Ecstasy and mushrooms are being used by the medical and psychiatric community to help heal depression, anxiety, and PTSD. Both these substances have recently been approved for further studies of their ability, with highly trained support in a controlled setting with active therapy, to help patients who have not found relief elsewhere.
A story in the New York Times today discusses the use of psilocybin, also known as magic mushrooms, in patient’s whose cancer brought them to a desperate place of depression and anxiety. While the researchers are not clear on how this drug works exactly, the trials thus far show it is effective, and after only one dose when administered in a controlled setting by psychiatrist and a social worker in a session lasting 8 hours. There were two small studies and both reported success with patients in whom traditional treatment had not led to improvement. There are also studies being done to look at its role in addiction treatment and non-cancer depression.
A story linked to in this same article discusses the use of ecstacy, or Molly/MDMA, in treating PTSD (post traumatic stress disorder). We think of this in soldiers who have returned from war, but it occurs in civilians with the same triggers- either a single traumatic event or repeated traumas like abuse. It seems that while the brain is under the influence of this medication, it can finally confront the trauma that caused the condition and this trauma can be dealt with during a therapy session much like the one used in the psilocybin trials. The brain and body overreact in an inappropriate way to a given stimulus and can’t stop- to the point where it interrupts the person’s life. This can manifest in nightmares or panic attacks or other reactions that make daily living incredibly difficult.
While psilocybin is a natural substance, and MDMA was created in a lab, both seem to allow the patient to look at themselves and their experiences from a detached perspective and examine thoughts and emotions. Despite a number of treatment approaches including medications and psychotherapy techniques, there is none that hugely effective in treating PTSD and many other mental illnesses. The FDA is allowing these studies to proceed in hopes of offering a cure, in a relatively short course of treatment, for illness that is resistant to conventional therapies. Moving these drugs off the most restrictive DEA schedules is essential to conducting clinical trials, just like what needs to be done for marijuana (which I wrote about last week). I’m looking forward to a day when all medications that have the potential to be medically useful are allowed to be fully investigated in clinical trials.
Our November election offered good news for marijuana. Several states, including California, Nevada, Maine and Massachusetts, voted to legalize recreational marijuana, joining Colorado, Oregon, Alaska, and Washington State. Many more states have legalized marijuana for medical purposes- although the qualifying conditions vary by state. A total of 26 states, plus the District of Columbia, have approved this use and these states have been helpful for studying the effects of marijuana on patients as a group.
Overall the studies show that marijuana legalization decreases the deaths from opioid overdoses. Scientific American wrote a great article summarizing the recent studies on marijuana and opioid use. Marijuana (cannabinoids are the names of the chemical group) has been shown to decrease dependence on prescription opioid pills like Percocet and oxycontin and is a pathway for people to get off the dangerous drugs. As people become accustomed to an opiate, they require a higher dose for the same effect. Since these substances can be lethal, the dose required to relieve pain can near the lethal dose and lead to death. In 2014, 14,000 people died from unintentional overdose of prescribed opiates. Guess how many people died in 2014 from marijuana overdose? Zero, and that’s according to the DEA. Marijuana use does not lead to overdose and it is far less addictive than opiates or even alcohol or cigarettes. This is why so many states have passed legislation to legalize it. The hold up, in terms of wider use of cannabinoids in medicine, is with the DEA (Drug Enforcement Agency) which still classifies it as a drug with no medical use. With the Class I status it is difficult to procure the substance in order perform clinical trials. Since the pharmaceutical companies don’t stand to profit from marijuana there is no financial incentive for funding studies or money for lobbying the DEA. Currently, it is easiest to look backwards at data and plainly see how different symptoms or behaviors changed, how many fewer opioids were prescribed, and how many fewer people died when medical marijuana was available to patients. We are also starting to see the benefits of cannabinoids in treating not just pain or nausea, but also in helping with mental health issues as well, such as PTSD and depression. The use of cannabinoids for pain is so widespread now that the NFL is about to consider allowing their players to use cannabinoids for pain as so many ex-players have found relief from its use and have cut their opiate use.
Here in the District of Columbia, the use of medical marijuana is legal, as well as the recreational use by private citizens if it is not sold. Let’s hope the federal government allows states to keep the laws here in DC and across the nation. Let them also see the wisdom in correcting the DEA classification so that bigger studies can be performed and we can incorporate cannabinoids into everyday evidence-based practice.
So the reality of our recent election is setting in. No matter how you voted, there is a lot of uncertainty ahead in the next few months. If the trend continues, it feels like anything could happen in the home stretch of 2016. We have seen horrible violence both abroad and domestically, and some of it has been been perpetuated by our own citizens against fellow citizens. I’ve had many friends ask me not-so-jokingly if I’ve had an increase in requests for xanax. They have symptoms of insomnia, crying, displaced anger and intense muscle tension. They tell me they may be in to see me soon as a patient.
- An anxiety state defined by our medical coding is “Apprehension or fear of impending actual or imagined danger, vulnerability, or uncertainty” (ICD 10 code 2016-17 where ICD means International Classification of Diseases). While generalized anxiety disorder is defined as persistent physical symptoms of anxiety for 6 months, an anxiety state may be temporary. If this temporary state is interfering with your ability to live your life you may need some short term medical help. In a couple of weeks I imagine some people will meet the criteria for an adjustment disorder or even depression. Here are two definitions from the ICD codes that qualify a diagnosis of adjustment disorder- they sound pretty relevant right now don’t they?
- A category of psychiatric disorders which are characterized by emotional or behavioral symptoms that develop within 3 months of a stressor and do not persist for more than an additional 6 months after the stressor is no longer present.
- Social, psychological, or emotional difficulties in adapting to a new culture or similar difficulties in adapting to one’s own culture as the result of rapid social or cultural changes.
The bottom line is that if you are concerned about how you’re handling the turmoil of this year, especially with the recent election, please talk to someone about it. We want to help you and throw you a life preserver if needed.
What if bright light for 30 min each morning could increase a man’s sexual satisfaction and even boost his testosterone levels? How much less Viagra would be prescribed?
We know that light therapy (using a lamp that that has the right wavelengths and strength) is an effective treatment for SAD (seasonal effective disorder). We are still in the midst of learning about light therapy and all of its potential. But knowing that most babies are conceived in June, when we have the maximum hours of daylight, there is a basis for looking into the effect of light on reproduction. A group in Italy studied a group of 38 sexually unsatisfied men and shared their results with the European Congress of Neuropsychopharmacology in September. This group of men had a mean sexual satisfaction score of 2/10 at the beginning of the study. After just 2 weeks of treatment with 30 minutes of 10000 lux light each morning, the mean score had increased to 6/10. In the control group, who was treated with filtered light, the mean score was 2.7/10. In addition to the subjective satisfaction score, the mens’ testosterone levels almost doubled. The retinohypothalamic tract (sunlight to retina to hypothalamus) is well established as the circadian rhythm pathway. Treating our brains with bright light at various times of day has different effects. Bright morning light helps us wake up, energizes us, and according to this study may improve a man’s sexual satisfaction and testosterone levels. Conversely, bright light at night, or even that from our phones and computers, can cause insomnia, make it hard to get out of bed in the morning, and affect our mood in a negative way. We’ll have another post about that soon, along with information about the types of lights needed.
This is a fascinating area of study. Be prepared to see more chronotherapy (time and light therapies) as they are non-pharmacologic treatments. That means they cost less, and have fewer side effects or interactions with medications, and they are helpful for mental health issues at the very least, if not more. Further, here at any of our Kelly Goodman Group locations we are open to discussing any complementary, integrative, or functional medicine treatment you would like to try.
We all deal with anxiety at times- it’s part of being human and serves a purpose in keeping us alert when something could have a bad outcome. But sometimes people develop feelings of anxiety that are too frequent, unrelated to a specific event, are out of proportion to a given event, or just don’t go away. More than 18% of Americans seek treatment for anxiety as adults. Unfortunately, only 41% of Americans with mental health symptoms seek medical care each year. Obviously these are terrible statistics in the abstract but when you imagine people actively suffering without access to care or not knowing how to get it, even though we have tools to help, it really brings it home. Don’t ignore your mental health! It’s just as important as your physical health and is interdependent with it. People with chronic physical illnesses are more likely to develop mental health problems and people with mental health problems have physical health ramifications if not physical health causes. Bottom line- these feelings of anxiety or panic are manifested physically in our bodies as part of our “fight or flight” response. So when anxiety is happening too often, this response really takes a toll on us. We can end up with problems like insomnia, headaches, muscle tension, trouble concentrating, as well as the irritability and worry or panic that comes with the feelings of anxiety.
A panic attack can happen when people have a constant low to moderate level of anxiety they are dealing with that will then explode in a panic attack. This includes feelings of doom, shortness of breath, heart palpitations, nausea, sweating and shaking. These attacks often come with no warning and are not related to a stressful or worrisome event. They can wake you up from sleep, happen at work or school, or even while trying to relax with family or friends. These attacks are terrifying and if you have not experienced one before you need to seek immediate medical attention to be sure that you are not in fact experiencing a heart attack, pulmonary embolism, or allergic reaction. Yes, panic attacks are that bad. Your body gives you signals that your life is at stake!
If you are experiencing symptoms of anxiety we want to help. There is a chance your anxiety symptoms are being caused by a thyroid, heart or lung issue so let’s make sure not to miss those. If your diagnosis is in fact an anxiety disorder, there are medications we can prescribe and monitor that can really help as well as excellent therapists who can teach you to manage symptoms. Let us know about your story, especially if these symptoms are interfering with your life- whether relationships, work, family responsibilities or health. We want to help you to live your healthiest life possible- physically and mentally. Kelly Goodman Group