MDMA: What you need to know about the radical new PTSD Treatment

Now it’s Ecstasy – new research shows that Ecstasy, or Molly – officially known as MDMA (3,4-methylenedioxymethamphetamine) – may also have beneficial aspects to it.

MDMA is typically thought of as an illicit street drug with potent effects¹. According to Drugabuse.gov, it produces feelings of increased energy, pleasure, and emotional warmth as well as hallucinogenic effects, including distorted sensory and time perception. These effects have made MDMA a popular drug among partygoers, who take it to enhance their experience at clubs, concerts, and raves. As one might expect from an illegal drug, though, it also has a number of negative side effects, including but not limited to irritability, increased aggression, depression, anxiety, and problems with memory or attention².

Furthermore, taken in large doses, MDMA can result in body temperature spikes that can cause liver, kidney, or heart failure – all of which can lead to death. In 2011 alone, MDMA resulted in over 22,000 emergency room visits³. Given its dangerous nature, the United States Drug Enforcement Administration (DEA) currently classifies MDMA as a Schedule 1 substance – a drug with no medically redeeming qualities and a high potential of abuse⁴.

With all the above in mind, you might be surprised to learn that the FDA announced last month that it had approved MDMA for Phase 3 clinical trials for the treatment of PTSD^5-6. As it turns out, MDMA has a long history of being used in therapeutic contexts, with clinicians using it to enhance psychotherapy⁷. Though initial reports seemed promising, this research was cut short when MDMA was banned in 1985. After years of petitioning by organizations such as the Multidisciplinary Association for Psychedelic Studies (MAPS), federal agencies have begun to loosen restrictions on such controlled substances, and researchers have begun the initial clinical trials necessary to investigate MDMA as a treatment for PTSD.

For many years, researchers had speculated that MDMA might be particularly helpful in treating PTSD by helping patients process their traumatic memories in a clinical setting⁸. Specifically, the warm, positive feelings induced by MDMA could increase the amount of trust that patients feel towards their therapist, and the sensory enhancing effects could lead to more effective processing of their traumatic memories⁹. Such effects could help patients to re-experience and re-evaluate their memories, perhaps reducing the amount of stress they cause.

Thus, MDMA is used in a very different way than typical psychoactive medications. Whereas a medication like a selective serotonin reuptake inhibitor (SSRI) might be taken daily over the course of months or years, MDMA-based therapies administer the drug in 2-3 carefully controlled sessions, with two trained therapists leading patients through their experience. A crucial piece of the puzzle is ensuring that patients feel a strong bond and trust in their therapists prior to beginning treatment with MDMA. Consequently, it’s not that MDMA has therapeutic qualities on its own but that it can be used in a therapeutic context to greatly enhance otherwise normal therapy sessions.

Research investigating MDMA has been promising. Initial studies that found that, in a controlled therapeutic setting, MDMA was safe for humans¹⁰. Following that, clinical trials began examining whether MDMA-assisted therapy could help patients with PTSD. The first study in this series found that 83% of subjects who received MDMA-assisted therapy reported significant improvements in their symptoms¹¹. In fact, three individuals who, despite years of previous therapy, had not been able to work due to their symptoms, were able to return to work after the study ended. The researchers followed-up with these initial patients and found that at least 74% of the patients studied (14 out of 19) “demonstrated meaningful, sustained reductions” in their symptoms of PTSD up to 3-1/2 years after treatment¹². Perhaps what is most impressive about these findings is that, in order to qualify for this study, patients had to have had years of previous therapy attempts. In other words, all of these patients had treatment-resistant PTSD. And yet, they experienced significant, long-term improvements in their symptoms through this new treatment.

As with any new treatment, much more research is needed. For instance, the researchers did not directly compare the MDMA-assisted therapy to other known treatments, such as SSRIs or cognitive behavioral therapy (CBT). Furthermore, these studies had extremely small sample sizes (a maximum of 22 patients), meaning that it is unclear how these effects will generalize to other contexts and populations. However, that is precisely why the FDA approved Phase 3 clinical trials – to enable researchers to begin larger scale testing to better evaluate the effectiveness of MDMA-assisted therapy.

Despite the preliminary nature of these findings, this work is extremely exciting. This treatment not only seemed to work as good as, if not better, than previously approved therapies, but patients experienced few negative side-effects and all reported that the treatment had an overall positive effect on their lives¹². Furthermore, taking MDMA within the therapeutic sessions did not increase the chances of patients taking other illegal drugs, which had been a major concern for researchers who worried that exposure to MDMA could serve as a gateway to other substances. Because the results have been so promising, researchers have begun petitioning the FDA for what is known as Breakthrough Therapy Designation for MDMA. In short, this designation would allow for much more rapid approval of MDMA for treatment, allowing it to be prescribed as soon as 2021.

To reiterate, MDMA can be a very dangerous drug – especially given that illegal versions can contain much more harmful substances¹³. However, we are finding that in the proper therapeutic contexts, it may have potentially life-saving consequences for individuals suffering from PTSD.