Is Post-Traumatic Stress Medication a Danger to Veterans?

I have not run any guest posts lately, but some months ago the AllTreatment site was kind enough to feature a guest post of my own, so I've arranged to return the favor with an article by Brandon Yu. He is a Managing Editor of Alltreatment.com. AllTreatment is an online rehab center directory and substance abuse information resource.‬

Opinions expressed in guest posts are not necessarily those of Addiction Inbox.
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By Brandon Yu

After spending weeks, months, or years on the battlefield, veterans often experience Post-Traumatic Stress Disorder (PTSD) when returning to civilian life. The Department of Veteran Affairs reports that 60% of men and 50% of women, not just veterans, experience some sort of trauma in their lifetimes. PTSD has been known to cause insomnia, depression, and a sense of detachment, making it difficult for veterans to readjust to society, and throwing their personal and professional lives into disarray.

While there may not be a cure for Post-Traumatic Stress Disorder, there are treatments, and certainly medication, to sooth its side-effects. The most popular medication for PTSD is the pharmaceutical Quetiapine, marketed as Seroquel by the biologics company AstraZeneca. A potent antipsychotic, Seroquel is often prescribed to treat symptoms of psychoses including schizophrenia, bipolar disorder, and acute manic episodes; numerous physicians claim that it is one of the few treatments that curbs the nightmares, insomnia and anxiety that come with PTSD. It is not considered a controlled substance, and not deemed addictive like other sleeping pills.

However, several families of veterans are calling for a Congressional investigation of Seroquel after reports of mistreatment over the drug have arisen. After some complaints that the treatment was not working, some doctors prescribed progressively larger doses for given patients, with certain ones receiving more than double the maximum recommended. Though only six similar deaths have been noted, there is a belief that there have been others. The New England Journal of Medicine recently published a report linking Seroquel use to heart failure, noting that 3 of 1,000 patients who suffered from cardiac arrest were noted to be on Seroquel at the time of death.

Seroquel is one of the more common medications in America, as it is one of the Department of Veterans Affairs’ most prescribed drugs and the fifth best-selling drug in the nation. It has been reported to help schizophrenia and PTSD, but some of its side effects, such as diabetes, weight gain, and uncontrollable muscle spasms, have caused AstraZeneca to receive multiple trips to court, with an estimated 10,000 product liability lawsuits. It is noted that although it is commonly prescribed for those suffering PTSD, Seroquel has not received FDA approval as proper treatment for insomnia. Families of veterans who are attempting a Congressional investigation on Seroquel are hoping for a clearer guideline of the side effects as well as the risk to one’s health.

Some Background on the Psychedelic Renaissance

Ecstasy, MAPS, and Post-Traumatic Stress Disorder.

The psychedelic drugs, new and old, are not only among the most powerful ever discovered, but are also tremendously difficult to study and utilize responsibly. By the mid-1990s, rumors about Ecstasy (MDMA) toxicity were everywhere. Unlike Prozac, but very much like LSD, Ecstasy not only blocks serotonin uptake, but also causes the release of additional serotonin, much the way cocaine and amphetamine cause the release of extra dopamine.

A study conducted by neurologist George Ricaurte at John Hopkins University under NIDA sponsorship seemed to show conclusive evidence of neurotoxic damage to the serotonin 5-HT receptors in the brains of monkeys given large doses of MDMA. A follow-up study of 30 MDMA users (existing users, since researchers didn’t have government permission to give MDMA to test subjects) showed 30 per cent less cerebrospinal serotonin, compared to a control group. However, the Johns Hopkins team did not have any baseline measurements for the MDMA users, and other neurologists raised technical objections about various aspects of the study, including dosage levels. As was often the case in such studies, the monkeys had been given a whopping dose, compared to the typical raver’s dose. Ricaurte insisted that the amount of MDMA consumed by a typical user in one night of raving was possibly enough to cause permanent brain damage. The government estimates that 10 million Americans have taken Ecstasy.

That would seem to be the end of the story, and a sobering lesson for today’s youth—but that is not how it turned out. A few years later, Dr. Charles Grob, psychiatry professor at the UCLA School of Medicine, received the first FDA approval ever given for the administration of MDMA to human volunteers. The result of Grob’s testing was that none of the volunteers showed any evidence of neuropsychological damage of any kind. In testimony before the U.S. Sentencing Commission, which was considering harsher penalties for MDMA possession in 2001, Dr. Grob seriously questioned the methodology of the Ricaurte studies: “It is very unfortunate that the lavishly funded NIDA-promoted position on so-called MDMA neurotoxicity has inhibited alternative research models which would better delineate the true range of effects of MDMA, including its potential application as a therapeutic medicine.” Science retracted its coverage of the Ricaurte findings.

It was eventually discovered that Dr. Ricaurte’s monkeys had been injected with amphetamine, not with MDMA—a discovery that also nullified four other published papers. Dr. Ricaurte explained that some labels had been switched, and a Johns Hopkins spokesperson called the whole thing “an honest mistake.” The basic questions about Ecstasy remain unanswered. Is there a line that separates a conceivably therapeutic dose of Ecstasy for mental ills or addictive ills from a possibly brain-damaging run of several dozen high-dosage trips? Perhaps the permanently altered receptor arrays, if they exist, don’t affect cognition or emotions in any significant way over the long run. Still, the risks of overindulgence appear to be at least potentially higher than the risks of overindulging in LSD or Ibogaine. All of the psychedelics tend to be more self-limiting than other categories of psychoactive drugs, anyway. After two or three days, even the most die-hard raver or LSD head is usually ready to take a break.

Rick Doblin and others at  the Multidisciplinary Association for Psychedelic Studies (MAPS) are now working with government investigators to pursue MDMA for the treatment of post-traumatic stress disorder. There are reports that very low doses of LSD sometimes have an antidepressant effect. One thing we know for certain is that people on SSRI medications or MAO inhibitors report that their experiences on LSD or Ecstasy are shorter and far less powerful than is typically the case.  There appears to be some competition for receptor sites when Zoloft meets LSD. In contrast to the diminished psychedelic experience while on SSRIs, the older norepinephrine-active tricyclics like Tofranil and Norpramine reportedly serve to potentiate the LSD or MDMA experience. None of these combinations is a wise idea, due to uncertainties about the interactions.

Even DMT, which experienced trippers compared to being shot out of a cannon, has returned as a legitimate study subject. Dr. Rick Strassman, then with the University of New Mexico’s School of Medicine, received approval for clinical testing of DMT. Strassman was drawn to the subject because of the molecule’s natural occurrence in the brain (which makes every man, woman, and child in America a drug criminal, chemically speaking). He gave DMT to 60 human volunteers over a study period of five years. Strassman was primarily interested in near-death experiences and mystical experiences. None of the supervised DMT sessions evidently resulted in any detectable harm to the participants. Strassman presents his views on the medical use of DMT in his book, DMT: The Spirit Molecule.

Adapted from The Chemical Carousel: What Science Tells Us About Beating Addiction by Dirk Hanson © 2008, 2009.

Graphics Credit: http://hightimes.com/