MDMA e Depressão

Portas da Percepção

hempadao 10 julho, 2015

por Fernando Beserra

A depressão é um transtorno mental e do comportamento que já foi interpretado, vivido e observado de formas muito distintas na história da humanidade. Na Grécia antiga, na tradição hipocrática, relacionavam o temperamento melancólico com a bile, neste caso, com a denominada bile negra. Haveria no corpo humano diferentes formas de bile que se relacionariam aos temperamentos humanos (sanguíneo, fleumático, colérico e melancólico). Na Idade Média o humor deprimido foi associado à Ascedia, na qual monges que se retiravam para o deserto seriam tomados “por Satanás”, segundo a interpretação da época (JARDIM, 2011). No início da psicopatologia moderna, Esquirol (1772-1840) relaciona a depressão a medicina em construção. Tratar-se-ia de um distúrbio primário do humor e o diagnóstico seria sindrômico, isto é, analisado por um conjunto de sinais e sintomas.

Não se trata, neste post, de avaliar as diferenças entre transtorno depressivo (leve, moderado, grave; com ou sem sintomas psicóticos), episódio depressivo, transtorno misto de ansiedade e depressão ou distimia. A depressão, tipicamente, cursa com sensações de reduções na energia psíquica, da libido (redução do interesse sexual), alterações no peso (aumentando ou decrescendo), no humor (hipotimia ou apatia; pode haver anedonia, isto é, redução da capacidade de sentir prazer), no pensamento (como o pensamento lentificado ou derreista…), na autoimagem e a perda da motivação. Também podem ocorrer alterações no sono, com hipersonia (dormir em excesso) ou insônia. É comum no humor triste a presença de choros frequentes e, em algumas depressões, a incapacidade de chorar. Estima-se que cerca de 15% da população passarão, em algum momento, por um episódio depressivo. Nos EUA estima-se que 7% da população teriam depressão maior (segundo classificação do DSM V, manual diagnóstico organizado pela Associação de Psiquiatria dos EUA).

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Riedlinger e outros (2001) debateram o uso do MDMA no tratamento da depressão, acumulando e debatendo dados já organizados com fins de analisar o uso deste empatógeno para contribuir no transtorno mental que mais acomete pessoas no mundo.

Desde 1962, van Praag sugeriu que a deficiência de serotonina (5-hidroxitriptamina) estaria relacionada a grande parte das depressões. Em 1982 ele conclui que 40% das depressões teriam como fator causal o desequilíbrio bioquímico no Sistema Nervoso Central (SNC). Um dos argumentos utilizados para reforçar esta tese foi o efeito, considerado naquele momento promissor, dos tratamentos que utilizavam 5HTP (5-Hidroxotriptofano) e L-triptofano. Deste modo, muito do tratamento na depressão seguiu esta lógica, especialmente, pela via medicamentosa, a exemplo dos inibidores seletivos de receptação da serotonina (ISRS), como Prozac, Zoloft, Paxil, etc. A tese do desequilíbrio bioquímico foi questionada por pesquisas posteriormente e observa-se, atualmente, que o uso de ISRS não é, de fato, nenhum tipo de panaceia, mesmo que tenha seu lugar no tratamento de depressões maiores.

Em 1950 as terapias com psicodélicos iniciaram um importante avanço, com resultados altamente promissores. Estas pesquisas e ações terapêuticas foram basicamente exterminadas, a duras penas para centenas de milhares de pessoas que poderiam se beneficiar destas terapias, ainda na década de 1970 (no caso do MDMA, a proibição ocorreu em 1985). Na década de 1950 o importante relatório: “Ataractic and Hallucinogenic Drugs in Psychiatry”, escrito por especialistas ligados à Organização Mundial de Saúde (OMS) já indicava posicionamentos interessantes e distintos da falácia dos psicodélicos como psicotomiméticos (produtores de psicose). No relatório descreve-se, por exemplo, que seria uma simplificação superficial estudar as reatividades padrões ao uso destes psicoativos; de forma distinta, a mesma droga em quantidades análogas poderia produzir efeitos muito diferentes dependendo da situação interpessoal e motivacional do uso. De acordo com Riedlinger e outros (2001, p. 267) o uso de MDMA em psicoterapia para “estimular sentimentos positivos, tais como abertura e empatia, parece recomendá-lo para um possível papel clínico no tratamento da depressão”.

Uma das questões centrais nas depressões mais graves é o aumento de probabilidade de ideação suicida, isto é, a possibilidade de a pessoa ter pensamentos e mesmo atos em direção a pôr fim a própria vida. O desespero e a desesperança podem ser cruciais nesta questão. Embora a psicoterapia seja importante nestes casos, pode demorar para que o paciente passe a ter uma boa relação transferencial com o terapeuta. O tempo, no caso de pensamentos suicidas, entretanto, pode ser algo escasso. Evidente que, neste caso, o suporte psicossocial é fundamental. A aposta de Riedlinger e outros (2001) é que, igualmente, neste cenário o MDMA pode ser um aliado muito importante da psicoterapia.

Por pelo menos 15 anos muitos dados foram reunidos nos tratamentos administrados por psiquiatras e psicólogos, na Psicoterapia com MDMA. De maneira geral, as pesquisas eram resultados de casos individuais ou, como se diz na literatura científica, anedóticos. Ainda falta, no caso da aplicação do MDMA aliado à psicoterapia no tratamento da depressão, estudos sistemáticos que forneçam evidências mais amplas da eficácia deste tratamento e comparação com outras terapêuticas disponíveis no tratamento de transtorno ou episódios depressivos. Os clínicos observaram que o MDMA fortifica a aliança terapêutica, aumentando a confiança e facilitando a abertura na psicoterapia. Alguns pacientes relatavam melhoria do humor, sentiram-se mais relaxados, melhoraram as relações com outras pessoas e melhoraram suas estimas de si, por dias ou semanas. Redlinger e outros (2001) citam os estudos de Eisner, publicados em 1989, em: “The MDMA history” nos quais há vários relatos de alívio dos sintomas depressivos após o uso de MDMA. Igualmente há exemplos no livro de Sophia Adamson: “Through the gateway of the heart”, que vamos, na segunda parte deste texto, traduzir um destes exemplos. Neste sentido, o MDMA não promoveria, como algumas drogas, apenas um alívio dos sintomas, mas igualmente a capacidade de olhar os problemas de forma real e frontalmente, com menor ansiedade, permitindo uma nova formulação de sentido sobre os mesmos. O resultado esperado é a possibilidade de uma comunicação construtiva em direção à melhoria da saúde mental.

Finalmente, importantes pesquisadores têm se posicionado a favor da regulamentação do MDMA, não apenas para os usos médicos e psicoterapêuticos, mas igualmente para o uso recreativo ou abrangente. Um destes exemplos é o grupo EmmaSofia. O mesmo ocorre hoje na Austrália. Além da análise dos efeitos positivos do MDMA aliado à psicoterapia no tratamento de transtornos mentais, observa-se, no uso recreativo, que muitas pessoas estão tomando “ecstasy” adulterado, com uma série de contaminantes tóxicos como o PMA. A falta de regulamentação, como temos observado também no Brasil, coloca os usuários em riscos de diversos danos e mesmo de morte. Segundo David Nutt, tomar MDMA de fato é menos perigoso do que andar de cavalo. Não é o que acontece quando a pessoa resolve tomar ecstasy ou MD em uma festa sem saber o que de fato está tomando. Por esta e outras tenho defendido que em diversos espaços existam equipes de redutores de danos capacitados não apenas para acolher possíveis bad trips, mas igualmente que testem as substâncias com reagentes próprios (test kits) para avaliar o que os usuários estão utilizando e orientá-los adequadamente. Mas isso é assunto para outro dia…

Referências:

ADAMSON, Sophia (ed). Through the gateway of the heart: accounts of experiences with MDMA and other empathogenic substances. San Francisco:

RIEDLINGER, June; R.Ph; PHARM, D.; MONTAGNE, Michael. Using MDMA in the treatment of Depression In: MDMA: a complete guide. Rochester/Vermont: Park Street Press, 2001.

MEDEW, Julia. Call to make ecstasy legal and sell it at pharmacies In: The Age Victoria (Jornal online). Disponível em: <http://www.theage.com.au/victoria/call-to-make-ecstasy-legal-and-sell-it-at-pharmacies-20150704-gi4vig.html>.

KREBS, Teri Suzanne. Protegendo os Direitos Humanos de pessoas que usam psicodélicos. Lancet Psychiatry. Vol 2. Abr 2015. Tradução de Fernando Beserra. Disponível em: <https://www.facebook.com/portashempadao/posts/363391893868289>.

Mais posts sobre o assunto no Portas da Percepção:

BESERRA, Fernando Rocha. Psicoterapia com MDMA. Hempadão. Disponível em: – https://hempadao.com/pt/infumacao/portas-da-percepcao/3155-psicoterapia-com-mdma.html

BESERRA, Fernando. Ecstasy em debate. Hempadão, 2015. Disponível em:https://hempadao.com/pt/infumacao/portas-da-percepcao/2941-ecstasy-em-debate.html

BESERRA, Fernando. MDMA e psicopatia: um amor possível? Hempadão, 2015. Disponível em:https://hempadao.com/pt/infumacao/portas-da-percepcao/2977-mdma-e-psicopatia-um-amor-possivel.html



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