MDMA, sometimes referred to as the party drug “ecstasy”, helped over 70% of patients in a small trial overcome their PTSD. In the Phase 3 trial, researchers found that three months of talk therapy were not nearly as effective as the talk therapy plus the monitored doses of MDMA.
“It’s not a panacea,” cautioned lead researcher Jennifer Mitchell, a professor of neurology at the University of California, San Francisco. But the approach shows a lot of promise.
Party drug, therapy drug
The trial followed 52 patients who completed MDMA-assisted therapy and 42 patients given a talk therapy plus placebo. Out of the people in the MDMA group, almost 90% responded well to therapy. They had meaningful reductions in nightmares, flashbacks, crippling anxiety, and other serious symptoms. After three months, 71% no longer even qualified for a PTSD diagnosis — compared to only 48% non-MDMA group.
MDMA is part of a class of party drugs that are illegal and have been banned from medical testing for decades. But the psychiatric field has long been interested in MDMA and other drugs like psychedelics for their therapeutic potential. Because there was a ban on trials, for a long time this potential was not studied at all. In recent years, however, that’s started to change.
Psychedelics and MDMA alter the user’s perceptions and thoughts, often inducing feelings of euphoria. From a biochemical perspective, MDMA primarily affects three neurotransmitters in the brain: serotonin, dopamine, and norepinephrine. These neurotransmitters are involved in mood regulation, emotional response, and social behavior. When someone takes MDMA, the drug increases the release of these neurotransmitters, leading to feelings of euphoria, emotional closeness, and decreased anxiety.
Because MDMA floods the brain with serotonin — the “feel good hormone” — it is quite popular as a party drug. But the effect on serotonin could also help patients process difficult emotions. MDMA also increases the communication between the amygdala and the hippocampus — and studies on patients with PTSD have found a reduction in communication between these areas.
Therapy and MDMA
Oxytocin, popularly known as the “love” or “bonding” hormone, also seems to play a role, says Mitchell. It seems to foster a level of self-compassion in PTSD patients, which in turn, makes them more likely to stick with psychotherapy. This is particularly important because therapy often asks people to face their trauma, which is understandably tough.
“The problem with talking about distressing memories is that it’s too distressing,” said Rachel Yehuda, director of the Center for Psychedelic Psychotherapy and Trauma Research at Mount Sinai in New York City. “By the time people come to therapy, they’ve often developed narratives about how unworthy they are,” adds Yehuda, who was not involved in this study.
There were no severe side effects, the researchers note. Some muscle tightness, nausea, and sweating were reported in some patients — but no one dropped out due to these side effects.
Another reason why the study is notable is because it included a diverse group of patients, including marginalized minorities. Due to disparities in trauma exposure, groups that include minorities, first responders, veterans, and victims of sexual abuse have a disproportionately large risk of developing PTSD. However, these diverse populations are often underrepresented in studies.
Can we see MDMA in clinical practie?
Overall, the researchers say “MDMA reduced PTSD symptoms and functional impairment in a diverse population with moderate to severe PTSD and was generally well tolerated.”
“MDMA simultaneously induces prosocial feelings and softens responses to emotionally challenging and fearful stimuli, potentially enhancing the ability of individuals with PTSD to benefit from psychotherapy by reducing sensations of fear, threat and negative emotionality,” the study concludes.
But there are some significant barriers to introducing this in clinical practice. Researchers excluded participants with high suicide risk, comorbid personality disorders and underlying cardiovascular disease from the study, and that could skew the results. There are also still regulatory barriers and there isn’t a clear treatment protocol so far.
But this trial showed consistent benefits of MDMA in an ethnoracially diverse group of individuals with longstanding moderate to severe PTSD and numerous comorbidities. With a low dropout rate and significant mental health improvements, this suggests that MDMA may just be a valuable weapon against PTSD.
The study was published in Nature.
