Why Do We Think Suffering Is Good for Us?

Author Article

For decades, psychoanalysts were against any medicating to treat anxiety, believing it would interfere with the therapeutic process.CreditCreditMaskot/Getty Images

Feeling anxious or depressed and want to get better? You have to really work at it and suffer through years of therapy and sometimes try lots of drugs. No pain, no gain, or so we’ve been told.

That would make a stoic happy, but as a psychiatrist — and an admittedly impatient one — I know that just because something feels bad doesn’t necessarily mean that it’s good for you. I’m pretty confident that people who are suffering prefer relief sooner rather than later and that if there was any way to make the treatment — be it psychotherapy or medication — more effective, they would gladly try it.

So I am cautiously optimistic that on Tuesday, the Food and Drug Administration approved esketamine, a nasal version of the drug ketamine, which appears to relieve depressive symptoms far faster than other antidepressants. There are risks: The drug is potentially addictive, heavy use can impair cognition, and it could induce a psychotic reaction in some patients. But if prescribed judiciously, esketamine should be a boon to the 25 percent of people with depression who fail to respond to current drugs.

I have been wondering if esketamine could be used for another purpose, too: to strengthen the effects of therapy. This is because it targets the neurotransmitter glutamate, which plays an important role in learning and memory.

There is intriguing neuroscience research that suggests that it may be possible to boost the efficacy of psychotherapy with drugs that share some of ketamine’s effects, somewhat the way athletes can enhance their performance with steroids.

A while back, I saw a young woman who had been mugged on her way home from work. She was pushed to the ground by an unseen assailant who stole her wallet and fled, leaving her shaken up but otherwise unharmed.

In the next few weeks, she become increasingly anxious when walking alone at night and had intrusive flashbacks of the assault during the day. Normally, you would lose this fear after being back on the street a few times and seeing that nothing traumatic happens. But she’d developed classic post-traumatic stress disorder, in which a previously safe situation provokes a persistent, and visceral, sense of danger.

She began exposure therapy with one of my colleagues in which she gradually confronted the situation she feared — a dark city street — alongside her therapist, who assured her that nothing terrible would happen. Like many people, she found this treatment upsetting and emotionally draining, but she stuck it out and eventually recovered.

What if we could use a drug to speed up a difficult treatment like that and make it more effective?

The psychologist JoAnn Difede and her colleagues at Weill Cornell Medical College, where I also work, addressed that question with a study in 2013 of 25 patients who developed PTSD after Sept. 11. They randomly assigned the participants to virtual reality exposure (12 weekly sessions of simulated attacks on the World Trade Center combined with patients’ recounting their traumatic experience in vivid detail) with either the drug d-cycloserine or a placebo.

Subjects who received exposure along with d-cycloserine showed faster and greater improvement in their PTSD and depressive symptoms, and the benefits persisted after six months of follow-up.

Of course, this was a very small study. A 2017 meta-analysis of 21 studies found that d-cycloserine was superior to a placebo in boosting the short-term effect of exposure-based therapy, though any long-term effects were less consistent. Studies of the drug in rodents have also found that it helps the animals recover from the fear of shocks much faster than a placebo.

How might this work? D-cycloserine is an antibiotic that, like ketamine, increases the activity of glutamate in key brain regions, which promotes connections between neurons. It seems to amp up the molecular machinery of learning. And psychotherapy is all about learning — to overcome fear and to better handle stress, among other lessons.

For decades, psychoanalysts were against medicating anxiety at all, because they believed it would interfere with the therapeutic process. Fortunately, those days are largely over. Many are now comfortable giving patients anti-anxiety benzodiazepines like Klonopin if they are having a hard time grappling with issues that arise in therapy. Treating excessive anxiety can allow patients to better face their pain and fears.

This research suggests we could be doing more to use drugs to turbocharge therapy.

The timing of drug and treatment is probably crucial. In one study, rats were trained to fear a particular context (cage) or a cue (white light) by pairing them with a mild shock. The animals then underwent fear-extinction therapy, either in one long session after receiving a benzodiazepine or in two sessions with the drug given in between. The latter group were more successful at getting over their fear, which suggests that some exposure therapy must precede the medication.

But maybe, with the help of the right drug, just a little therapy could go a long way.

One small study randomized 20 subjects with PTSD to receive just two sessions of therapy in addition to either MDMA (the party drug Ecstasy) or a placebo. Those who got MDMA had fewer PTSD symptoms and were more open and less “neurotic” than those who took a placebo at a two-month follow-up.

It’s not that surprising. MDMA is known to promote openness and lack of defensiveness, both of which might be conducive to attaining insights. Could that wisdom be as enduring as the kind acquired during months of therapy? It’s possible. After all, therapy and prescription drugs like antidepressants change the brain in surprisingly similar ways.

Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College, and a contributing opinion writer.

Cannabis and Pain

Author Article

This could be the delicious anti-inflammatory treat you’ve been looking for.

Cannabis and Pain

For more than 20 percent of Americans, chronic pain is part of daily life. Many aren’t getting the relief they need.

Pain treatments have been typically limited to nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid medications, which carry the risk of addiction. Both have risks of side effects. With opioids frequently in the headlines, many people with chronic pain can’t get access to the medication they depend on to get through the day without intense pain.

As a possible alternative to long-term opioid use for chronic pain, many people are turning to cannabis. Cannabis has a long history of medical use and is especially effective in the treatment of pain.

Cannabidiol (CBD) has gained mainstream attention for its effectiveness in treating a number of conditions including pain, both acute and chronic.

Combining CBD and THC

In states where medical marijuana is legal, a combination of CBD and THC can be used for pain to great effect, and is more potent than when CBD is used alone. The complementary nature of the compounds is known as the entourage effect.

Best 3 Recommended CBD Oils

If medical marijuana isn’t available legally in your state, you might still be able to find relief from chronic or acute pain by using hemp-derived CBD.

CBD extracts are available in multiple forms, but the most popular is an oil base. CBD oils can be mixed into many different recipes for ingestion or added to lotions, massage oils, or balms at different concentrations to match your need.

Below are CBD oils recommended by Green Flower Media and CannaInsider:

CBD Mango Smoothie Recipe for Pain Relief

Author and cannabis advocate Sandra Hinchcliffe shares a favorite smoothie recipe from her forthcoming book “CBD Every Day.”

CBD oil is mixed with mango and orange juice for a refreshing drink to ease your aches and pains.

Research has shown that mango can heighten the effects of cannabinoids because they share a compound called myrcene which is a terpene found in both cannabis and mango.

The result? A more effective, longer-lasting experience.

Citrus fruits also contain a large quantity of antioxidants, giving them anti-inflammatory properties. That makes this smoothie the perfect vehicle for your pain-relieving CBD oil dose.

Sandra’s Mango Canna-Booster Smoothie

Serves: 2 smoothies (8 oz each)

Ingredients

  • 1 cup fresh-squeezed blood orange juice, room temperature (you can substitute any fresh-squeezed orange juice)
  • ⅓ cup fresh coconut milk
  • Preferred or specific dose of CBD oil
  • 2 large or 3 medium mangoes, sliced and partially frozen
  • ½ cup ice

Directions

  1. To a blender, add the orange juice, coconut milk, and CBD oil. Blend until creamy.
  2. Add the frozen mango and ice into the blender. Blend until icy and creamy.
  3. Serve immediately. Enjoy!

Even if marijuana is legal in your state, it continues to be illegal under federal law. While there are some claims that CBD derived from hemp (rather than a cannabis plant) is legal in all 50 states, other reports point out legality isn’t so straightforward. We suggest checking your state’s laws regarding CBD oil.

Kristi is a freelance writer and mother who spends most of her time caring for people other than herself. She’s frequently exhausted and compensates with an intense caffeine addiction. Find her on Twitter.

Reposted with permission from our media associate Healthline.

We Looked Into The Real Benefits of Acupuncture

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By Markham Heid

In 1991, on a trail high in the Austrian-Italian Alps, two hikers stumbled onto a man’s 5,000-year-old corpse. Now known as “Ötzi” the Iceman, the corpse bore more than a dozen clusters of skin tattoos.

Experts first assumed the tattoos were ornamental. But researchers have since noted that many of Ötzi’s inkings are located in places along his back and spine that correspond with traditional Chinese acupuncture points—points targeted for the treatment of digestive disorders. An analysis of Ötzi’s gut turned up the remnants of parasitic worms, and Ötzi’s pack contained a fruit known to help treat GI problems.

Experts broadly agree that acupuncture has been around since at least 100 B.C. While controversial, the Ötzi tattoo researchers say their findings suggest that a “treatment modality similar to acupuncture” may have existed more than 5,000 years ago.

If nothing else, acupuncture qualifies as a “time-tested” form of therapy. And while many conventional doctors and scientists dismiss it as pseudo-medicine, it’s hard to believe acupuncture could have persisted for millennia if there weren’t something to it. The research to date, while incomplete, suggests acupuncture may provide real therapeutic benefits.

What is acupuncture?

Traditional Chinese medicine holds that a sort of vital energy or life force—known as a person’s qi (pronounced or also known as “chi”)—flows through the body along defined pathways or “meridians.” Diseases are believed to cause (or be caused by) disruptions or “disharmonies” in the flow of a person’s qi. The needle pokes we all associate with acupuncture are meant to correct or influence these disharmonies.

Some contemporary acupuncture practitioners play down the stuff about qi and meridians. Also, acupuncture comes in many shapes and sizes: for example, some acupuncturists incorporate electrical stimulation. But needle insertions in specific points are a universal trait of the therapy.


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From the perspective of conventional medicine, a therapy doesn’t “work” unless it both outperforms a placebo and does so via an identifiable “mechanism of action.” Like a high schooler taking a math exam, it’s not enough to for acupuncture to come up with the right answer—it also has to show its work.

A lot of researchers have gone looking for evidence that acupuncture “works,” but experts disagree in their interpretations of the study results. “There have been several recent meta-analyses [on specific conditions] that concluded acupuncture had a statistically significant benefit,” says Vitaly Napadow, an acupuncture researcher and director of the Center for Integrative Pain Neuroimaging at Massachusetts General Hospital and Harvard Medical School. “But depending on who you talk to, you’ll get different answers about whether they believe in specific acupuncture effects or if they think the role of placebo effect or expectancy made the difference.”

Napadow’s take: It’s not a panacea that will cure all ills, but there are some areas where acupuncture is promising and, given its safety profile, should be recommended. “I think its mechanisms depend on the disease it’s trying to treat,” he says.

For nausea- or pain-related conditions, acupuncture may activate nerve receptors in the skin that modulate levels of nervous system chemicals or signals involved in these ailments, he explains. Meanwhile, for conditions like arthritis or tendonitis, the micro-injuries caused by acupuncture pin pricks may draw blood and its healing elements to the affronted area—causing a temporary reduction in symptoms, he says.

But as of today, all these mechanisms are speculative and need to be confirmed by more research. There’s also debate over whether the stuff about qi or meridians is useful. Some studies that have compared sham acupuncture—basically, needles stuck in at random—to true acupuncture have failed to find a difference in patient outcomes, while others have concluded that legit acupuncture outperformed the sham procedure.

To sum all this up, everything to do with acupuncture is controversial. But for some conditions, the existing research suggests the practice may confer real and meaningful benefits.

Does acupuncture work for pain?

“This is the area where we have the most data,” Napadow says. And the results are encouraging.

A comprehensive 2018 review found that, for patients managing chronic pain, acupuncture outperformed a sham procedure and “standard” care, which usually meant pain pills. “If our study had been on a drug, we’d say the drug works—there’s a statistically significant effect there,” says Andrew Vickers, first author of that study and a biostatistician at Memorial Sloan Kettering Cancer Center in New York City.

Vickers’ study focused on patients suffering from pain associated with four common ailments: back and neck pain, arthritis, shoulder pain, and headaches. Acupuncture was similarly effective for each of these conditions, his study found. Also, acupuncture’s benefits were durable: After a year of treatment, the average patient reported only a minor drop it its efficacy.

“It could be that acupuncture is just a very effective placebo,” Vickers says. But when you consider the lack of good treatment options for long-term pain—and the risks associated with prescription pain pills or surgeries—acupuncture is “a reasonable referral option” for patients with chronic pain, he says.

Can acupuncture treat gut disorders?

The evidence on acupuncture for gut problems is mixed. A 2017 study inAnnals of Internal Medicine found that, for patients suffering from severe constipation, acupuncture significantly outperformed a sham procedure when it came to improving the frequency of bowel movements. But more research is needed to assess the long-term effects of acupuncture, that study’s authors write.

Meanwhile, a 2013 review from a group of Chinese researchers found evidence that acupuncture may beat out some common prescription drugs for the treatment of inflammatory bowel disease (IBD). But the authors of that review say the studies they turned up were generally of “low” quality. A 2007 review from a German team linked acupuncture with significant improvements in quality of life and “disease activity scores” (a measure that determines whether symptoms have reduced) among patients with Crohn’s disease and ulcerative colitis—the two most common forms of IBD. But the authors of that review say the studies they turned up were generally of “low” quality—meaning the design or execution of the studies was poor, and so the results are shaky.

Long story short, the jury’s still out.

Does acupuncture work for fertility?

Proponents of acupuncture have long recommended it for female menstrual health and fertility. And a 2014 research review from Australia found “preliminary” evidence that acupuncture could help regulate a woman’s menstrual cycle and “assist” healthy ovulation.

How (in the hell) could it do that? Some research has hypothesized that acupuncture may help stimulate and also regulate uterine and ovarian blood flow, which could help thicken the lining of a woman’s uterus, which in turn could facilitate embryo implantation and successful pregnancy. But all this is theoretical.

2018 study, also from Australia, tracked more than 800 women undergoing in vitro fertilization (IVF). It found no significant uptick in successful births among those who underwent acupuncture versus those who didn’t.

Can acupuncture treat depression?

Again, the research is all over the map. A 2010 review found “insufficient” evidence backing acupuncture for the treatment of depression. But, more recently, a team of UK academics determined that there was “promising” clinical evidence showing acupuncture could help treat depression—enough to warrant further research.

It’s probably worth noting that, even when it comes to prescription antidepressants (namely, SSRIs), there’s considerable expert disagreement about whether these pills outperform placebos. While the data on acupuncture for the treatment of depression is inconsistent, some studies suggest it’s “at least” as effective as prescription drugs.

Does it work for anything else?

Pick a medical condition or mental health disorder, and there’s probably some evidence suggesting acupuncture may help treat it. But the reality is that, as of today, experts are still trying to wrap their heads around acupuncture and its role in medicine.

There are two things that can be said for acupuncture: It’s relatively inexpensive, and it comes with very few side effects, Napadow says. If the alternative is an expensive procedure or pills—especially opioids or other medications with serious side effects—you lose very little by giving acupuncture a try first, he adds.