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Bhagavan C, Glue P, Evans W, Reynolds L, Turner T, King C, Russell BR, Morunga E, Mills JL, Layton G, Menkes DB. Effect of MDMA-assisted therapy on mood and anxiety symptoms in advanced-stage cancer (EMMAC): study protocol for a double-blind, randomised controlled trial. Trials 2024; 25:336. [PMID: 38773523 PMCID: PMC11110200 DOI: 10.1186/s13063-024-08174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/13/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Symptoms of anxiety and depression are common in patients with terminal illness and multiple challenges exist with timely and effective care in this population. Several centres have reported that one dose of the serotonergic psychedelic psilocybin, combined with therapeutic support, improves these symptoms for up to 6 months in this patient group. Drawing upon related therapeutic mechanisms, 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy may have the potential to achieve similar, positive mental health outcomes in this group. Preliminary evidence also supports the tolerability of MDMA-assisted therapy for anxiety and depression in advanced-stage cancer. METHODS Up to 32 participants with advanced-stage cancer and associated depression and anxiety will be randomised in a 1:1 ratio into one of two blinded parallel treatment arms. The intervention group will receive 120 mg (+ 60 mg optional supplemental dose) MDMA-assisted therapy. The psychoactive control group will receive 20 mg oral (+ 10 mg optional supplemental dose) methylphenidate-assisted therapy. For each medication-assisted therapy session, participants will undergo two 90-min therapeutic support sessions in the week preceding, and one 90-min support session the day after the experimental session. A battery of measures (mood, anxiety, quality of life, mystical experience, spiritual wellbeing, attitudes towards death, personality traits, holistic health and wellbeing, connectedness, demoralisation, expectations, qualitative data and safety measures) will be assessed at baseline and through to the end of the protocol. Participants will be followed up until either 12 months post-randomisation or death, whichever occurs first. DISCUSSION This study will examine the effect of MDMA-assisted therapy on symptoms of anxiety and depression in advanced-stage cancer. Potential therapeutic implications include establishing the safety and effectiveness of a novel treatment that may relieve mental suffering in patients with life-threatening illness. TRIAL REGISTRATION Trial registered on Australian New Zealand Clinical Trials Registry. REGISTRATION NUMBER ACTRN12619001334190p. Date registered: 30/09/2019. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378153&showOriginal=true&isReview=true.
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Affiliation(s)
- Chiranth Bhagavan
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Paul Glue
- Department of Psychological Medicine, Division of Health Sciences, University of Otago, 464 Cumberland Street, Central Dunedin, Dunedin, 9016, New Zealand
| | - Will Evans
- Mana Health, 7 Ruskin St, Parnell, Auckland, 1052, New Zealand
| | - Lisa Reynolds
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Thivya Turner
- Te Whatu Ora Southern, Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Chris King
- Te Whatu Ora Southern, Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Bruce R Russell
- School of Pharmacy, University of Otago, 18 Frederick Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Eva Morunga
- Te Whatu Ora Te Toka Tumai, Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Jessica Lee Mills
- University of Auckland, 6 Symonds Street, Auckland, 1010, New Zealand
| | - Geoff Layton
- Ashburn Clinic, 496 Taieri Road, Halfway Bush, Dunedin, 9010, New Zealand
| | - David B Menkes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Waikato Clinical Campus, Peter Rothwell Academic Centre, Pembroke Street, Hamilton, 3240, New Zealand
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Mayer FP, Niello M, Bulling S, Zhang YW, Li Y, Kudlacek O, Holy M, Kooti F, Sandtner W, Rudnick G, Schmid D, Sitte HH. Mephedrone induces partial release at human dopamine transporters but full release at human serotonin transporters. Neuropharmacology 2023; 240:109704. [PMID: 37703919 DOI: 10.1016/j.neuropharm.2023.109704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
Mephedrone (4-methylmethcathinone) is a cathinone derivative that is recreationally consumed for its energizing and empathogenic effects. The stimulating properties are believed to arise from the ability of mephedrone to interact with the high-affinity transporters for dopamine (DA) (DAT) and norepinephrine (NET), whereas the entactogenic effect presumably relies on its activity at the serotonin (5-HT) transporter (SERT). Early studies found that mephedrone acts as a releaser at NET, DAT and SERT, and thus promotes efflux of the respective monoamines. Evidence linked drug-induced reverse transport of 5-HT via SERT to prosocial effects, whereas activity at DAT is strongly correlated with abuse liability. Consequently, we sought to evaluate the pharmacology of mephedrone at human (h) DAT and SERT, heterologously expressed in human embryonic kidney 293 cells, in further detail. In line with previous studies, we report that mephedrone evokes carrier-mediated release via hDAT and hSERT. We found this effect to be sensitive to the protein kinase C inhibitor GF109203X. Electrophysiological recordings revealed that mephedrone is actively transported by hDAT and hSERT. However, mephedrone acts as a full substrate of hSERT but as a partial substrate of hDAT. Furthermore, when compared to fully efficacious releasing agents at hDAT and hSERT (i.e. S(+)-amphetamine and para-chloroamphetamine, respectively) mephedrone displays greater efficacy as a releaser at hSERT than at hDAT. In summary, this study provides additional insights into the molecular mechanism of action of mephedrone at hDAT and hSERT.
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Affiliation(s)
- Felix P Mayer
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Marco Niello
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Simon Bulling
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Yuan-Wei Zhang
- Department of Pharmacology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8066, USA
| | - Yang Li
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Oliver Kudlacek
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Marion Holy
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Fatemeh Kooti
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Walter Sandtner
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Gary Rudnick
- Department of Pharmacology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8066, USA
| | - Diethart Schmid
- Institute for Physiology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria
| | - Harald H Sitte
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Center for Addiction Research and Science - AddRess, Medical University of Vienna, Waehringer Strasse 13a, A-1090, Vienna, Austria.
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Lear MK, Smith SM, Pilecki B, Stauffer CS, Luoma JB. Social anxiety and MDMA-assisted therapy investigation: a novel clinical trial protocol. Front Psychiatry 2023; 14:1083354. [PMID: 37520237 PMCID: PMC10379654 DOI: 10.3389/fpsyt.2023.1083354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background Social anxiety disorder (SAD) is a serious and prevalent psychiatric condition that heavily impacts social functioning and quality of life. Though efficacious treatments exist for SAD, remission rates remain elevated and a significant portion of those affected do not access effective treatment, suggesting the need for additional evidence-based treatment options. This paper presents a protocol for an open-label pilot study of MDMA-assisted therapy (MDMA-AT) for social anxiety disorder. The study aims to assess preliminary treatment outcomes, feasibility and safety, and psychological and physiological processes of change in the treatment of SAD with MDMA-AT. A secondary aim includes the development of a treatment manual for MDMA-AT for SAD. Method The outlined protocol is a randomized, open-label delayed treatment study. We will recruit 20 participants who meet criteria with moderate-to-severe social anxiety disorder (SAD) of the generalized subtype. Participants will be randomly assigned to an immediate treatment (n = 10) or delayed treatment condition (n = 10). Those in the immediate treatment condition will proceed immediately to active MDMA-AT consisting of three preparation sessions, two medicine sessions in which they receive oral doses of MDMA, and six integration sessions over approximately a 16-week period. The delayed treatment condition will receive the same intervention after a 16-week delay. Our primary outcome is SAD symptom reduction as measured by the Liebowitz Social Anxiety Scale administered by blinded raters at post-treatment and 6 month follow up. Secondary outcomes include changes in functional impairment, feasibility and safety measures, and novel therapeutic processes of change including shame and shame-related coping, belongingness, self-concealment, and self-compassion at post-treatment. Exploratory outcomes are also discussed. Discussion The results of this pilot trial advance the field's understanding of the acceptability and potential effectiveness of MDMA-AT for social anxiety disorder and provide an overview of relevant therapeutic mechanisms unique to SAD. We hope findings from this protocol will inform the design of subsequent larger-scale randomized controlled trials (RCT) examining the efficacy of MDMA-AT for SAD. Clinical trial registration https://clinicaltrials.gov/, NCT05138068.
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Affiliation(s)
- M. Kati Lear
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
| | - Sarah M. Smith
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
| | - Brian Pilecki
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
| | - Chris S. Stauffer
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
| | - Jason B. Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
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De Felice B, Parolini M. Exposure to 3,4-methylenedioxymethamphetamine (MDMA) induced biochemical but not behavioral effects in Daphnia magna. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2023; 100:104163. [PMID: 37257268 DOI: 10.1016/j.etap.2023.104163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
Among amphetamine like stimulants (ATS), the 3,4-methylenedioxymethamphetamine (MDMA) is often detected in sewage and surface waters, representing a potential threat for organisms because of its peculiar mechanism of action (i.e., stimulatory and hallucinogenic). The present study aimed at investigating biochemical (i.e., oxidative stress and energetic biomarkers) and behavioral (i.e., swimming activity) effects induced by a 21-days exposure to two concentrations (50 ng/L and 500 ng/L) of MDMA towards Daphnia magna. The amount of reactive oxygen species (ROS), the activity of antioxidant (SOD, CAT, GPx) and detoxifying (GST) enzymes and lipid peroxidation were measured as oxidative stress-related endpoints. Total energy content was estimated from the measurement of protein, carbohydrate and lipid content to assess energy reserves. The modulation of swimming activity was assessed as behavioral endpoint. Slight effects of MDMA exposure on oxidative stress responses and energy reserves were observed, while no alterations of the swimming behavior was noted.
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Affiliation(s)
- Beatrice De Felice
- University of Milan, Department of Environmental Science and Policy, Via Celoria 26, I-20133 Milan, Italy.
| | - Marco Parolini
- University of Milan, Department of Environmental Science and Policy, Via Celoria 26, I-20133 Milan, Italy
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Mayer FP, Niello M, Cintulova D, Sideromenos S, Maier J, Li Y, Bulling S, Kudlacek O, Schicker K, Iwamoto H, Deng F, Wan J, Holy M, Katamish R, Sandtner W, Li Y, Pollak DD, Blakely RD, Mihovilovic MD, Baumann MH, Sitte HH. Serotonin-releasing agents with reduced off-target effects. Mol Psychiatry 2023; 28:722-732. [PMID: 36352123 PMCID: PMC9645344 DOI: 10.1038/s41380-022-01843-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022]
Abstract
Increasing extracellular levels of serotonin (5-HT) in the brain ameliorates symptoms of depression and anxiety-related disorders, e.g., social phobias and post-traumatic stress disorder. Recent evidence from preclinical and clinical studies established the therapeutic potential of drugs inducing the release of 5-HT via the 5-HT-transporter. Nevertheless, current 5-HT releasing compounds under clinical investigation carry the risk for abuse and deleterious side effects. Here, we demonstrate that S-enantiomers of certain ring-substituted cathinones show preference for the release of 5-HT ex vivo and in vivo, and exert 5-HT-associated effects in preclinical behavioral models. Importantly, the lead cathinone compounds (1) do not induce substantial dopamine release and (2) display reduced off-target activity at vesicular monoamine transporters and 5-HT2B-receptors, indicative of low abuse-liability and low potential for adverse events. Taken together, our findings identify these agents as lead compounds that may prove useful for the treatment of disorders where elevation of 5-HT has proven beneficial.
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Affiliation(s)
- Felix P. Mayer
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria ,grid.255951.fDepartment of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Jupiter, FL 33458 USA
| | - Marco Niello
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria
| | - Daniela Cintulova
- grid.5329.d0000 0001 2348 4034Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - Spyridon Sideromenos
- grid.22937.3d0000 0000 9259 8492Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria
| | - Julian Maier
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria
| | - Yang Li
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria ,grid.8547.e0000 0001 0125 2443Present Address: Institutes of Brain Science, Fudan University, Shanghai, 200032 China
| | - Simon Bulling
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria
| | - Oliver Kudlacek
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria
| | - Klaus Schicker
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria
| | - Hideki Iwamoto
- grid.255951.fStiles-Nicholson Brain Institute and Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Jupiter, FL 33458 USA
| | - Fei Deng
- grid.11135.370000 0001 2256 9319IDG McGovern Institute for Brain Research, Peking University, 100871 Beijing, China
| | - Jinxia Wan
- grid.11135.370000 0001 2256 9319IDG McGovern Institute for Brain Research, Peking University, 100871 Beijing, China
| | - Marion Holy
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria
| | - Rania Katamish
- grid.255951.fDepartment of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Jupiter, FL 33458 USA
| | - Walter Sandtner
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria
| | - Yulong Li
- grid.11135.370000 0001 2256 9319IDG McGovern Institute for Brain Research, Peking University, 100871 Beijing, China
| | - Daniela D. Pollak
- grid.22937.3d0000 0000 9259 8492Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria
| | - Randy D. Blakely
- grid.255951.fDepartment of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Jupiter, FL 33458 USA ,grid.255951.fStiles-Nicholson Brain Institute and Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Jupiter, FL 33458 USA
| | - Marko D. Mihovilovic
- grid.5329.d0000 0001 2348 4034Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - Michael H. Baumann
- grid.94365.3d0000 0001 2297 5165Designer Drug Research Unit, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224 USA
| | - Harald H. Sitte
- grid.22937.3d0000 0000 9259 8492Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Waehringer Strasse 13a, 1090 Vienna, Austria ,grid.22937.3d0000 0000 9259 8492AddRess, Center for Addiction Research and Science, Medical University of Vienna, Vienna, Austria
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Lewis CR, Tafur J, Spencer S, Green JM, Harrison C, Kelmendi B, Rabin DM, Yehuda R, Yazar-Klosinski B, Cahn BR. Pilot study suggests DNA methylation of the glucocorticoid receptor gene (NR3C1) is associated with MDMA-assisted therapy treatment response for severe PTSD. Front Psychiatry 2023; 14:959590. [PMID: 36815187 PMCID: PMC9939628 DOI: 10.3389/fpsyt.2023.959590] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023] Open
Abstract
Background Previous research has demonstrated that epigenetic changes in specific hypothalamic-pituitary-adrenal (HPA) genes may predict successful psychotherapy in post-traumatic stress disorder (PTSD). A recent Phase 3 clinical trial reported high efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for treating patients with severe PTSD compared to a therapy with placebo group (NCT03537014). This raises important questions regarding potential mechanisms of MDMA-assisted therapy. In the present study, we examined epigenetic changes in three key HPA axis genes before and after MDMA and placebo with therapy. As a pilot sub-study to the parent clinical trial, we assessed potential HPA epigenetic predictors for treatment response with genomic DNA derived from saliva (MDMA, n = 16; placebo, n = 7). Methylation levels at all 259 CpG sites annotated to three HPA genes (CRHR1, FKBP5, and NR3C1) were assessed in relation to treatment response as measured by the Clinician-Administered PTSD Scale (CAPS-5; Total Severity Score). Second, group (MDMA vs. placebo) differences in methylation change were assessed for sites that predicted treatment response. Results Methylation change across groups significantly predicted symptom reduction on 37 of 259 CpG sites tested, with two sites surviving false discovery rate (FDR) correction. Further, the MDMA-treatment group showed more methylation change compared to placebo on one site of the NR3C1 gene. Conclusion The findings of this study suggest that therapy-related PTSD symptom improvements may be related to DNA methylation changes in HPA genes and such changes may be greater in those receiving MDMA-assisted therapy. These findings can be used to generate hypothesis driven analyses for future studies with larger cohorts.
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Affiliation(s)
- Candace R. Lewis
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
- Neurogenomics Division, Translational Genomics Research Institute (TGen), Phoenix, AZ, United States
- *Correspondence: Candace R. Lewis,
| | | | - Sophie Spencer
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Joseph M. Green
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | | | - Benjamin Kelmendi
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | | | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States
| | | | - Baruch Rael Cahn
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, United States
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA, United States
- Baruch Rael Cahn,
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Effects of Selective Serotonin Reuptake Inhibitor Use on 3,4-Methylenedioxymethamphetamine-Assisted Therapy for Posttraumatic Stress Disorder: A Review of the Evidence, Neurobiological Plausibility, and Clinical Significance. J Clin Psychopharmacol 2022; 42:464-469. [PMID: 36018231 DOI: 10.1097/jcp.0000000000001595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among the renewed applications of psychedelic medicines in psychiatry, 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for posttraumatic stress disorder (PTSD) has demonstrated the most promise in early small-scale studies. Recent exploratory analyses from prior clinical trials of MDMA-assisted therapy for PTSD have suggested that recent use of selective serotonin reuptake inhibitors (SSRIs)-the only medication class with United States Food and Drug Administration (FDA) approval to treat PTSD-can significantly dampen the efficacy of this novel therapy. Although psychedelic medicines are not yet FDA approved, MDMA is very likely to be the first to achieve FDA approval-perhaps within the next 2 years. Given this timeline, the field would benefit from more knowledge about potential interactions between this novel therapy and our current treatments. METHODS This brief report reviews selected literature in the basic and clinical neurosciences relevant to the interaction of SSRIs and MDMA. FINDINGS The possibility that SSRI use could dampen future responses to MDMA-assisted therapy for PTSD raises many important questions about the biological mechanisms as well as ethical implications around the most appropriate way to counsel patients. In this brief report, we compare the evidence for SSRIs and MDMA-assisted therapy in the treatment of PTSD and discuss what is known about the neurobiological interactions between these 2 medicines. CONCLUSIONS There is strong neurobiological plausibility for the hypothesis that chronic SSRI use dampens response to MDMA-assisted therapy, although current knowledge in the field is limited and primarily relates to acute pharmacodynamic interactions. Our commentary highlights the urgent need for future work dedicated to addressing this important clinical topic.
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Luoma JB, Shahar B, Kati Lear M, Pilecki B, Wagner A. Potential processes of change in MDMA-Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self-transcendence, and therapeutic relationships. Hum Psychopharmacol 2022; 37:e2824. [PMID: 34739165 PMCID: PMC9285360 DOI: 10.1002/hup.2824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/04/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Researchers have suggested that psychotherapy may be enhanced by the addition of 3,4-methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder. DESIGN This is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes. RESULTS We first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self-transcendence and self-transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors. CONCLUSION We discuss how processes of change may extend beyond the MDMA dosing sessions themselves.
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Affiliation(s)
- Jason B. Luoma
- Portland Psychotherapy Clinic, Research, & Training CenterPortlandOregonUSA
| | - Ben Shahar
- The Hebrew University of JerusalemJerusalemIsrael
| | - M. Kati Lear
- Portland Psychotherapy Clinic, Research, & Training CenterPortlandOregonUSA
| | - Brian Pilecki
- Portland Psychotherapy Clinic, Research, & Training CenterPortlandOregonUSA
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9
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Henner RL, Keshavan MS, Hill KP. Review of potential psychedelic treatments for PTSD. J Neurol Sci 2022; 439:120302. [DOI: 10.1016/j.jns.2022.120302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/27/2022] [Accepted: 05/24/2022] [Indexed: 12/20/2022]
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10
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Glavonic E, Mitic M, Adzic M. Hallucinogenic drugs and their potential for treating fear-related disorders: Through the lens of fear extinction. J Neurosci Res 2022; 100:947-969. [PMID: 35165930 DOI: 10.1002/jnr.25017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 12/29/2022]
Abstract
Fear-related disorders, mainly phobias and post-traumatic stress disorder, are highly prevalent, debilitating disorders that pose a significant public health problem. They are characterized by aberrant processing of aversive experiences and dysregulated fear extinction, leading to excessive expression of fear and diminished quality of life. The gold standard for treating fear-related disorders is extinction-based exposure therapy (ET), shown to be ineffective for up to 35% of subjects. Moreover, ET combined with traditional pharmacological treatments for fear-related disorders, such as selective serotonin reuptake inhibitors, offers no further advantage to patients. This prompted the search for ways to improve ET outcomes, with current research focused on pharmacological agents that can augment ET by strengthening fear extinction learning. Hallucinogenic drugs promote reprocessing of fear-imbued memories and induce positive mood and openness, relieving anxiety and enabling the necessary emotional engagement during psychotherapeutic interventions. Mechanistically, hallucinogens induce dynamic structural and functional neuroplastic changes across the fear extinction circuitry and temper amygdala's hyperreactivity to threat-related stimuli, effectively mitigating one of the hallmarks of fear-related disorders. This paper provides the first comprehensive review of hallucinogens' potential to alleviate symptoms of fear-related disorders by focusing on their effects on fear extinction and the underlying molecular mechanisms. We overview both preclinical and clinical studies and emphasize the advantages of hallucinogenic drugs over current first-line treatments. We highlight 3,4-methylenedioxymethamphetamine and ketamine as the most effective therapeutics for fear-related disorders and discuss the potential molecular mechanisms responsible for their potency with implications for improving hallucinogen-assisted psychotherapy.
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Affiliation(s)
- Emilija Glavonic
- Department of Molecular Biology and Endocrinology, "VINČA" Institute of Nuclear Sciences-National Institute of thе Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milos Mitic
- Department of Molecular Biology and Endocrinology, "VINČA" Institute of Nuclear Sciences-National Institute of thе Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Miroslav Adzic
- Department of Molecular Biology and Endocrinology, "VINČA" Institute of Nuclear Sciences-National Institute of thе Republic of Serbia, University of Belgrade, Belgrade, Serbia
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11
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Nichols DE. Entactogens: How the Name for a Novel Class of Psychoactive Agents Originated. Front Psychiatry 2022; 13:863088. [PMID: 35401275 PMCID: PMC8990025 DOI: 10.3389/fpsyt.2022.863088] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
Abstract
At first glance, it appears there is little difference between the molecular structures of methylenedioxymethamphetamine (MDMA), which has an N-methyl attached to its amino group, and methylenedioxyamphetamine (MDA), a primary amine that is recognized to have hallucinogenic activity. It is known from studies with other hallucinogenic amphetamines that N-methylation of hallucinogenic amphetamines attenuates or abolishes hallucinogenic activity. Nevertheless, MDMA is biologically active and has a potency only slightly less than its MDA parent. Importantly, it is the Ievo-isomer of hallucinogenic phenethylamines that is more biologically active, whereas it is the dextro isomer of MDMA that is more active. This reversal of stereochemistry for the activity of two very closely related molecules is a very powerful clue that their mechanisms of action differ. Finally, extension of the alpha-methyl of hallucinogenic amphetamines to an alpha-ethyl moiety completely abolishes their hallucinogenic activity. Ultimately, we extended the alpha-methyl group of MDMA to an alpha-ethyl to afford a molecule we named (N-Methyl-1-(1,3-benzodioxol-5-yl)-2-butanamine (MBDB) that retained significant MDMA-like psychoactivity. Hence, there are three structural features that distinguish MDMA from the hallucinogenic amphetamines: (1) the N-methyl on the basic nitrogen, (2) the reversal of stereochemistry and, (3) tolerance of an alpha-ethyl moiety as contrasted with the alpha-methyl of hallucinogenic phenethylamines. Clearly, MDMA is distinct from classical hallucinogenic phenethylamines in its structure, and its psychopharmacology is also unique. Thus, in 1986 I proposed the name "Entactogen" for the pharmacological class of drugs that includes 3,4-methylenedioxymethamphetamine (MDMA) and other substances with a similar psychopharmacological effect. The name is derived from roots that indicate that entactogens produce a "touching within." Rather than having significant psychostimulant, or hallucinogenic effects, MDMA powerfully promotes affiliative social behavior, has acute anxiolytic effects, and can lead to profound states of introspection and personal reflection. Its mechanism of action is now established as involving transport of MDMA by the neuronal serotonin reuptake carrier followed by carrier-mediated release of stored neuronal serotonin.
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Affiliation(s)
- David E Nichols
- Division of Chemical Biology and Medicinal Chemistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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12
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Trotter PD, Smith SA, Moore DJ, O’Sullivan N, McFarquhar MM, McGlone FP, Walker SC. Acute tryptophan depletion alters affective touch perception. Psychopharmacology (Berl) 2022; 239:2771-2785. [PMID: 35554625 PMCID: PMC9385795 DOI: 10.1007/s00213-022-06151-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE Affiliative tactile interactions help regulate physiological arousal and confer resilience to acute and chronic stress. C-tactile afferents (CTs) are a population of unmyelinated, low threshold mechanosensitive cutaneous nerve fibres which respond optimally to a low force stimulus, moving at between 1 and 10 cm/s. As CT firing frequencies correlate positively with subjective ratings of touch pleasantness, they are hypothesised to form the first stage of encoding affiliative tactile interactions. Serotonin is a key modulator of social responses with known effects on bonding. OBJECTIVES The aim of the present study was to determine the effect of acutely lowering central serotonin levels on perceptions of CT-targeted affective touch. METHODS In a double blind, placebo-controlled design, the effect of acute tryptophan depletion (ATD) on 25 female participants' ratings of directly and vicariously experienced touch was investigated. Psychophysical techniques were used to deliver dynamic tactile stimuli; some velocities were targeted to optimally activate CTs (1-10 cm/s), whereas other, faster and slower strokes fell outside the CT optimal range. Discriminative tactile function, cold pain threshold and tolerance were also measured. RESULTS ATD significantly increased pleasantness ratings of both directly and vicariously experienced affective touch, increasing discrimination of the specific hedonic value of CT targeted velocities. While ATD had no effect on either tactile or cold pain thresholds, there was a trend for reduced tolerance to cold pain. CONCLUSIONS These findings are consistent with previous reports that depletion of central serotonin levels modulates neural and behavioural responsiveness to appetitive sensory signals.
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Affiliation(s)
- Paula D. Trotter
- Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool, UK
| | - Sharon A. Smith
- Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool, UK
| | - David J. Moore
- Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool, UK
| | | | - Martyn M. McFarquhar
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Francis P. McGlone
- Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool, UK ,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Susannah C. Walker
- Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool, UK
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13
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Wagner AC. Couple Therapy With MDMA-Proposed Pathways of Action. Front Psychol 2021; 12:733456. [PMID: 34858270 PMCID: PMC8631777 DOI: 10.3389/fpsyg.2021.733456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/05/2021] [Indexed: 12/03/2022] Open
Abstract
MDMA's first identified potential as a therapeutic catalyst was for couple therapy. Early work in the 1970s and 1980s explored its potential amongst seasoned psychotherapists and their clients. With the completion of the first pilot trial of MDMA-assisted psychotherapy with couples for PTSD, and as the possibility of conducting MDMA-assisted psychotherapy trials expands due to new regulatory frameworks, we have an opportunity to explore and investigate how and why MDMA-assisted couples therapy works. This theoretical paper will explore the neurobiological and neurochemical effects of MDMA in a relational context, the emotional, behavioral, cognitive and somatic effects within a dyadic frame, and how empathy, communication, perception of social connection/support, non-avoidance, openness, attachment/safety, bonding/social intimacy and relationship satisfaction, are all impacted by MDMA, and can be harnessed to facilitate systems-level and interpersonal healing and growth. A model to support MDMA-assisted couple therapy is introduced, and future directions, including implications for intervention development and delivery, will be elucidated.
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King F, Hammond R. Psychedelics as Reemerging Treatments for Anxiety Disorders: Possibilities and Challenges in a Nascent Field. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:190-196. [PMID: 34690582 DOI: 10.1176/appi.focus.20200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although psychedelics initially showed promise in treating anxiety disorders, psychedelics were criminalized and research halted in the early 1970s. A subsequent resurgence of research into psychiatric benefits of psychedelic-assisted psychotherapy in the last 20 years has led to a potential paradigm shift in the treatment of numerous psychiatric disorders, including anxiety disorders. Despite accumulating evidence and likely U.S. Food and Drug Administration approval in the next 2-3 years, the emerging field of psychedelic medicine faces several challenges. Obstacles include ongoing barriers on the regulatory level, lack of education, stigma among mental health clinicians, cost and scalability, and a dearth of specialized personnel prepared to provide these treatments. Deeper issues of ethical responsibility and inclusivity also exist given the historical discovery and use of psychedelics by indigenous peoples throughout the world as well the ongoing disparities in mental health delivery and access within psychiatry and psychedelic research.
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Affiliation(s)
- Franklin King
- Department of Psychiatry, Harvard Medical School, Boston (King); Center for Neuroscience of Psychedelics, Massachusetts General Hospital, Boston (King); private practice, Boston (Hammond)
| | - Rebecca Hammond
- Department of Psychiatry, Harvard Medical School, Boston (King); Center for Neuroscience of Psychedelics, Massachusetts General Hospital, Boston (King); private practice, Boston (Hammond)
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15
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Walsh JJ, Llorach P, Cardozo Pinto DF, Wenderski W, Christoffel DJ, Salgado JS, Heifets BD, Crabtree GR, Malenka RC. Systemic enhancement of serotonin signaling reverses social deficits in multiple mouse models for ASD. Neuropsychopharmacology 2021; 46:2000-2010. [PMID: 34239048 PMCID: PMC8429585 DOI: 10.1038/s41386-021-01091-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023]
Abstract
Autism spectrum disorder (ASD) is a common set of heterogeneous neurodevelopmental disorders resulting from a variety of genetic and environmental risk factors. A core feature of ASD is impairment in prosocial interactions. Current treatment options for individuals diagnosed with ASD are limited, with no current FDA-approved medications that effectively treat its core symptoms. We recently demonstrated that enhanced serotonin (5-HT) activity in the nucleus accumbens (NAc), via optogenetic activation of 5-HTergic inputs or direct infusion of a specific 5-HT1b receptor agonist, reverses social deficits in a genetic mouse model for ASD based on 16p11.2 copy number variation. Furthermore, the recreational drug MDMA, which is currently being evaluated in clinical trials, promotes sociability in mice due to its 5-HT releasing properties in the NAc. Here, we systematically evaluated the ability of MDMA and a selective 5-HT1b receptor agonist to rescue sociability deficits in multiple different mouse models for ASD. We find that MDMA administration enhances sociability in control mice and reverses sociability deficits in all four ASD mouse models examined, whereas administration of a 5-HT1b receptor agonist selectively rescued the sociability deficits in all six mouse models for ASD. These preclinical findings suggest that pharmacological enhancement of 5-HT release or direct 5-HT1b receptor activation may be therapeutically efficacious in ameliorating some of the core sociability deficits present across etiologically distinct presentations of ASD.
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Affiliation(s)
- Jessica J Walsh
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Pierre Llorach
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel F Cardozo Pinto
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Wendy Wenderski
- Department of Pathology, Stanford Medical School, Stanford, CA, USA
- Department of Genetics, Stanford Medical School, Stanford, CA, USA
- Department of Developmental Biology, Stanford Medical School, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Daniel J Christoffel
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Juliana S Salgado
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald R Crabtree
- Department of Pathology, Stanford Medical School, Stanford, CA, USA
- Department of Genetics, Stanford Medical School, Stanford, CA, USA
- Department of Developmental Biology, Stanford Medical School, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Robert C Malenka
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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16
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Luoma J, Lear MK. MDMA-Assisted Therapy as a Means to Alter Affective, Cognitive, Behavioral, and Neurological Systems Underlying Social Dysfunction in Social Anxiety Disorder. Front Psychiatry 2021; 12:733893. [PMID: 34646176 PMCID: PMC8502812 DOI: 10.3389/fpsyt.2021.733893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric disorder that can assume a chronic course even when treated. Despite the identification of evidence-based pharmacological and behavioral treatments for SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine (MDMA) has been proposed as a promising adjunctive treatment to psychological interventions for disorders characterized by social dysfunction. A small randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for social anxiety in autistic adults offered encouraging results, but more research is sorely needed to explore the potential for MDMA-AT in treating SAD. This review aims to stimulate future study by summarizing research on disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD and proposing how MDMA-AT may alter these systems across four domains. First, we review research highlighting the roles of social anhedonia and reduced social reward sensitivity in maintaining SAD, with specific attention to the reduction in positive affect in social situations, infrequent social approach behaviors, and related social skills deficits. We posit that MDMA-AT may enhance motivation to connect with others and alter perceptions of social reward for an extended period following administration, thereby potentiating extinction processes, and increasing the reinforcement value of social interactions. Second, we review evidence for the central role of heightened social evaluative threat perception in the development and maintenance of SAD and consider how MDMA-AT may enhance experiences of affiliation and safety when interacting with others. Third, we consider the influence of shame and the rigid application of shame regulation strategies as important intrapersonal processes maintaining SAD and propose the generation of self-transcendent emotions during MDMA sessions as a mechanism of shame reduction that may result in corrective emotional experiences and boost memory reconsolidation. Finally, we review research on the role of dysfunctional interpersonal behaviors in SAD that interfere with social functioning and, in particular, the development and maintenance of close and secure relationships. We discuss the hypothesized role of MDMA-AT in improving social skills to elicit positive interpersonal responses from others, creating a greater sense of belonging, acceptance, and social efficacy.
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Affiliation(s)
- Jason Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
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Latimer D, Stocker MD, Sayers K, Green J, Kaye AM, Abd-Elsayed A, Cornett EM, Kaye AD, Varrassi G, Viswanath O, Urits I. MDMA to Treat PTSD in Adults. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:125-149. [PMID: 34421149 PMCID: PMC8374929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Post-traumatic stress disorder (PTSD) has become one of the most common psychiatric diagnosis in the United States specifically within the veteran population. The current treatment options for this debilitating diagnosis include trauma-focused psychotherapies along with selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI).1 MDMA has recently been shown as a novel therapeutic agent with promisingly results in the treatment of PTSD. MDMA is a psychoactive compound traditionally categorized as a psychedelic amphetamine that deemed a Schedule I controlled substance in the 1980s. Prior to its status as a controlled substance, it was used by psychotherapists for an array of psychiatric issues. In more recent times, MDMA has resurfaced as a potential therapy for PTSD and the data produced from randomized, controlled trials back the desire for MDMA to be utilized as an effective pharmacologic therapy in conjunction with psychotherapy.2.
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Affiliation(s)
- Dustin Latimer
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Michael D Stocker
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Kia Sayers
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Jackson Green
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Adam M Kaye
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Alaa Abd-Elsayed
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Elyse M Cornett
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Alan D Kaye
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Giustino Varrassi
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Omar Viswanath
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
| | - Ivan Urits
- Latimer, Louisiana State University Health Science Center, Department of Psychiatry and Behavioral Medicine in Baton Rouge. Michael D. Stocker, Kia Sayers, Louisiana State University New Orleans School of Medicine. Green, Visions Adolescent Treatment Center, Department of Mental Health, Los Angeles, CA. Adam M. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, WI. Elyse M. Cornett, Alan D. Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA
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Oeri HE. Beyond ecstasy: Alternative entactogens to 3,4-methylenedioxymethamphetamine with potential applications in psychotherapy. J Psychopharmacol 2021; 35:512-536. [PMID: 32909493 PMCID: PMC8155739 DOI: 10.1177/0269881120920420] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The last two decades have seen a revival of interest in the entactogen 3,4-methylenedioxy-N-methylamphetamine (MDMA) as an adjunct to psychotherapy, particularly for the treatment of post-traumatic stress disorder. While clinical results are highly promising, and MDMA is expected to be approved as a treatment in the near future, it is currently the only compound in its class of action that is being actively investigated as a medicine. This lack of alternatives to MDMA may prove detrimental to patients who do not respond well to the particular mechanism of action of MDMA or whose treatment calls for a modification of MDMA's effects. For instance, patients with existing cardiovascular conditions or with a prolonged history of stimulant drug use may not fit into the current model of MDMA-assisted psychotherapy, and could benefit from alternative drugs. This review examines the existing literature on a host of entactogenic drugs, which may prove to be useful alternatives in the future, paying particularly close attention to any neurotoxic risks, neuropharmacological mechanism of action and entactogenic commonalities with MDMA. The substances examined derive from the 1,3-benzodioxole, cathinone, benzofuran, aminoindane, indole and amphetamine classes. Several compounds from these classes are identified as potential alternatives to MDMA.
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Affiliation(s)
- Hans Emanuel Oeri
- Hans Emanuel Oeri, University of Victoria,
3800 Finnerty Rd, Victoria, British Columbia V8P 5C2, Canada.
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19
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Müller F, Holze F, Dolder P, Ley L, Vizeli P, Soltermann A, Liechti ME, Borgwardt S. MDMA-induced changes in within-network connectivity contradict the specificity of these alterations for the effects of serotonergic hallucinogens. Neuropsychopharmacology 2021; 46:545-553. [PMID: 33219313 PMCID: PMC8027447 DOI: 10.1038/s41386-020-00906-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 12/29/2022]
Abstract
It has been reported that serotonergic hallucinogens like lysergic acid diethylamide (LSD) induce decreases in functional connectivity within various resting-state networks. These alterations were seen as reflecting specific neuronal effects of hallucinogens and it was speculated that these shifts in connectivity underlie the characteristic subjective drug effects. In this study, we test the hypothesis that these alterations are not specific for hallucinogens but that they can be induced by monoaminergic stimulation using the non-hallucinogenic serotonin-norepinephrine-dopamine releasing agent 3,4-methylenedioxymethamphetamine (MDMA). In a randomized, placebo-controlled, double-blind, crossover design, 45 healthy participants underwent functional magnetic resonance imaging (fMRI) following oral administration of 125 mg MDMA. The networks under question were identified using independent component analysis (ICA) and were tested with regard to within-network connectivity. Results revealed decreased connectivity within two visual networks, the default mode network (DMN), and the sensorimotor network. These findings were almost identical to the results previously reported for hallucinogenic drugs. Therefore, our results suggest that monoaminergic substances can induce widespread changes in within-network connectivity in the absence of marked subjective drug effects. This contradicts the notion that these alterations can be regarded as specific for serotonergic hallucinogens. However, changes within the DMN might explain antidepressants effects of some of these substances.
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Affiliation(s)
- Felix Müller
- Department of Psychiatry (UPK), University of Basel, Basel, 4002, Switzerland.
| | - Friederike Holze
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, 4031, Switzerland
| | - Patrick Dolder
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, 4031, Switzerland
| | - Laura Ley
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, 4031, Switzerland
| | - Patrick Vizeli
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, 4031, Switzerland
| | - Alain Soltermann
- Department of Psychiatry (UPK), University of Basel, Basel, 4002, Switzerland
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, 4031, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, 4002, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, 23538, Germany
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20
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Chaliha D, Mamo JC, Albrecht M, Lam V, Takechi R, Vaccarezza M. A Systematic Review of the MDMA Model to Address Social Impairment in Autism. Curr Neuropharmacol 2021; 19:1101-1154. [PMID: 33388021 PMCID: PMC8686313 DOI: 10.2174/1570159x19666210101130258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/27/2020] [Accepted: 12/13/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by repetitive behaviours, cognitive rigidity/inflexibility, and social-affective impairment. Unfortunately, no gold-standard treatments exist to alleviate the core socio-behavioural impairments of ASD. Meanwhile, the prosocial empathogen/entactogen 3,4-methylene-dioxy-methamphetamine (MDMA) is known to enhance sociability and empathy in both humans and animal models of psychological disorders. OBJECTIVE We review the evidence obtained from behavioural tests across the current literature, showing how MDMA can induce prosocial effects in animals and humans, where controlled experiments were able to be performed. METHODS Six electronic databases were consulted. The search strategy was tailored to each database. Only English-language papers were reviewed. Behaviours not screened in this review may have affected the core ASD behaviours studied. Molecular analogues of MDMA have not been investigated. RESULTS We find that the social impairments may potentially be alleviated by postnatal administration of MDMA producing prosocial behaviours in mostly the animal model. CONCLUSION MDMA and/or MDMA-like molecules appear to be an effective pharmacological treatment for the social impairments of autism, at least in animal models. Notably, clinical trials based on MDMA use are now in progress. Nevertheless, larger and more extended clinical studies are warranted to prove the assumption that MDMA and MDMA-like molecules have a role in the management of the social impairments of autism.
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Affiliation(s)
| | | | | | | | | | - Mauro Vaccarezza
- Address correspondence to this author at the Curtin Medical School, Curtin Health Innovation Research Institute, P.O. Box 6845, WA 6102 Perth, Australia; Tel: 08 9266 7671; E-mail:
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21
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Feduccia AA, Jerome L, Mithoefer MC, Holland J. Discontinuation of medications classified as reuptake inhibitors affects treatment response of MDMA-assisted psychotherapy. Psychopharmacology (Berl) 2021; 238:581-588. [PMID: 33221932 PMCID: PMC7826309 DOI: 10.1007/s00213-020-05710-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE MDMA-assisted psychotherapy is under investigation as a novel treatment for posttraumatic stress disorder (PTSD). The primary mechanism of action of MDMA involves the same reuptake transporters targeted by antidepressant medications commonly prescribed for PTSD. OBJECTIVES Data were pooled from four phase 2 trials of MDMA-assisted psychotherapy. To explore the effect of tapering antidepressant medications, participants who had been randomized to receive active doses of MDMA (75-125 mg) were divided into two groups (taper group (n = 16) or non-taper group (n = 34)). METHODS Between-group comparisons were made for PTSD and depression symptom severity at the baseline and the primary endpoint, and for peak vital signs across two MDMA sessions. RESULTS Demographics, baseline PTSD, and depression severity were similar between the taper and non-taper groups. At the primary endpoint, the non-taper group (mean = 45.7, SD = 27.17) had a significantly (p = 0.009) lower CAPS-IV total scores compared to the taper group (mean = 70.3, SD = 33.60). More participants in the non-taper group (63.6%) no longer met PTSD criteria at the primary endpoint than those in the taper group (25.0%). The non-taper group (mean = 12.7, SD = 10.17) had lower depression symptom severity scores (p = 0.010) compared to the taper group (mean = 22.6, SD = 16.69). There were significant differences between groups in peak systolic blood pressure (p = 0.043) and diastolic blood pressure (p = 0.032). CONCLUSIONS Recent exposure to antidepressant drugs that target reuptake transporters may reduce treatment response to MDMA-assisted psychotherapy.
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Affiliation(s)
| | - Lisa Jerome
- MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Michael C Mithoefer
- MAPS Public Benefit Corporation, Santa Cruz, CA, USA
- Medical University of South Carolina, Charleston, SC, USA
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22
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Hussain JH, Gilbert N, Costello A, Schofield CJ, Kemsley EK, Sutcliffe OB, Mewis RE. Quantification of MDMA in seized tablets using benchtop 1H NMR spectroscopy in the absence of internal standards. Forensic Chem 2020. [DOI: 10.1016/j.forc.2020.100263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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23
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Carroll FI, Lewin AH, Mascarella SW, Seltzman HH, Reddy PA. Designer drugs: a medicinal chemistry perspective (II). Ann N Y Acad Sci 2020; 1489:48-77. [PMID: 32396701 DOI: 10.1111/nyas.14349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 12/18/2022]
Abstract
During 2012-2018, the clandestine manufacture of new psychoactive substances (NPS) designed to circumvent substance control regulations increased exponentially worldwide, with concomitant increase in fatalities. This review focuses on three compound classes identified as synthetic opioids, synthetic amphetamines, and synthetic cannabinoids and highlights the medicinal chemistry precedents utilized by clandestine laboratories to develop new NPS with increased brain penetration, longer duration of action, and greater potency. Chemical approaches to illicit drug abuse treatment options, particularly for opioid use disorder, are also discussed.
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Affiliation(s)
- F Ivy Carroll
- Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina
| | - Anita H Lewin
- Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina
| | - S Wayne Mascarella
- Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina
| | - Herbert H Seltzman
- Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina
| | - P Anantha Reddy
- Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina
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24
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Sbarski B, Akirav I. Cannabinoids as therapeutics for PTSD. Pharmacol Ther 2020; 211:107551. [PMID: 32311373 DOI: 10.1016/j.pharmthera.2020.107551] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 03/08/2020] [Indexed: 02/09/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a complex disorder that involves dysregulation of multiple neurobiological systems. The traumatic stressor plays a causal role in producing psychological dysfunction and the pattern of findings suggests that the hypothalamic-pituitary-adrenal (HPA) axis, which is instrumental for stress adaptation, is critically dysfunctional in PTSD. Given the lack of understanding of the basic mechanisms and underlying pathways that cause the disorder and its heterogeneity, PTSD poses challenges for treatment. Targeting the endocannabinoid (ECB) system to treat mental disorders, and PTSD in particular, has been the focus of research and interest in recent years. The ECB system modulates multiple functions, and drugs enhancing ECB signaling have shown promise as potential therapeutic agents in stress effects and other psychiatric and medical conditions. In this review, we focus on the interaction between the ECB-HPA systems in animal models for PTSD and in patients with PTSD. We summarize evidence supporting the use of cannabinoids in preventing and treating PTSD in preclinical and clinical studies. As the HPA system plays a key role in the mediation of the stress response and the pathophysiology of PTSD, we describe preclinical studies suggesting that enhancing ECB signaling is consistent with decreasing PTSD symptoms and dysfunction of the HPA axis. Overall, we suggest that a pharmacological treatment targeted at one system (e.g., HPA) may not be very effective because of the heterogeneity of the disorder. There are abnormalities across different neurotransmitter systems in the pathophysiology of PTSD and none of these systems function uniformly among all patients with PTSD. Hence, conceptually, enhancing ECB signaling may be a more effective avenue for pharmacological treatment.
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Affiliation(s)
- Brenda Sbarski
- School of Psychological Sciences, Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Irit Akirav
- School of Psychological Sciences, Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel.
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25
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Mead J, Parrott A. Mephedrone and MDMA: A comparative review. Brain Res 2020; 1735:146740. [PMID: 32087112 DOI: 10.1016/j.brainres.2020.146740] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 01/10/2023]
Abstract
Mephedrone and MDMA are both constituents of party drugs, with mephedrone being relatively new compared to MDMA. This review compares current knowledge regarding the patterns of usage and neuropsychobiological effects of both mephedrone and MDMA. Both drugs share common psychoactive effects, the duration of which is significantly shorter with mephedrone use, attributing towards a pattern of binge use among users. Both drugs have also been associated with adverse health, psychiatric, and neurocognitive problems. Whilst there is extensive research into the psychobiological problems induced by MDMA, the evidence for mephedrone is comparatively limited. The adverse effect profile of mephedrone appears to be less severe than that of MDMA. Users often believe it to be safer, although both drugs have been associated with overdoses. The neurotoxic potential of mephedrone appears to be low, whereas MDMA can cause long-term damage to the serotonergic system, although this needs further investigation. The abuse liability of mephedrone is significantly greater than that of MDMA, raising concerns regarding the impact of lifetime usage on users. Given that mephedrone is relatively new, the effects of long-term exposure are yet to be documented. Future research focused on lifetime users may highlight more severe neuropsychobiological effects from the drug.
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Affiliation(s)
- Jessica Mead
- Department of Psychology, School of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom.
| | - Andrew Parrott
- Department of Psychology, School of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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26
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Aguilar MA, García-Pardo MP, Parrott AC. Of mice and men on MDMA: A translational comparison of the neuropsychobiological effects of 3,4-methylenedioxymethamphetamine ('Ecstasy'). Brain Res 2020; 1727:146556. [PMID: 31734398 DOI: 10.1016/j.brainres.2019.146556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022]
Abstract
MDMA (3,4-methylendioxymethamphetamine), also known as Ecstasy, is a stimulant drug recreationally used by young adults usually in dance clubs and raves. Acute MDMA administration increases serotonin, dopamine and noradrenaline by reversing the action of the monoamine transporters. In this work, we review the studies carried out over the last 30 years on the neuropsychobiological effects of MDMA in humans and mice and summarise the current knowledge. The two species differ with respect to the neurochemical consequences of chronic MDMA, since it preferentially induces serotonergic dysfunction in humans and dopaminergic neurotoxicity in mice. However, MDMA alters brain structure and function and induces hormonal, psychomotor, neurocognitive, psychosocial and psychiatric outcomes in both species, as well as physically damaging and teratogen effects. Pharmacological and genetic studies in mice have increased our knowledge of the neurochemical substrate of the multiple effects of MDMA. Future work in this area may contribute to developing pharmacological treatments for MDMA-related disorders.
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Affiliation(s)
- Maria A Aguilar
- Department of Psychobiology, Faculty of Psychology, Valencia University, Valencia, Spain.
| | | | - Andrew C Parrott
- Department of Psychology, Swansea University, Swansea, United Kingdom; Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia
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27
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Heifets BD, Salgado JS, Taylor MD, Hoerbelt P, Cardozo Pinto DF, Steinberg EE, Walsh JJ, Sze JY, Malenka RC. Distinct neural mechanisms for the prosocial and rewarding properties of MDMA. Sci Transl Med 2019; 11:eaaw6435. [PMID: 31826983 PMCID: PMC7123941 DOI: 10.1126/scitranslmed.aaw6435] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/01/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022]
Abstract
The extensively abused recreational drug (±)3,4-methylenedioxymethamphetamine (MDMA) has shown promise as an adjunct to psychotherapy for treatment-resistant psychiatric disease. It is unknown, however, whether the mechanisms underlying its prosocial therapeutic effects and abuse potential are distinct. We modeled both the prosocial and nonsocial drug reward of MDMA in mice and investigated the mechanism of these processes using brain region-specific pharmacology, transgenic manipulations, electrophysiology, and in vivo calcium imaging. We demonstrate in mice that MDMA acting at the serotonin transporter within the nucleus accumbens is necessary and sufficient for MDMA's prosocial effect. MDMA's acute rewarding properties, in contrast, require dopaminergic signaling. MDMA's prosocial effect requires 5-HT1b receptor activation and is mimicked by d-fenfluramine, a selective serotonin-releasing compound. By dissociating the mechanisms of MDMA's prosocial effects from its addictive properties, we provide evidence for a conserved neuronal pathway, which can be leveraged to develop novel therapeutics with limited abuse liability.
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Affiliation(s)
- Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Juliana S Salgado
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Madison D Taylor
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Paul Hoerbelt
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Daniel F Cardozo Pinto
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Elizabeth E Steinberg
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Jessica J Walsh
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Ji Y Sze
- Department of Molecular Pharmacology and Rose F. Kennedy Intellectual and Developmental Disabilities Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Robert C Malenka
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA.
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28
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DePierro J, Lepow L, Feder A, Yehuda R. Translating Molecular and Neuroendocrine Findings in Posttraumatic Stress Disorder and Resilience to Novel Therapies. Biol Psychiatry 2019; 86:454-463. [PMID: 31466562 PMCID: PMC6907400 DOI: 10.1016/j.biopsych.2019.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/08/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022]
Abstract
Many biological systems are altered in association with posttraumatic stress disorder (PTSD) and resilience. However, there are only few approved pharmacological treatments for PTSD, and no approved medications to enhance resilience. This article provides a critical review of select neurobiological findings in PTSD and resilience, and also of pharmacologic approaches that have emerged from this work. The medications summarized involve engagement with targets in the adrenergic, hypothalamic-pituitary-adrenal axis, and neuropeptide Y systems. Other highlighted approaches involve the use of ketamine and 3,4-methylenedioxymethamphetamine-assisted psychotherapy, which recently surfaced as promising strategies for PTSD, though the neurobiological mechanisms underlying their actions, including for promoting resilience, are not yet fully understood. The former approaches fall within the broad concept of "rational pharmacotherapy," in that they attempt to directly target dysregulated systems known to be associated with posttraumatic symptoms. To the extent that use of ketamine and 3,4-methylenedioxymethamphetamine promotes symptom improvement and resilience in PTSD, this provides an opportunity for reverse translation and identification of relevant targets and mechanisms of action through careful study of biological changes resulting from these interventions. Promoting resilience in trauma-exposed individuals may involve more than pharmacologically manipulating dysregulated molecules and pathways associated with developing and sustaining PTSD symptom severity, but also producing a substantial change in mental state that increases the ability to engage with traumatic material in psychotherapy. Neurobiological examination in the context of treatment studies may yield novel targets and promote a greater understanding of mechanisms of recovery from trauma.
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Affiliation(s)
- Jonathan DePierro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren Lepow
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York.
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29
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Effects of MDMA on attention to positive social cues and pleasantness of affective touch. Neuropsychopharmacology 2019; 44:1698-1705. [PMID: 31042696 PMCID: PMC6785008 DOI: 10.1038/s41386-019-0402-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 12/29/2022]
Abstract
The psychostimulant drug ±3,4-methylenedioxymethamphetamine (MDMA) reportedly produces distinctive feelings of empathy and closeness with others. MDMA increases social behavior in animal models and has shown promise in psychiatric disorders, such as autism spectrum disorder (ASD) and post-traumatic stress disorder (PTSD). How it produces these prosocial effects is not known. This behavioral and psychophysiological study examined the effects of MDMA, compared with the prototypical stimulant methamphetamine (MA), on two measures of social behavior in healthy young adults: (i) responses to socially relevant, "affective" touch, and (ii) visual attention to emotional faces. Men and women (N = 36) attended four sessions in which they received MDMA (0.75 or 1.5 mg/kg), MA (20 mg), or a placebo in randomized order under double-blind conditions. Responses to experienced and observed affective touch (i.e., being touched or watching others being touched) were assessed using facial electromyography (EMG), a proxy of affective state. Responses to emotional faces were assessed using electrooculography (EOG) in a measure of attentional bias. Subjective ratings were also included. We hypothesized that MDMA, but not MA, would enhance the ratings of pleasantness and psychophysiological responses to affective touch and increase attentional bias toward positive facial expressions. Consistent with this, we found that MDMA, but not MA, selectively enhanced ratings of pleasantness of experienced affective touch. Neither drug altered the ratings of pleasantness of observed touch. On the EOG measure of attentional bias, MDMA, but not MA, increased attention toward happy faces. These results provide new evidence that MDMA can enhance the experience of positive social interactions; in this case, pleasantness of physical touch and attentional bias toward positive facial expressions. The findings are consistent with evidence that the prosocial effects are unique to MDMA relative to another stimulant. Understanding the behavioral and neurobiological processes underlying the distinctive social effects of MDMA is a key step to developing the drug for psychiatric disorders.
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30
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Vizeli P, Meyer zu Schwabedissen HE, Liechti ME. Role of Serotonin Transporter and Receptor Gene Variations in the Acute Effects of MDMA in Healthy Subjects. ACS Chem Neurosci 2019; 10:3120-3131. [PMID: 30589533 DOI: 10.1021/acschemneuro.8b00590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Methylenedioxymethamphetamine (MDMA; ecstasy) is used recreationally and has been investigated as an adjunct to psychotherapy. Most acute effects of MDMA can be attributed to activation of the serotonin (5-hydroxytryptamine [5-HT]) system. Genetic variants, such as single-nucleotide polymorphisms (SNPs) and polymorphic regions in 5-HT system genes, may contribute to interindividual differences in the acute effects of MDMA. We characterized the effects of common genetic variants within selected genes that encode the 5-HT system (TPH1 [tryptophan 5-hydroxylase 1] rs1800532 and rs1799913, TPH2 [tryptophan 5-hydroxylase 2] rs7305115, HTR1A [5-HT1A receptor] rs6295, HTR1B [5-HT1B receptor] rs6296, HTR2A [5-HT2A receptor] rs6313, and SLC6A4 [serotonin transporter] 5-HTTLPR and rs25531) on the physiological and subjective response to 125 mg of MDMA compared with placebo in 124 healthy subjects. Data were pooled from eight randomized, double-blind, placebo-controlled studies that were conducted in the same laboratory. TPH2 rs7305115, HTR2A rs6313, and SLC6A4 5-HTTLPR polymorphisms tended to moderately alter some effects of MDMA. However, after correcting for multiple comparisons, none of the tested genetic polymorphisms significantly influenced the response to MDMA. Variations in genes that encode key targets in the 5-HT system did not significantly influence the effects of MDMA in healthy subjects. Interindividual differences in the 5-HT system may thus play a marginal role when MDMA is used recreationally or therapeutically.
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Affiliation(s)
- Patrick Vizeli
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, Department of Clinical Research, University Hospital Basel, University of Basel, Basel CH-4056, Switzerland
| | | | - Matthias E. Liechti
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, Department of Clinical Research, University Hospital Basel, University of Basel, Basel CH-4056, Switzerland
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31
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Dipasquale O, Selvaggi P, Veronese M, Gabay AS, Turkheimer F, Mehta MA. Receptor-Enriched Analysis of functional connectivity by targets (REACT): A novel, multimodal analytical approach informed by PET to study the pharmacodynamic response of the brain under MDMA. Neuroimage 2019; 195:252-260. [PMID: 30953835 PMCID: PMC6547164 DOI: 10.1016/j.neuroimage.2019.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/11/2019] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
One of the main limitations of pharmacological fMRI is its inability to provide a molecular insight into the main effect of compounds, leaving an open question about the relationship between drug effects and haemodynamic response. The aim of this study is to investigate the acute effects of 3,4-methylenedioxymethamphetamine (MDMA) on functional connectivity (FC) using a novel multimodal method (Receptor-Enriched Analysis of functional Connectivity by Targets - REACT). This approach enriches the resting state (rs-)fMRI analysis with the molecular information about the distribution density of serotonin receptors in the brain, given the serotonergic action of MDMA. Twenty healthy subjects participated in this double-blind, placebo-controlled, crossover study. A high-resolution in vivo atlas of four serotonin receptors (5-HT1A, 5-HT1B, 5-HT2A, and 5-HT4) and its transporter (5-HTT) was used as a template in a two-step multivariate regression analysis to estimate the spatial maps reflecting the whole-brain connectivity behaviour related to each target under placebo and MDMA. Results showed that the networks exhibiting significant changes after MDMA administration are the ones informed by the 5-HTT and 5-HT1A distribution density maps, which are the main targets of this compound. Changes in the 5-HT1A-enriched functional maps were also associated with the pharmacokinetic levels of MDMA and MDMA-induced FC changes in the 5-HT2A-enriched maps correlated with the spiritual experience subscale of the Altered States of Consciousness Questionnaire. By enriching the rs-fMRI analysis with molecular data of voxel-wise distribution of the serotonin receptors across the brain, we showed that MDMA effects on FC can be understood through the distribution of its main targets. This result supports the ability of this method to characterise the specificity of the functional response of the brain to MDMA binding to serotonergic receptors, paving the way to the definition of a new fingerprint in the characterization of new compounds and potentially to a further understanding to the response to treatment. MDMA connectivity effects understood through the distribution of 5-HT1A and 5-HTT. Direct link between PK levels of MDMA and 5-HT1A-enriched functional connectivity maps. Ability to link receptor targets to functional mechanisms underlying behaviour. Mapping pharmacodynamic effects onto the drug's molecular targets.
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Affiliation(s)
- Ottavia Dipasquale
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Pierluigi Selvaggi
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Mattia Veronese
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Anthony S Gabay
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Federico Turkheimer
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Curry DW, Berro LF, Belkoff AR, Sulima A, Rice KC, Howell LL. Sensitization to the prosocial effects of 3,4-methylenedioxymethamphetamine (MDMA). Neuropharmacology 2019; 151:13-20. [PMID: 30922893 DOI: 10.1016/j.neuropharm.2019.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/13/2019] [Accepted: 03/13/2019] [Indexed: 01/11/2023]
Abstract
The recreational drug 3,4-methylenedioxymethamphetamine (MDMA) has well documented prosocial effects and is currently under clinical investigation as a treatment for patients with PTSD, autism, and other conditions. Early clinical trials have found that MDMA-assisted therapy may have robust long-lasting therapeutic effects, yet the mechanism by which acute treatments produce these long-term effects is unclear. Sensitization to certain behavioral drug effects is a common rodent model used to assess long-lasting neurobiological adaptations induced by acute drug treatments. Nine independent experiments were undertaken to investigate if and how mice sensitize to the prosocial effects of MDMA. When treated with 7.8 mg/kg MDMA and paired every other day for a week, MDMA-induced social interaction increased precipitously across treatment sessions. This previously unreported phenomenon was investigated and found to be heavily influenced by a social context and 5-HT2AR activation. Social sensitization did not appear to develop if mice were administered MDMA in isolation, and pretreatment with MDL100907, a selective 5-HT2AR antagonist, inhibited the development of social sensitization. However, when MDL100907 was administered to mice that had already been sensitized, it did not attenuate social interaction, suggesting that 5-HT2AR activity may be necessary for the development of social sensitization but not the expression of MDMA-induced social behavior. Additional investigation is warranted to further explore the phenomenon of social sensitization and to determine the underlying neurobiological mechanisms.
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Affiliation(s)
- Daniel W Curry
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Laís F Berro
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Andie R Belkoff
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Agnieszka Sulima
- Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Kenner C Rice
- Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Leonard L Howell
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA.
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Sevenster D, Visser RM, D'Hooge R. A translational perspective on neural circuits of fear extinction: Current promises and challenges. Neurobiol Learn Mem 2018; 155:113-126. [PMID: 29981423 PMCID: PMC6805216 DOI: 10.1016/j.nlm.2018.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 06/20/2018] [Accepted: 07/03/2018] [Indexed: 02/07/2023]
Abstract
Fear extinction is the well-known process of fear reduction through repeated re-exposure to a feared stimulus without the aversive outcome. The last two decades have witnessed a surge of interest in extinction learning. First, extinction learning is observed across species, and especially research on rodents has made great strides in characterising the physical substrate underlying extinction learning. Second, extinction learning is considered of great clinical significance since it constitutes a crucial component of exposure treatment. While effective in reducing fear responding in the short term, extinction learning can lose its grip, resulting in a return of fear (i.e., laboratory model for relapse of anxiety symptoms in patients). Optimization of extinction learning is, therefore, the subject of intense investigation. It is thought that the success of extinction learning is, at least partly, determined by the mismatch between what is expected and what actually happens (prediction error). However, while much of our knowledge about the neural circuitry of extinction learning and factors that contribute to successful extinction learning comes from animal models, translating these findings to humans has been challenging for a number of reasons. Here, we present an overview of what is known about the animal circuitry underlying extinction of fear, and the role of prediction error. In addition, we conducted a systematic literature search to evaluate the degree to which state-of-the-art neuroimaging methods have contributed to translating these findings to humans. Results show substantial overlap between networks in animals and humans at a macroscale, but current imaging techniques preclude comparisons at a smaller scale, especially in sub-cortical areas that are functionally heterogeneous. Moreover, human neuroimaging shows the involvement of numerous areas that are not typically studied in animals. Results obtained in research aimed to map the extinction circuit are largely dependent on the methods employed, not only across species, but also across human neuroimaging studies. Directions for future research are discussed.
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Affiliation(s)
- Dieuwke Sevenster
- Laboratory of Biological Psychology, Department of Psychology, KU Leuven, Tiensestraat 102, B-3000 Leuven, Belgium; Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
| | - Renée M Visser
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Rudi D'Hooge
- Laboratory of Biological Psychology, Department of Psychology, KU Leuven, Tiensestraat 102, B-3000 Leuven, Belgium
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Dunlap LE, Andrews AM, Olson DE. Dark Classics in Chemical Neuroscience: 3,4-Methylenedioxymethamphetamine. ACS Chem Neurosci 2018; 9:2408-2427. [PMID: 30001118 PMCID: PMC6197894 DOI: 10.1021/acschemneuro.8b00155] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Better known as "ecstasy", 3,4-methylenedioxymethamphetamine (MDMA) is a small molecule that has played a prominent role in defining the ethos of today's teenagers and young adults, much like lysergic acid diethylamide (LSD) did in the 1960s. Though MDMA possesses structural similarities to compounds like amphetamine and mescaline, it produces subjective effects that are unlike any of the classical psychostimulants or hallucinogens and is one of the few compounds capable of reliably producing prosocial behavioral states. As a result, MDMA has captured the attention of recreational users, the media, artists, psychiatrists, and neuropharmacologists alike. Here, we detail the synthesis of MDMA as well as its pharmacology, metabolism, adverse effects, and potential use in medicine. Finally, we discuss its history and why it is perhaps the most important compound for the future of psychedelic science-having the potential to either facilitate new psychedelic research initiatives, or to usher in a second Dark Age for the field.
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Affiliation(s)
- Lee E Dunlap
- Department of Chemistry , University of California, Davis , One Shields Avenue , Davis , California 95616 , United States
| | - Anne M Andrews
- Departments of Psychiatry and Chemistry & Biochemistry, Semel Institute for Neuroscience and Human Behavior, and Hatos Center for Neuropharmacology , University of California , Los Angeles , California 90095 , United States
| | - David E Olson
- Department of Chemistry , University of California, Davis , One Shields Avenue , Davis , California 95616 , United States
- Department of Biochemistry & Molecular Medicine, School of Medicine , University of California, Davis , 2700 Stockton Blvd, Suite 2102 , Sacramento , California 95817 , United States
- Center for Neuroscience , University of California, Davis , 1544 Newton Ct , Davis , California 95616 , United States
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MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? Prog Neuropsychopharmacol Biol Psychiatry 2018. [PMID: 29524515 DOI: 10.1016/j.pnpbp.2018.03.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
MDMA-assisted psychotherapy for treatment of PTSD has recently progressed to Phase 3 clinical trials and received Breakthrough Therapy designation by the FDA. MDMA used as an adjunct during psychotherapy sessions has demonstrated effectiveness and acceptable safety in reducing PTSD symptoms in Phase 2 trials, with durable remission of PTSD diagnosis in 68% of participants. The underlying psychological and neurological mechanisms for the robust effects in mitigating PTSD are being investigated in animal models and in studies of healthy volunteers. This review explores the potential role of memory reconsolidation and fear extinction during MDMA-assisted psychotherapy. MDMA enhances release of monoamines (serotonin, norepinephrine, dopamine), hormones (oxytocin, cortisol), and other downstream signaling molecules (BDNF) to dynamically modulate emotional memory circuits. By reducing activation in brain regions implicated in the expression of fear- and anxiety-related behaviors, namely the amygdala and insula, and increasing connectivity between the amygdala and hippocampus, MDMA may allow for reprocessing of traumatic memories and emotional engagement with therapeutic processes. Based on the pharmacology of MDMA and the available translational literature of memory reconsolidation, fear learning, and PTSD, this review suggests a neurobiological rationale to explain, at least in part, the large effect sizes demonstrated for MDMA in treating PTSD.
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(±)-MDMA and its enantiomers: potential therapeutic advantages of R(-)-MDMA. Psychopharmacology (Berl) 2018; 235:377-392. [PMID: 29248945 DOI: 10.1007/s00213-017-4812-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
The use of (±)-3,4-methylenedioxymethamphetamine ((±)-MDMA) as an adjunct to psychotherapy in the treatment of psychiatric and behavioral disorders dates back over 50 years. Only in recent years have controlled and peer-reviewed preclinical and clinical studies lent support to (±)-MDMA's hypothesized clinical utility. However, the clinical utility of (±)-MDMA is potentially mitigated by a range of demonstrated adverse effects. One potential solution could lie in the individual S(+) and R(-) enantiomers that comprise (±)-MDMA. Individual enantiomers of racemic compounds have been employed in psychiatry to improve a drug's therapeutic index. Although no research has explored the individual effects of either S(+)-MDMA or R(-)-MDMA in humans in a controlled manner, preclinical research has examined similarities and differences between the two molecules and the racemic compound. This review addresses information related to the pharmacodynamics, neurotoxicity, physiological effects, and behavioral effects of S(+)-MDMA and R(-)-MDMA that might guide preclinical and clinical research. The current preclinical evidence suggests that R(-)-MDMA may provide an improved therapeutic index, maintaining the therapeutic effects of (±)-MDMA with a reduced side effect profile, and that future investigations should investigate the therapeutic potential of R(-)-MDMA.
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Curry DW, Young MB, Tran AN, Daoud GE, Howell LL. Separating the agony from ecstasy: R(-)-3,4-methylenedioxymethamphetamine has prosocial and therapeutic-like effects without signs of neurotoxicity in mice. Neuropharmacology 2018; 128:196-206. [PMID: 28993129 PMCID: PMC5714650 DOI: 10.1016/j.neuropharm.2017.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 01/26/2023]
Abstract
S,R(+/-)-3,4-methylenedioxymethamphetamine (SR-MDMA) is an amphetamine derivative with prosocial and putative therapeutic effects. Ongoing clinical trials are investigating it as a treatment for post-traumatic stress disorder (PTSD) and other conditions. However, its potential for adverse effects such as hyperthermia and neurotoxicity may limit its clinical viability. We investigated the hypothesis that one of the two enantiomers of SR-MDMA, R-MDMA, would retain the prosocial and therapeutic effects but with fewer adverse effects. Using male Swiss Webster and C57BL/6 mice, the prosocial effects of R-MDMA were measured using a social interaction test, and the therapeutic-like effects were assessed using a Pavlovian fear conditioning and extinction paradigm relevant to PTSD. Locomotor activity and body temperature were tracked after administration, and neurotoxicity was evaluated post-mortem. R-MDMA significantly increased murine social interaction and facilitated extinction of conditioned freezing. Yet, unlike racemic MDMA, it did not increase locomotor activity, produce signs of neurotoxicity, or increase body temperature. A key pharmacological difference between R-MDMA and racemic MDMA is that R-MDMA has much lower potency as a dopamine releaser. Pretreatment with a selective dopamine D1 receptor antagonist prevented SR-MDMA-induced hyperthermia, suggesting that differential dopamine signaling may explain some of the observed differences between the treatments. Together, these results indicate that the prosocial and therapeutic effects of SR-MDMA may be separable from the stimulant, thermogenic, and potential neurotoxic effects. To what extent these findings translate to humans will require further investigation, but these data suggest that R-MDMA could be a more viable therapeutic option for the treatment of PTSD and other disorders for which SR-MDMA is currently being investigated.
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Affiliation(s)
- Daniel W Curry
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Matthew B Young
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Andrew N Tran
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Georges E Daoud
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Leonard L Howell
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Simmler LD. Monoamine Transporter and Receptor Interaction Profiles of Synthetic Cathinones. CURRENT TOPICS IN NEUROTOXICITY 2018. [DOI: 10.1007/978-3-319-78707-7_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Synthetic cathinones are derivatives of the naturally occurring compound cathinone, the main psychoactive ingredient in the khat plant Catha edulis. Cathinone is the β-keto analog of amphetamine, and all synthetic cathinones display a β-keto moiety in their structure. Several synthetic cathinones are widely prescribed medications (e.g., bupropion, Wellbutrin®), while others are problematic drugs of abuse (e.g., 4-methylmethcathinone, mephedrone). Similar to amphetamines, synthetic cathinones are psychomotor stimulants that exert their effects by impairing the normal function of plasma membrane transporters for dopamine (DAT), norepinephrine (NET), and 5-HT (SERT). Ring-substituted cathinones like mephedrone are transporter substrates that evoke neurotransmitter release by reversing the normal direction of transporter flux (i.e., releasers), whereas pyrrolidine-containing cathinones like 3,4-methylenedioxypyrovalerone (MDPV) are potent transporter inhibitors that block neurotransmitter uptake (i.e., blockers). Regardless of molecular mechanism, all synthetic cathinones increase extracellular monoamine concentrations in the brain, thereby enhancing cell-to-cell monoamine signaling. Here, we briefly review the mechanisms of action, structure-activity relationships, and in vivo pharmacology of synthetic cathinones. Overall, the findings show that certain synthetic cathinones are powerful drugs of abuse that could pose significant risk to users.
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Sessa B. Why MDMA therapy for alcohol use disorder? And why now? Neuropharmacology 2017; 142:83-88. [PMID: 29126911 DOI: 10.1016/j.neuropharm.2017.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/15/2017] [Accepted: 11/03/2017] [Indexed: 01/26/2023]
Abstract
Alcohol use disorder represents a serious clinical, social and personal burden on its sufferers and a significant financial strain on society. Current treatments, both psychological and pharmacological are poor, with high rates of relapse after medical detoxification and dedicated treatment programs. The earliest historical roots of psychedelic drug-assisted psychotherapy in the 1950s were associated with Lysergic acid diethylamide (LSD)-assisted psychotherapy to treat what was then called, alcoholism. But results were varied and psychedelic therapy with LSD and other 'classical' psychedelics fell out of favour in the wake of socio-political pressures and cultural changes. A current revisiting of psychedelic clinical research is now targeting substance use disorders - and particularly alcohol use disorder - again. 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy has never been formally explored as a treatment for any form of substance use disorder. But in recent years MDMA has risen in prominence as an agent to treat posttraumatic stress disorder (PTSD). With its unique receptor profile and a relatively well-tolerated subjective experience of drug effects when used clinically, MDMA Therapy is ideally suited to allow a patient to explore and address painful memories without being overwhelmed by negative affect. Given that alcohol use disorder is so often associated with early traumatic experiences, the author is proposing in a current on-going UK-based study that patients with alcohol use disorder who have undergone a medical detoxification from alcohol might benefit from a course of MDMA-assisted psychotherapy. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.
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Walpola IC, Nest T, Roseman L, Erritzoe D, Feilding A, Nutt DJ, Carhart-Harris RL. Altered Insula Connectivity under MDMA. Neuropsychopharmacology 2017; 42:2152-2162. [PMID: 28195139 PMCID: PMC5603811 DOI: 10.1038/npp.2017.35] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 12/14/2022]
Abstract
Recent work with noninvasive human brain imaging has started to investigate the effects of 3,4-methylenedioxymethamphetamine (MDMA) on large-scale patterns of brain activity. MDMA, a potent monoamine-releaser with particularly pronounced serotonin- releasing properties, has unique subjective effects that include: marked positive mood, pleasant/unusual bodily sensations and pro-social, empathic feelings. However, the neurobiological basis for these effects is not properly understood, and the present analysis sought to address this knowledge gap. To do this, we administered MDMA-HCl (100 mg p.o.) and, separately, placebo (ascorbic acid) in a randomized, double-blind, repeated-measures design with twenty-five healthy volunteers undergoing fMRI scanning. We then employed a measure of global resting-state functional brain connectivity and follow-up seed-to-voxel analysis to the fMRI data we acquired. Results revealed decreased right insula/salience network functional connectivity under MDMA. Furthermore, these decreases in right insula/salience network connectivity correlated with baseline trait anxiety and acute experiences of altered bodily sensations under MDMA. The present findings highlight insular disintegration (ie, compromised salience network membership) as a neurobiological signature of the MDMA experience, and relate this brain effect to trait anxiety and acutely altered bodily sensations-both of which are known to be associated with insular functioning.
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Affiliation(s)
- Ishan C Walpola
- Department of Psychiatry, McGill University Faculty of Medicine, McGill University, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, 6825 LaSalle Boulevard, Montreal, Quebec, Canada H4H 1R3, Tel: 5147662010, E-mail:
| | - Timothy Nest
- Department of Psychiatry, McGill University Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Leor Roseman
- Division of Brain Sciences, Faculty of Medicine, Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - David Erritzoe
- Division of Brain Sciences, Faculty of Medicine, Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | | | - David J Nutt
- Division of Brain Sciences, Faculty of Medicine, Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Division of Brain Sciences, Faculty of Medicine, Centre for Neuropsychopharmacology, Imperial College London, London, UK
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Abstract
Previous attempts to identify a unified theory of brain serotonin function have largely failed to achieve consensus. In this present synthesis, we integrate previous perspectives with new and older data to create a novel bipartite model centred on the view that serotonin neurotransmission enhances two distinct adaptive responses to adversity, mediated in large part by its two most prevalent and researched brain receptors: the 5-HT1A and 5-HT2A receptors. We propose that passive coping (i.e. tolerating a source of stress) is mediated by postsynaptic 5-HT1AR signalling and characterised by stress moderation. Conversely, we argue that active coping (i.e. actively addressing a source of stress) is mediated by 5-HT2AR signalling and characterised by enhanced plasticity (defined as capacity for change). We propose that 5-HT1AR-mediated stress moderation may be the brain's default response to adversity but that an improved ability to change one's situation and/or relationship to it via 5-HT2AR-mediated plasticity may also be important - and increasingly so as the level of adversity reaches a critical point. We propose that the 5-HT1AR pathway is enhanced by conventional 5-HT reuptake blocking antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), whereas the 5-HT2AR pathway is enhanced by 5-HT2AR-agonist psychedelics. This bipartite model purports to explain how different drugs (SSRIs and psychedelics) that modulate the serotonergic system in different ways, can achieve complementary adaptive and potentially therapeutic outcomes.
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Affiliation(s)
- RL Carhart-Harris
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - DJ Nutt
- Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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Cadoni C, Pisanu A, Simola N, Frau L, Porceddu PF, Corongiu S, Dessì C, Sil A, Plumitallo A, Wardas J, Di Chiara G. Widespread reduction of dopamine cell bodies and terminals in adult rats exposed to a low dose regimen of MDMA during adolescence. Neuropharmacology 2017; 123:385-394. [DOI: 10.1016/j.neuropharm.2017.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 11/16/2022]
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Kelmendi B, Adams TG, Southwick S, Abdallah CG, Krystal JH. Posttraumatic Stress Disorder: an integrated overview and neurobiological rationale for pharmacology. ACTA ACUST UNITED AC 2017; 24:281-297. [PMID: 31404451 DOI: 10.1111/cpsp.12202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thirty years of research on the biology of posttraumatic stress disorder now provides a foundation for hypotheses related to the mechanisms underlying the pharmacotherapy of this disorder. Only two medications, sertraline and paroxetine, are approved by the U.S. Food and Drug Administration for the treatment of PTSD. While these medications are somewhat effective, other treatment mechanisms must be explored to address the unmet need for effective treatment. This article provides a concise summary of advances in our understanding of the neurobiology of PTSD that suggest novel approaches to pharmacotherapy.
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Affiliation(s)
- Benjamin Kelmendi
- Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Thomas G Adams
- Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Steven Southwick
- Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Chadi G Abdallah
- Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - John H Krystal
- Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT.,Psychiatry Services, Yale-New Haven Hospital, New Haven, CT
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Puxty DJ, Ramaekers JG, de la Torre R, Farré M, Pizarro N, Pujadas M, Kuypers KPC. MDMA-Induced Dissociative State not Mediated by the 5-HT 2A Receptor. Front Pharmacol 2017; 8:455. [PMID: 28744219 PMCID: PMC5504523 DOI: 10.3389/fphar.2017.00455] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/23/2017] [Indexed: 11/13/2022] Open
Abstract
Previous research has shown that a single dose of MDMA induce a dissociative state, by elevating feelings of depersonalization and derealization. Typically, it is assumed that action on the 5-HT2A receptor is the mechanism underlying these psychedelic experiences. In addition, other studies have shown associations between dissociative states and biological parameters (heart rate, cortisol), which are elevated by MDMA. In order to investigate the role of the 5-HT2 receptor in the MDMA-induced dissociative state and the association with biological parameters, a placebo-controlled within-subject study was conducted including a single oral dose of MDMA (75 mg), combined with placebo or a single oral dose of the 5-HT2 receptor blocker ketanserin (40 mg). Twenty healthy recreational MDMA users filled out a dissociative states scale (CADSS) 90 min after treatments, which was preceded and followed by assessment of a number of biological parameters (cortisol levels, heart rate, MDMA blood concentrations). Findings showed that MDMA induced a dissociative state but this effect was not counteracted by pre-treatment with ketanserin. Heart rate was the only biological parameter that correlated with the MDMA-induced dissociative state, but an absence of correlation between these measures when participants were pretreated with ketanserin suggests an absence of directional effects of heart rate on dissociative state. It is suggested that the 5-HT2 receptor does not mediate the dissociative effects caused by a single dose of MDMA. Further research is needed to determine the exact neurobiology underlying this effect and whether these effects contribute to the therapeutic potential of MDMA.
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Affiliation(s)
- Drew J Puxty
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - Rafael de la Torre
- Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d'Investigacions MèdiquesBarcelona, Spain.,Spanish Biomedical Research Centre in Physiopathology of Obesity and NutritionSantiago de Compostela, Spain.,Facultat de Ciencies de la Salut i de la Vida, Universitat Pompeu FabraBarcelona, Spain
| | - Magí Farré
- Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d'Investigacions MèdiquesBarcelona, Spain.,Department of Pharmacology, Therapeutic and Toxicology, Universitat Autonoma de BarcelonaBarcelona, Spain.,Hospital Universitari Germans Trias i Pujol, Clinical PharmacologyBadalona, Spain
| | - Neus Pizarro
- Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d'Investigacions MèdiquesBarcelona, Spain.,Department of Pharmacology, Therapeutic and Toxicology, Universitat Autonoma de BarcelonaBarcelona, Spain
| | - Mitona Pujadas
- Integrative Pharmacology and Neurosciences Systems Research Group, Institut Hospital del Mar d'Investigacions MèdiquesBarcelona, Spain.,Spanish Biomedical Research Centre in Physiopathology of Obesity and NutritionSantiago de Compostela, Spain
| | - Kim P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
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46
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Sessa B. MDMA and PTSD treatment. Neurosci Lett 2017; 649:176-180. [DOI: 10.1016/j.neulet.2016.07.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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47
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Sessa B. Can 3,4,-methylenedioxymethamphetamine therapy be used to treat alcohol use disorder? JOURNAL OF PSYCHEDELIC STUDIES 2017. [DOI: 10.1556/2054.01.2016.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ben Sessa
- Imperial College London, London, England, UK
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48
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Neurochemical substrates of the rewarding effects of MDMA: implications for the development of pharmacotherapies to MDMA dependence. Behav Pharmacol 2016; 27:116-32. [PMID: 26650254 DOI: 10.1097/fbp.0000000000000210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In recent years, studies with animal models of reward, such as the intracranial self-stimulation, self-administration, and conditioned place preference paradigms, have increased our knowledge on the neurochemical substrates of the rewarding effects of 3,4-methylenedioxymetamphetamine (MDMA) in rodents. However, pharmacological and neuroimaging studies with human participants are scarce. Serotonin [5-hydroxytryptamine (5-HT)], dopamine (DA), endocannabinoids, and endogenous opiates are the main neurotransmitter systems involved in the rewarding effects of MDMA in rodents, but other neurotransmitters such as glutamate, acetylcholine, adenosine, and neurotensin are also involved. The most important finding of recent research is the demonstration of differential involvement of specific neurotransmitter receptor subtypes (5-HT2, 5-HT3, DA D1, DA D2, CB1, μ and δ opioid, etc.) and extracellular proteins (DA and 5-HT transporters) in the acquisition, expression, extinction, and reinstatement of MDMA self-administration and conditioned place preference. It is important to extend the research on the effects of different compounds acting on these receptors/transporters in animal models of reward, especially in priming-induced, cue-induced, and stress-induced reinstatement. Increase in knowledge of the neurochemical substrates of the rewarding effects of MDMA may contribute to the design of new pharmacological treatments for individuals who develop MDMA dependence.
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Olsen RA, Macaskill AC, Harper DN. Differential effects of 3,4-methylenedioxymethamphetamine, methamphetamine, meta-Chlorophenylpiperazine, and scopolamine on behavioral repetition versus variation in rats. Pharmacol Biochem Behav 2016; 150-151:170-181. [PMID: 27826121 DOI: 10.1016/j.pbb.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Abstract
Acute administration of drugs of abuse, such as MDMA and methamphetamine, disrupts performance on many operant tasks, for example, those used to study memory. This might occur in part because drugs make behavior, in general, more repetitive or more variable, or because they produce a more global disruption to performance. The current study explored this across two experiments by employing Neuringer's 'reinforced variability' procedure. Varied behavior was reinforced at some times during the session and repetitive behavior at other times; lights signalled the behavior required. This procedure allowed an investigation of whether a particular drug made behavior more variable (affected behavior when repetition was required), more repetitive (affected behavior when variability was required), or produced a global disruption (affected both components). In Experiment 1, MDMA increased variability while methamphetamine affected both components. In Experiment 2, m-CPP affected both components while scopolamine affected both components at lower doses and increased variability at higher doses. These results indicate both that the reinforced variability procedure can be used to isolate the specific effects of drugs of abuse on the variability of behavior, and that the specific impact of a given drug needs to be considered when interpreting pharmacological disruptions to operant task performance.
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Affiliation(s)
- Rebecca A Olsen
- C/- School of Psychology, Victoria University of Wellington, PO Box 600, Wellington, New Zealand
| | - Anne C Macaskill
- C/- School of Psychology, Victoria University of Wellington, PO Box 600, Wellington, New Zealand.
| | - David N Harper
- C/- School of Psychology, Victoria University of Wellington, PO Box 600, Wellington, New Zealand
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50
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Kelmendi B, Adams TG, Yarnell S, Southwick S, Abdallah CG, Krystal JH. PTSD: from neurobiology to pharmacological treatments. Eur J Psychotraumatol 2016; 7:31858. [PMID: 27837583 PMCID: PMC5106865 DOI: 10.3402/ejpt.v7.31858] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/28/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a chronic debilitating psychiatric disorder characterized by symptoms of re-experience, avoidance, and hyperarousal that can arise immediately or many years after exposure to a traumatic event and injury. Although extensive research has been done over the past 30 years, the etiology of PTSD remains largely unknown. Several neurobiological systems have been implicated in the pathophysiology and vulnerability for developing PTSD; however, first-line pharmacotherapies are limited. Less than 30% achieve full remission, and even then, approved pharmacological treatments often take weeks for therapeutic effect. This article aims to review the pathophysiology of PTSD within multiple neurobiological systems and how these mechanisms are used as pharmacologic targets of treatment, as well as their potential for future targets of intervention.
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Affiliation(s)
- Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Clinical Neuroscience Division, Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT;
| | - Thomas G Adams
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Clinical Neuroscience Division, Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Stephanie Yarnell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Steven Southwick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Clinical Neuroscience Division, Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Chadi G Abdallah
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Clinical Neuroscience Division, Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Clinical Neuroscience Division, Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT
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