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July 13, 2018

MDMA and PTSD

MDMA therapy

MDMA as a catalyst for effective treatment of PTSD

MDMA – or 3,4-methylenedioxymethamphetamine – is a chemical psychoactive substance that forms the main ingredient for the recreational drug, ecstasy.  Clinical trials currently underway using MDMA as an adjunct therapy for the management and treatment of PTSD are demonstrating positive results.

Originally manufactured in the early 1900s to help control bleeding, MDMA became more commonly used in the 1970s and early 1980s by some psychiatrists to assist in the treatment of Post-Traumatic Stress Disorder (PTSD).1

PTSD is a disorder that develops in some people who experience a shocking, dangerous or traumatic event.  At any given point, there are 1.4 million Australians suffering from PTSD.3 Continuing symptoms, include flashbacks, family disruption, increased misuse of alcohol and other drugs, and suicide.2

The main theory behind using MDMA to treat PTSD lies with a key symptom of the disorder being avoidance of emotions due to anxiety and re-traumatising.4 MDMA, often referred to as “empathogen” or “entactogen”, tends to increase the feelings of empathy and trust, and allows for an “increased awareness of inner experience”.2

How does it work as a therapeutic agent?

A key aspect behind why MDMA is demonstrating effectiveness for the management and treatment of PTSD in a clinical setting, is its apparent ability to assist patients to be more expressive during a controlled psychotherapy session.

MDMA appears to reduce anxiety associated with recalling traumatic experiences allowing for increased insight and memory.  Negative memories are perceived as less negative allowing for the therapist and the patient to engage in productive therapeutic sessions without the patient becoming hyper-aroused due to stress.

In combination with psychotherapy, the use of MDMA provides the capacity “to hold the traumatised patient in a state of emotional security, providing a state of empathic self-reflection in which, for the first time in their lives, they can be with their traumatic memories without being overwhelmed by the powerful negative affect that usually accompanies recall of their most frightening thoughts”.5

MDMA’s main effect is through stimulating the release of a brain chemical called serotonin.  Serotonin helps us regulate mood, appetite, sleep, temperature and sexual desire.  When consumed, MDMA triggers the release of large amounts of serotonin which can significantly improve mood, confidence and feelings of happiness, as well as enhance positive social behaviour.

There appears to be very limited side effects to the treatment when used in a controlled setting. Long term harms are rare and rigorous experimental trials have found no long-term neurocognitive deficits in participants.2

Current research

Early clinical trials demonstrated positive results, with some researchers claiming that one MDMA assisted psychotherapy session can give results equivalent to five months of weekly therapy.6 However, research into the use of the drug as a therapeutic agent was shut down in 1986 when the drug was made illegal around the world due to increased use in recreational settings.

Restrictions on research were lifted in the early 1990s when the United States FDA (Food and Drug Administration) approved experiments in which MDMA could be used as an adjunct to psychotherapy.  In 2017 the FDA referred to MDMA assisted treatment for PTSD as a ‘breakthrough therapy’ and formally endorsed the use of the drug in clinical trials.4

MDMA is not Ecstasy.

Whilst the research into the use of MDMA for PTSD appears promising, it is important to note that clinical MDMA and recreational ecstasy share few comparable features.

Recreational ecstasy may only contain a minimal amount of actual MDMA with the other ingredients unknown and thus potentially dangerous, dosage cannot be regulated and those that choose to take the drug have not undergone any rigorous testing to ensure that they are fit to consume.

Clinical MDMA, on the other hand, when manufactured in a controlled clinical environment, is pure and all ingredients and dosage is known. Its use is highly regulated and administered only in a controlled session with trained health professionals. Treatment is only available for patients that meet a positive diagnosis of PTSD and any side effects are managed by trained medical professionals.

Understanding the clear distinction between the two types of drugs and the way they are used is important. Being clear on their differences helps to ensure that media reporting of toxicity or harms caused by ecstasy doesn’t adversely impact on the potential of MDMA being a successful and safe drug to treat people with an often debilitating psychiatric condition.

It is also important to note that MDMA is used as an adjunct to ongoing psychotherapy and only used in a controlled environment, for a select few people, and with highly trained professionals.  There is no clinical use of ecstasy as a recreational drug.

References
  1. Doblin, Rick. A Clinical Plan for MDMA (Ecstasy) in the treatment of posttraumatic stress disorder (PTSD): Partnering with the FDA. 2, s.l. : Journal of Psychoactive Drugs, 2002, Vol. 34. 185-194.
  2. Scutti, S. MDMA enhances treatment for veterans with PTSD, study finds. s.l. : CNN, 2018.
  3. ABS. Prevalence of Mental Disorders. [Online] 2007. [Cited: Jun 10, 2018.].
  4. Lee, Nicole. Weekly Dose: ecstasy, the party drug that could be used to treat PTSD. The Conversation. [Online] April 6, 2016. [Cited: August 10, 2018.]
  5. Sessa, Ben. Why Psychiatry Need 3,4-Methylenedioxymethamphetamine: A Child Psychiatrist’s Perspective. s.l. : Neurotherapeutics, 2017, Vol. 14. 741-749.
  6. Amoroso, Timothy. The psychopharmacology of 3,4 Methylenedioxymethamphetamine and its role in the treatment of posttraumatic stress disorder. 5, s.l. : Journal of Psychactive Drugs, 2015, Vol. 47. 337-344.