Psicoterapia com MDMA

Portas da Percepção

hempadao 24 abril, 2015

por Fernando Beserra

MDMA

A psicoterapia com 3-4, metilenodioximetanfetamina (MDMA) não é propriamente uma novidade, tal como ocorre com a psicoterapia com LSD. Esta modalidade de psicoterapia já era praticada nos idos dos anos 70, com grande influência do psicólogo Leo Zeff (que foi introduzido ao LSD quando trabalhava como psicólogo clínico, de abordagem junguiana, em 1961) e da terapeuta Ann Shulgin. Igualmente, realizaram psicoterapias com MDMA, antes de sua proibição, pesquisadores como Stanislav Grof, Ralph Metzner, Torten Passie e George Greer. O MDMA tem grandes potenciais de colaboração para a psicoterapia ou terapias paliativas. Auto-amor, alegria, perdão, aceitação, paz: são elementos extremamente desejáveis no processo terapêutico e são amplamente acessíveis, no contexto adequado, por meio do uso do MDMA.

Dentre importantes efeitos do MDMA pode-se destacar a redução da resposta de medo, o que indica um potencial terapêutico para casos de fobia. Diferente de ansiolíticos clássicos, o MDMA não é sedativo; além disso, o paciente pode usá-lo sem que haja perda de memória ao longo e após a sessão terapêutica. Nos casos de fobia, o MDMA permite – no setting terapêutico – que o paciente avalie como é estar menos ansioso e mais relaxado diante de um estimulo fóbico. Este resultado ocorre, a nível neurofisiológico, com a redução da atividade da amigdala esquerda, principal região no sistema nervoso central que possibilita a sensação de medo. No mesmo contexto, o MDMA mostra-se extremamente promissor no tratamento de outro transtorno de ansiedade, o Transtorno de Estresse Pós-Traumático (TEPT). Em 2005 a equipe do psicólogo Rick Doblin obteve autorização para pesquisar o efeito do MDMA em pacientes com TEPT. Dos 20 pacientes que iniciaram o estudo 16 concluíram o mesmo. As pessoas com Transtorno de Estresse Pós-Traumático recordam continuamente os atos que produziram o trauma e não conseguem evitar a lembrança, que ocorre como uma espécie de re-experiência do estressor que produziu o trauma. É possível que o TEPT curse com pesadelos recorrentes e flashbacks. O transtorno pode levar o paciente a um aumento significativo de ansiedade, com problemas relacionados no sono, ao estresse (reação de alarme) e a atenção (hipervigilância e hipotenacidade), além disso a pessoa pode se isolar, buscando manter-se o mais distante possível a tudo que lembre a cena traumática (que pode incluir, dentre outros, situações de estupro, de assassinato, em especial em situação de guerra, etc.).

Nem tudo são flores na pesquisa com psicodélicos: uma equipe de pesquisadores na Espanha, financiada pela Multidisciplinary Association for Psychedelic Studies (MAPS) iniciou uma pesquisa sobre o efeito da psicoterapia com MDMA em um conjunto de pacientes com TEPT. A pesquisa previa uma população (N) de 29 mulheres que tinham sido estupradas, com grupo experimental e grupo controle. No entanto, lamentavelmente o estudo foi interrompido pelas “autoridades” antidrogas de Madrid quando apenas 7 sujeitos da pesquisa haviam passado pela pesquisa. Diferente desta tentativa na Espanha, nos EUA já existem alguns estudos finalizados. Alguns deles já resultaram em artigos publicados em importantes revistas científicas. No Journal of Psychopharmacology, em 2012, Mithofer, Doblin e outros, analisaram os resultados do follow up de uma pesquisa que realizaram com psicoterapia com MDMA para tratamento de TEPT, indicando que as melhorias nos sintomas do Transtorno de Estresse Pós-traumático mantiveram-se mesmo após longo período após o uso de MDMA. Além disso, outro dado fundamental, nenhum dos participantes tiveram danos decorrentes da pesquisa.

Como se pode observar no site do MAPS, há diversos estudos já concluídos com MDMA associados à psicoterapia e os resultados são, em geral, animadores. Muitos estudos encontram=se em desenvolvimento, inclusive uma pesquisa para avaliar a eficácia terapêutica da psicoterapia com MDMA para autistas.

Uma teoria ainda não testada, cientificamente, é que o MDMA poderia ser útil para pacientes com esquizofrenia, no contexto psicoterapêutico, de modo a facilitar insights e minimizar mecanismos de defesa. Por fim, além da psicoterapia, ainda existem indícios, com pesquisas já publicadas, de que o MDMA pode ser um importante analgésico; inclusive funcionando em casos nos quais a morfina não tem os efeitos desejados.

Método terapêutico

Fato interessante, do ponto de vista terapêutico, é que, assim com o LSD ou psilocibina, o MDMA precisa de poucas utilizações para que tenha um efeito terapêutico, evitando-se assim que os pacientes tenham uma droga de uso para toda vida (GREER, 1998). Se isso interessa à indústria farmacêutico, já é outra história… Além disso, o MDMA já teve sua patente expirada. As sessões com MDMA duram, em média, 08 horas. Tanto Leo Zeff como terapeutas posteriores beberam muito da fonte do psiquiatra Stanislav Grof, isto é, praticavam a psicoterapia com o paciente com headphone, escutando, em geral, músicas clássicas e com uma máscara tapa-olhos. Tipicamente, era apenas após a sessão que conduzia-se um diálogo sobre a experiência. Leo Zeff, por exemplo, solicitava ao paciente que trouxesse imagens de familiares e haviam mesmo um acordo terapêutico antes das sessões.

Alguns processos pessoais foram estimulados, por exemplo, por Mithoefer como meditações ou manter um diário de sonhos. Certamente são processos que facilitam o contato com a realidade imaginal e, por conseguinte, as experiências com psicodélicos. Antes das sessões os sujeitos da pesquisa (ou clientes, dependendo do objetivo) eram esclarecidos sobre como seria conduzida a sessão, os riscos e o ambiente seguro que se criava ali. Passavam por um mapeamento por meio de exames e anamnese, de forma que o terapeuta conheça o histórico de doenças, além de temas emocionalmente importantes para a pessoa em particular, que podem vir a emergir ao longo das sessões.

Por fim, estamos falando da psicoterapia com MDMA e não desta coisa que, tantas vezes, é consumida no Brasil, com qual nome for. Veja o resultado de uma pesquisa da polícia técnico-científica em São Paulo sobre as balas encontradas neste Estado: http://coletivodar.org/2012/08/ecstasy-consumido-em-sao-paulo-nao-e-ecstasy/.

Referências:

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. Disponível em: https://hempadao.com/pt/infumacao/portas-da-percepcao/2977-mdma-e-psicopatia-um-amor-possivel.html

GREER, George R.; TOLBERT, Requa. A method of conducing therapeutic sessions with MDMA. Journal of Psychoactive Drugs. Oct. 1998. Vol. 30. p. 371-379. Disponível em: http://www.heffter.org/board-greer2.htm

HOLLAND, Julie. Potential clinical uses for MDMA In: Ecstasy: the complete guide. Rochester/ Vermont: Park Street Press, S/d.

MITHOEFER, Michael. MDMA-Assisted Psychotherapy: How Different is it from Other Psychotherapy? Disponível em: <http://www.maps.org/news-letters/v23n1/v23n1_p10-14.pdf

MAPS>

MAPS. Estudo com MDMA na Espanha: <http://www.maps.org/mdma-spain-news-timeline/360-mdma-ptsd-spain-study>.

MITHOEFER, Michael C; WAGNER, Mark T; MITHOEFER, Ann T; JEROME, Lisa; MARTIN, Scott F; YAZAR-KLOSINSKI, Berra; MICHEL, Yvonne; BREWERTON, Timothy D; DOBLIN, Rick. Durability of improvement in posttraumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamineassisted psychotherapy: a prospective longterm follow-up study. Journal of Psychopharmacology. Disponível em: <http://www.maps.org/research-archive/mdma/mithoefer_etal_2012_ltfu.pdf>



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