In this episode of the Psychedelic Medicine Podcast, Dr. David Rabin, MD, PhD joins to discuss whether genes can be predictive of one's response to MDMA Therapy. Dr. Rabin, a board-certified psychiatrist and neuroscientist, is the co-founder & chief medical officer at Apollo Neuroscience. In addition to his clinical psychiatry practice, Dr. Rabin is also the co-founder & executive director of The Board of Medicine, and a psychedelic clinical researcher currently evaluating the mechanism of psychedelic-assisted psychotherapy in treatment-resistant mental illnesses.
In this conversation, Dr. Rabin shares his research into epigenetic responses to MDMA-therapy, exploring topics of trauma, gene expression, and personalized, data-driven medicine. He discusses the seminal discovery that trauma can cause epigenetic changes in the structure and function of the cortical system and his own research findings that uncovered a reversal of these changes associated with MDMA-assisted therapy. Dr. Rabin hopes further research in this area may allow for leveraging epigenetic data to determine which psychedelic medicine a particular patient may be most likely to respond to and track how effective a given treatment has been. In closing, he expresses excitement about bringing objective biological precision to mental health treatment, drawing a parallel to the discovery of antibiotics which allowed for much more tailored treatments of infections which has saved countless lives.
In this episode you'll hear:
- Response rates to psychedelic-assisted therapy for PTSD versus conventional therapies
- The consequences of ineffective treatment for PTSD
- MDMA-assisted therapy as preventative care and the societal cost savings involved
- Genetics, epigenetics, and gene expression
- Using epigenetic data from simple saliva swabs to better gauge response to MDMA-assisted therapy for PTSD
Quotes:
"Most of the treatments we have available today for PTSD—that are the FDA-cleared, considered gold standard treatments—only actually induce remission from illness… in about 30% of people. So of the 100% of the millions of people every year that are getting treated for PTSD, with the best treatments that we have that are currently available, only 30%—at best—are getting better long term. Everyone else has a diagnosis of PTSD for life." [3:55]
"MDMA-assisted therapy for people with PTSD is having an effect that's similar to what we saw with the discovery of antibiotics for infection." [8:07]
"Folks with severe PTSD who went through this trial, when they received MDMA-assisted therapy, [the researchers] saw a statistically significant change—in terms of repair—of the cortisol receptor's epigenetic code which reflects improved structure and function of that receptor site. But not only that—we saw that the amount that people got better… was directly correlated with… the amount of remodeling and repair at the receptor site." [18:36]
"Epigenetic code is actually something that can be modified by experiences in our environment. And trauma—or PTSD diagnoses, a series of significant traumas over time—can in fact change epigenetic code of the cortisol receptor gene. And that changes how the cortisol receptor gene gets made, and it changes its function." [29:52]
"PTSD is a disorder of learned fear. How do we treat PTSD? In animals and humans, we provide the same stimulation that they were getting that they are now afraid of in the context of safety. That's how exposure therapy works, that's how MDMA therapy works to some extent—all of these tools and techniques work to treat PTSD effectively… in the same way. It's called safety conditioning." [36:48]
Links:
Dr. Rabin's article: Pilot study suggests DNA methylation of the glucocorticoid receptor gene (NR3C1) is associated with MDMA-assisted therapy treatment response for severe PTSD
Dr. Rabin's website
Dr. Rabin on LinkedIn
Dr. Rabin on Instagram
Dr. Rabin on Twitter
Apollo Neuroscience website
Psychedelic Medicine Association
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