There have already been studies previous to this one that establish safe bounds for dosage of chemically pure MDMA in a clinical setting, many of which are targeted at patients with "no tolerance" (aka drug naïve).

You are clutching pearls pretty hard here. Experimental medicine is not without risks. Apparently 8 whole active study group participants (less than 10%) experienced mild tachycardia, aka fast heartbeat, in a setting full of trained medical professionals with the skills and equipment to handle such events. There was also some sweating and nervousness. Compare that to a moderate to bad episode of PTSD and it's a walk in the park by comparison. This is highly ethical research. Take a breath and carefully read the full study and some of its references, as well as some other ones prior to this phase 3 trial, if you are seriously concerned about this issue.

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#96

Post by InSteady »

randomNumber7 wrote: post #77
d1lanka wrote: post #71

Earlier quoted context omitted.

> I'm very sceptical about mdma for medical treatment. Data disagrees with you. I have seen tremendous improvement in quality of life of veterans with PTSD with just a few MDMA assisted therapy sessions.

I couldn't find information about dosage and regularity in the paper. If it really is just a few sessions with enough time between then im ok with that. But there should be enough scientific evidence that anything more is very dangerous.

>But there should be enough scientific evidence that anything more is very dangerous.

By all means, go find it and report back!

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#97

Post by InSteady »

staticautomatic wrote: post #58
fshbbdssbbgdd wrote: post #16

I’m skeptical that a placebo control for MDMA can be valid. The effects of MDMA are pretty noticeable. The study actually asked participants if they thought they were on MDMA, and most answered correctly. If the participants can tell, it somewhat defeats the purpose of having a placebo control group.

Why not use another group taking an amphetamine in addition to one taking an inert placebo?

As effective as that might be in terms of a proper active control group, it does not seem terribly ethical to give amphetamines to patients with PTSD without any medically sound reason to do so.

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#98

Post by [deleted] »

Alupis wrote: post #75
jrflowers wrote: post #66

Earlier quoted context omitted.

Alupis is simply trying to help out Science in an objective and apolitical way by pointing out that some phrases can rile people up into hooting and hollering. Phrases like “assigned female at birth” can, to use an empirical term, “whip one up into a real doozy of a tizzy” that can only be quelled by posting. Anything that might trigger Poster’s Rage is definitionally Not Science because scientific words do not make…

The very fact that you are this "riled up" about a plainly obvious statement such as I have made here only serves to validate my position. Take a look at your statements and tell me you are arguing from a scientific standpoint and not one from your own personal political ideology. You cannot, in good faith, make this claim.

[deleted]

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#99

Post by Alupis »

tmpX7dMeXU wrote: post #94
Alupis wrote: post #33

Earlier quoted context omitted.

> That being said, for people with severe PTSD this is surely a godsend. This seems a bit of a premature statement. The long term usage affects of MDMA use can be very costly, and I suspect long term use of something that provides artificial "feel good" emotion will have a tremendous downside for people who are already struggling with normality. > sex assigned at birth... female sex assigned at birth As an aside - in…

Please don’t paint your obvious naivety re gender as scientific enlightenment. This is real populist Ben Shapiro reasoning and I’d really hope that this community is above it. The reality is that esp. when we are talking about mental health it is important to be specific about the nature of a sex/gender breakdown. Could it be a question of hormones? Socialisation? The author/s are using concise language in a scientif…

You seem to be conflating gender with sex?

Re: MDMA-assisted therapy for PTSD: A randomized, placebo-controlled phase 3 trial

#100

Post by pcthrowaway »

InSteady wrote: post #95
randomNumber7 wrote: post #81

Earlier quoted context omitted.

Thank you and sorry for not reading carfully enough. It's still a pretty heavy dosage. Most sane ravers would take less with more time in between. But I guess if you stop after 3 sessions it is ok. They gave everyone the same dosage without considering the body mass. Then 120mg as initial dosis for someone who has no tolerance is a crazy kick (considering body mass of ~80kg).

Taking multiple "points" (100mg doses) in a single session is extremely common among enjoyers of MDMA. People don't really build tolerance to MDMA when they use it responsibly. This is a phase 3 clinical trial, aka the last and most rigorous phase before potential FDA approval. There have already been studies previous to this one that establish safe bounds for dosage of chemically pure MDMA in a clinical setting, man…

> Taking multiple "points" (100mg doses) in a single session is extremely common among enjoyers of MDMA.

300mg, especially for someone without prior MDMA experience, is an absolutely unhinged hero dose.

300mg spaced out over the course of 12 hours or so is somewhat less so, but you absolutely will get fewer effects on re-dosing, and fewer the next day as well if you dose again.

That said 120mg should be pretty safe for anyone, but with lower-tolerance or lighter users, could definitely reduce their ability to engage in meaningful conversation or retain any memory of what they discussed.

Which isn't to say they won't come away from the experience feeling warm fuzzies and possibly with significant improvements in their PTSD symptoms, but it does make me wonder if it's a good way to study how much of that is the talk therapy and how much is just the therapeutic effects of the drug

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