MDMA (3,4-methylenedioxymethamphetamine, also known as Ecstasy), may one day offer hope for individuals with posttraumatic stress disorder (PTSD), even people for whom other treatments have failed. Clinical trial results out today in the Journal of Psychopharmacology, published by SAGE, suggests that MDMA can be administered to subjects with PTSD without evidence of harm and could offer sufferers a vital window with reduced fear responses wherepsychotherapy can take effect.

Before MDMA became used recreationally under the street name Ecstasy, hundreds of psychiatrists and psychotherapists around the world administered MDMA as a catalyst to psychotherapy. MDMA was criminalized in the U.S. in 1985 (it had been illegal in the UK since 1977).  Several decades later, this study is the first completed randomized, double-blinded clinical trial to evaluate MDMA as a therapeutic adjunct in any patient population.

Belmont, MA-based Rick Doblin, Ph.D., President of the Multidisciplinary Association for Psychedelic Studies (www.maps.org, a non-profit psychedelic and medical marijuana research and educational organization that sponsored the study), together with South Carolina-based psychiatrist Michael Mithoefer, MD and colleagues, conducted a pilot Phase II clinical trial with 20 patients with chronic PTSD persisting for an average of over 19 years. Prior to enrolling in the MDMA study, subjects were required to have
received, and failed to obtain relief, from both psychotherapy and psychopharmacology.

Participants treated with a combination of MDMA and psychotherapy saw clinically and statistically significant improvements in their PTSD – over 80% of the trial group no longer met the diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV-TR) following the trial, compared to only 25% of the placebo group. In addition, all three subjects who reported being unable to work due to PTSD were able to return to work following treatment with MDMA.

The trial centered on two eight-hour psychotherapy sessions scheduled about 3-5 weeks apart, where 12 subjects received MDMA, and eight took a placebo. Subjects were also given psychotherapy on a weekly basis before and after each experimental session. A blinded, independent rater tested each subject using a PTSD scale at baseline, and at intervals four days after each session and two months after the second session. The clinical response was significant – 10 of the 12 in the treatment group responded to the treatment compared with just two of the eight in the placebo group. During the trial, the subjects did not experience any drug-related Serious Adverse Events (SAEs), nor any adverse neurocognitive effects or clinically significant blood pressure or temperature increases.

After the two-month follow-up, subjects in the placebo group were offered the option to participate in the treatment process again, to receive MDMA on an open-label basis, acting as their own controls. Seven of the eight placebo subjects elected to receive MDMA-assisted psychotherapy, with successful treatment outcomes similar to the subjects initially randomized to MDMA. PTSD involves exaggerated and uncontrolled fear responses. To treat these, psychotherapists need to help sufferers revisit traumatic experiences. But patients often suffer intolerable feelings when they revisit the trauma, or numb themselves emotionally, resulting in the psychotherapy having little effect. The goal of using MDMA is to temporarily reduce fear and increase trust without inhibiting emotions, especially painful emotions, allowing these patients a window where psychotherapy for their PTSD is effective.

MDMA’s pharmacological effects include serotonin release, 5HT2 receptor stimulation and increase in levels of the neurohormones oxytocin, prolactin and cortisol.

Importantly, this trial involved concentrated periods of patient-therapist contact (31 hours over two months) including two all-day therapy sessions and overnight stays in the clinic. “These are not usual features of psychotherapy practice in the outpatient setting,” says Michael Mithoefer. MDMA-assisted psychotherapy would require special clinics equipped for longer treatment sessions and overnight stays if an MDMA-based treatment were approved. “This method also involves patient preparation and close follow-up to support further processing of emotions and integration of cognitive shifts that may occur,” Mithoefer adds, stressing that these are vital for safety and therapeutic effect.

Measures like these may prove a price worth paying, however, to alleviate the debilitating effects of PTSD on sufferers in future.

The authors caution that the study does have limitations – for example they did not look at gender and ethnic factors in their sample selection. Another important limitation was that most participants and trial investigators guessed accurately whether they were in the treatment or the placebo group. The placebo had no psychoactive effect and investigators could detect raised blood pressure and other symptoms in the MDMA group. A long-term follow-up to the study just published, evaluating subjects an average of about 40 months post-treatment, is underway.

The investigators have now received the go ahead from the U.S. Food and Drug Administration (FDA) for a protocol for a three-arm, dose-response design that they expect will result in successful blinding. This new study is for U.S. veterans with war-related PTSD, most from Iraq and Afghanistan and a few from Vietnam.  MAPS is currently sponsoring MDMA/PTSD Phase 2 pilot studies in Switzerland and Israel, and is working to start additional pilot studies in Canada, Jordan and Spain.

The safety and efficacy of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic treatment-resistant posttraumatic stress disorder: the first randomised controlled pilot study by Michael C. Mithoefer, M.D., Mark T. Wagner, Ph.D., Ann T. Mithoefer, B.S.N., Lisa Jerome, Ph.D., and Rick Doblin, Ph.D. is published today (19th July 2010) in the Journal of Psychopharmacology.

The Journal of Psychopharmacology is published by SAGE, on behalf of the British Association for Psychopharmacology.

A treatment manual by the study’s sponsor, the Multidisciplinary Association for Psychedelic Studies on this topic can be found here.

MAPS’ Investigator’s Brochure, reviewing and summarizing the entire published scientific literature on MDMA and Ecstasy, can be found here.

High blood pressure affects about 40% of adults in the UK and is a major risk factor for heart attack, heart failure, kidney disease and stroke. It was already known that some patients getting their blood pressure levels checked by a doctor can suffer what’s known as the ‘white coat’ effect – their blood pressure levels increase due to nerves or stress at being in a clinical setting.

The study involving 8,575 patients has shown that the ‘white coat’ effect is more dramatic in patients with very high blood pressure – their blood pressure levels can rise by as much as 29 units if a doctor checks it, compared with a rise of 17 units if a nurse is taking the measurement.

The point is that finding an accurate indicator of cardiovascular or heart disease has traditionally been difficult. The best diagnostic tests remain in the hands of the experts and require sophisticated instrumentation such as Dual-Source Infinity CT and Cardiac Specialists such as Professor Avijit Lahiri.

WHY IS THAT IMPORTANT? High levels of salt raise blood pressure and cause cardiovascular disease.

The new research from CASH surveyed 784 products in the largest survey of its kind in the UK, across supermarket shelves, independent shops and takeaway restaurants. The survey reveals very high levels of salt hidden in bought Indian & South Asian cuisine including; takeaways, ready meals, cooking sauces, chutneys, pickles and side dishes.
Curry dishes frequently top the poll as the UK’s favourite meals, but these findings highlight that the nation is blindly consuming dangerous levels of salt.  As well as main curry dishes being high in salt; you can more than DOUBLE your salt intake with extras such as chutney and Naan bread.  The lack of clear labelling on the packaging, combined with the spicy ingredients masking the salty flavour, makes it very hard for people to know how much salt they are eating.

Takeaway Your Life

Takeaways are thought of as a convenient option, however CASH found large variations in the salt content of the same curries from different restaurants in London’s famous curry street Brick Lane.  CASH found the lowest takeaway to be a Vegetable Korma (1.37g per portion) and the highest a Chicken Tikka Masala (6.81g per portion), so a simple swap could cut your salt intake by up to 4 times in the main meal alone.

“A regular ’Curry Night’ is becoming a British institution, making these high salt levels extremely worrying” says CASH Campaign Manager & Nutritionist Katharine Jenner. “This survey shows salt can be hidden behind all the spices and chilli in your curry, even in side dishes and sauces.  Add to this the lack of clear labelling on packaging and in takeaway restaurants, and it makes it very hard for consumers to choose a healthy option.”

See www.actiononsalt.org.uk for more information and tables detailing the products and their associated salt levels. Patients concerned about the affects of eating too much salty curry and / or with a curry worry about subsequent pain should see the article by Professor Avijit Lahiri – Chest Pain – Cardiac or not?

Anyone suspected of having cancer who is urgently referred by their GP will have the legal right to wait no more than 2 weeks to see a specialist, and people referred for elective procedures will have the legal right to start treatment within 18 weeks. Health Secretary Andy Burnham said: “The NHS Constitution gives patients the right to get the services that they are entitled to, and the power to challenge the NHS where it does not deliver. As the NHS strives to move from good to great and becomes more people-centred and preventative, the Constitution will ensure that all the improvements it makes can be safeguarded for generations to come.”

In a recent consultation, nearly nine out of ten people supported the proposals to give patients the right to maximum waiting times for elective treatment and for urgent cancer referrals, or for the NHS to look for an alternative provider (from independent sources such as in Capital Health) if this is not possible. From April 2012, all those eligible aged 40-74 will have the legal right to an NHS Health Check every five years to assess their risk of heart disease,  stroke, diabetes and kidney disease.

Plans have also commenced for patients suspected of having cancer to get key diagnostic tests within one week of seeing a GP.  From 2011/12, the initial focus is on providing the tests and results associated with lung, colorectal and ovarian cancer within two weeks and subject to the necessary funding being available, this will then be expanded to include the relevant tests and results for all cancers within one week.

Watch the video.

Anyone seeking to test themselves for anything from a full screen to individual tests including viruses or haemoglobin can do so by contacting a reputable and controlled pathology laboratory. To arrange any test you can click here and for a description of the different types of tests along with what they mean – here is an excellent starting point written by Consultant Diagnostic Pathologists.

There has therefore been a major need for a more accurate cardiology screening method. There have been tremendous improvements in our knowledge of the underlying process of cardiovascular disease (CVD), but unfortunately 30%  of people who have a heart attack don’t survive therefore early detection is critically important.  Early detection is confounded by the fact that almost 80% of the patients have had “silent” heart disease for many years. It’s important to obtain an accurate and rapid diagnosis of coronary artery disease at the outset and exclude non-cardiac chest pain, since there may serious consequences with a missed diagnosis. Also it’s vital to understand that the symptoms of heart disease are different in men than women.

The latest scanners come with ‘interesting’ names and for those people interested in the technology, they are called:

Dual-source ultra-fast CT scanner (Definition), combined with the hybrid CT+Gamma Camera (SPECT-CT) (Symbia T6), 4D- Echocardiography.

This is recognised as the latest state-of-the-art digital and remote telemetry system for exercise testing and 24 hour ECG monitoring. Furthermore, this new diagnostic approach is non-invasive.

Anyone concerned about heart disease or seeking information on how to go about obtaining a full and accurate diagnosis should read Chest Pain – Cardiac or Not by Prof Lahiri.

In Capital Health works with only those senior medical consultants who are internally acknowledged experts, and facilitates communication directly between them and patients or other people seeking the latest authoritative facts.

1. I assume my doctor is right, but what does this diagnosis mean?
2. How do I know that this information is correct and relevant to me?
3. What are the latest technologies and treatment options?
4. Who are the experts?
5. Do I need a second opinion?
6. Where do I go and who should I see?
7. Can I afford it?

For those who become more knowledgeable about the options available, the questions become far more specific.  These might include:

• How do I decide on what type of hip replacement to have?
• What are the latest medically recognised cancer treatments, and what actually works?
• Should I have surgery on my slipped disc and if so, what sort of surgery should I have?
• Should I see an orthopaedic surgeon or a neurosurgeon?

This is covered more thoroughly in the section on patient empowerment on the in Capital Health Website -

This, plus the section advising on pre-consultation preparation will help people to ensure they get the best care.

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Against this backdrop, only around 20 per cent of plastic surgery patients are now referred to psychologists due to their unrealistic psychological expectations, according to cosmetic surgeons at nationwide clinic Mybreast.

Female and male patients who show signs of poor body image are often referred to see a clinical psychologist to analyse whether surgery is the right choice for them. Although these patients are mainly female, Dr Alex Clarke, a psychologist at The Royal Free Hospital in London, says there is an increasing number of men with physical insecurities and psychological issues as well, especially in the area of ‘man boobs’.