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Can MDMA Help People with PTSD Find Ecstasy?
Most people have heard of the illicit drug “ecstasy” (also known as “E,” “X,” or “XTC”) in the context of the underground rave scene. However, the active ingredient in ecstasy, MDMA (3,4-methylenedioxymethamphetamine), is being investigated for its use in psychiatry too.
The History of MDMA
MDMA was actually first synthesized and patented by Merck in 1912, but the first report of it being given to patients wasn’t until 1978, after recreational use of the drug had already begun. This is likely as Merck wasn’t interested in MDMA, only what they could turn MDMA into (methylhydrastinine, a compound that stopped normal bleeding). In this first report by Shulgin and Nichols MDMA’s effect was described as, “an easily controlled altered state of consciousness with emotional and sensual overtones.”
Shulgin introduced the compound to his colleagues and some began using it as a psychotherapy catalyst although no controlled studies were performed.
In 1985 the U.S. Drug Enforcement Agency named MDMA a schedule 1 drug. This schedule indicates that the drug:
- has a high potential for abuse
- has no currently accepted medical use in the United States
- the drug is not safe to use under medical supervision.
This was in spite of the fact that doctors and an administrative law judge recommending that it be considered a schedule 3 drug which would have recognized that it had a medical use.
MDMA and Post-Traumatic Stress Disorder
Right now, the focus of MDMA research is on MDMA-assisted psychotherapy for patients with post-traumatic stress disorder (PTSD).
In the first completed double-blind placebo-controlled phase 2 study, MDMA was administered to 20 patients with chronic, treatment-resistant PTSD in two eight-hour sessions supervised by male and female co-therapists. Nondrug therapy sessions were used both before and after these sessions to prepare for and then integrate the experience for patients.
Significant improvement was seen in those who were administered the MDMA over those who took the placebo. On the Clinician-Administered PTSD Scale (CAPS), those who took the drug shows an 83 percent reduction, while those who took the placebo showed a 25 percent reduction. At four months, CAPS reduction had been further reduced in both populations.
Seven of the eight who received the placebo then elected to try the same procedure and they showed similar response rates.
How Does MDMA-Assisted Therapy Work?
This is a question without an answer, at the moment, but it appears that MDMA allows patients to access deep emotions without being overwhelmed by fear as MDMA seems to lower fear levels. MDMA also seems to allow for “corrective positive experiences” where positive, affirming experiences during the session seem to carry over into a more positive perspective of the world.
“Without the study I don’t think I could have ever dug down deep, I was so afraid of the fear,” one patient said. “In the sessions there was just no fear; that builds your confidence. When I tried in therapy before, it would send me into a tailspin.”
Another said, “It’s like night and day for me compared to other methods of therapy. Without MDMA, I didn’t even know where I needed to go. Maybe one of the things the drug does is let your mind relax and get out of the way because the mind is so protective about the injury.”
The pharmacological effects of MDMA include:
- serotonin release
- serotonin type 2 receptor stimulation
- increase in oxytocin
- increase in prolactin
- increase in cortisol
According to Dr. Michael C. Mithoefer, “Studies suggest that oxytocin plays an important role in stress response, reduces the fear response, and increases social affiliation and trust35-39; thus, elevated oxytocin levels might help patients form a therapeutic alliance and revisit traumatic experiences in an emotionally engaged state.”
Risks of MDMA
Of course, nothing is without risk, and risks with MDMA in a medical setting include increased anxiety, confusion, ruminations, and dissociation. However, with proper professional support these risks can be substantially reduced. In illicit settings the risks associated with MDMA use are much greater and include physical risks including hyperthermia and dehydration or overhydration.
There is no clear evidence of long-term adverse effects, but there hasn’t been enough research done to conclusively make remarks about the possible adverse effects. It’s also important to note that what has been studied has been very limited use of the drug and not when the drug is taken repeatedly such as in recreational settings.
Final Opinion of MDMA Use in Psychiatry
Personally, I’m extremely disappointed that such a promising compound was shelved for so many years for political reasons. I think any compound that can help alleviate suffering in such a short time span is extremely hopeful not just for those with PTSD, but for those with all sorts of psychological issues. It’s very early days in this research, but I’m buoyed to see doctors finally making decisions about how this drug should be used over politicians.
For references and more information, please see Psychiatric Times: Does MDMA Have a Role in Clinical Psychiatry? by Michael C. Mithoefer, MD.
Also check out the Huffington Post Live chat I was involved in that includes one of the researchers looking into LSD use in psychiatry: A Long Strange Trip.