MDMA Therapy for PTSD Outlining the historic resurgence of psychedelics in treating PTSD and social anxiety

MDMA, also known as “ecstasy” and “molly”, is classified as a Schedule I drug in the U.S. and is illegal in most places in the world. As a popular psychoactive party drug, MDMA is known to induce feelings of bliss and euphoria while riding its high, followed by intense bouts of depression and emotional withdrawal in its aftermath. Now, however, the drug is finding its way once again into the world of therapy . But how?

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MDMA was first synthesized in 1912 by a German pharmaceutical company, Merck, during a search for a drug to control blood clotting. It layed dormant until 1965 when Alexander Shulgin synthesized it and used it in self-trials. In the 1970’s, a small group of psychiatrists then began to use the drug as a facilitator during their psychotherapy sessions. In particular, they noted its ability to help patients communicate more openly, and spontaneously achieve insights about their struggles. However, at the same time, MDMA also began to grow in popularity as a party drug. This meant that, in 1985, it was designated as a Schedule I drug, and clinical experiments looking into its potential as a therapeutic agent were forced to cease.

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Since 2010, amid a flurry of interest in psychoactive tools from LSD to psilocybin and ketamine, research has once again begun looking at the therapeutic effects of MDMA. So far, studies have found mixed results. For example, a study from 2014 showed that past users of the drugs have a higher risk of clinical depression, impulsiveness, and sleep disturbance than non-users. What’s more, another study found that teenagers who use ecstasy are more likely than their peers to experience elevated depressive symptoms. At the same time, research has also shown that, when used as a facilitator for talk therapy in controlled settings, the drug produces net positive results.

The landmark study came in 2010. Back then, researchers assigned 20 people with chronic PTSD to psychotherapy either with MDMA or an inactive placebo. The drug was administered in two 8-hour sessions alongside ordinary therapy. At a 2-month follow-up, 83% of those who took MDMA saw their symptoms improve, whereas only 25% of those in the placebo group saw improvement. Additionally, neither group experienced any serious side effects related to the treatment, such as negative neurocognitive effects or significant increases in blood pressure.

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These exciting results have since been replicated, and MDMA-assisted therapy is now undergoing a Phase 3 clinical trial by the Multidisciplinary Association for Psychedelic Studies (MAPS). Aiming to create an FDA-approved standardized MDMA-assisted psychotherapy practice for PTSD by the end of 2021, MAPS hopes to train at least 300 therapists in the practice before then.

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In addition to treating PTSD, MDMA-assisted therapy has also shown success in treating social anxiety among patients with autism. For example, in a recent double-blind study, 12 autistic adults with severe social anxiety were selected to randomly receive MDMA or an inactive placebo during therapy sessions. Those who received the drug saw their social anxiety points reduce by 44 on average, whereas those in the placebo group saw reductions of just 19 points.

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But how might this be the case? How does MDMA expedite therapy results?

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MDMA is known to increase the presence of several neurotransmitters in the brain. In particular, it increases levels of serotonin, which is thought to generate feelings of wellbeing and happiness, and oxytocin, known as the “love drug” thanks to its purported role in enabling social bonds. Taken together, these factors mean that people with PTSD or autism may be better able to control their anxiety and trust their therapist, thus increasing their likelihood of engaging openly, and therefore being more susceptible to treatment.

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By enabling social bonding in this way, patients on MDMA are able to form a trusting relationship with their therapists, known as a therapeutic alliance, at a much faster rate than conventional therapies. For example, under normal circumstances, patients require 9-12 weeks to establish a strong therapeutic alliance with their therapist via cognitive-behavioral therapy (CBT). With MDMA-assisted therapy, however, this timeframe is much shorter, perhaps after 4-6 weeks of treatment.

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Another potential factor contributing to MDMA’s promise is the nature of the experience. MDMA is thought to make people susceptible to cognitive restructuring (the identification of irrational thoughts and how to resolve them). While on MDMA, patients are inclined to bring up early experiences of abuse or lack of support, and achieve insight on how to reframe these thoughts. This expedites treatment times as the patient and therapist needn’t spend as many hours verbally recognising, deconstructing and reconstructing new mental frameworks via the Socratic method, as in CBT.

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More than this, from brain imaging technology, researchers have also been able to see that MDMA reduces blood flow to the amygdala and the hippocampus, parts of the brain important for emotions and memory. Researchers have interpreted this to mean that, during therapy, when directed to specific traumatic memories, patents are less emotionally connected to them. This helps people to disassociate from their traumas, and thus better able to perceive them at a vantage point from which they may be confronted and overcome.

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Thanks to its usage as a recreational drug for almost half a century, MDMA still has a questionable reputation. Nonetheless, recent studies on MDMA’s usage in clinical settings clearly demonstrate its potential as a therapeutic tool. A powerful substance, when used in the right context, MDMA appears to have huge potential in expediting talk therapy treatment times.

References:

1. The National Institute on Drug Abuse: “What is the History of MDMA?”

2. Serrano, Alfonso: “MDMA’s Journey from Molly to Medicine”, Scientific American, November 3, 2017:

3. Montreal University: “Speed and ecstasy associated with depression in teenagers”,

Science Daily, April 18 2012

4. Taurah L. et al: “Depression, impulsiveness, sleep, and memory in past and present

polydrug users of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy)” PubMed, February 2014

5. MAPS: “MDMA-Assisted Psychotherapy Study Protocols”

6. Mithoefer, Michael, MD.: “MDMA-Assisted Psychotherapy: How Different is it from Other

Psychotherapy?”

7. Stone, Will: “MDMA, Or Ecstasy, Shows Promise As A PTSD Treatment”

8. Dodgson, Lindsay: “MDMA could help autistic people with their social anxiety, according

to a new study”, Insider, September 27 2018

9. Danforth, Alicia L.et al: “Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study”, Springer Link, September 2018

10. Danforth, Alicia L. et al: “MDMA-assisted therapy: A new treatment model for social

anxiety in autistic adults”, El Sevier, January 2016

11. Psychopharmacology Institute

12. Miller, Sara G.: “MDMA for PTSD? How Ecstasy Ingredient Works in the Brain”, Live Science, December 5th 2016