Elle: Could A Club Drug Be The Secret To Curing PTSD?

Summary: Elle Magazine speaks to MDMA-assisted psychotherapy study participant Julie Nelson about her experience overcoming posttraumatic stress disorder (PTSD) through a MAPS-sponsored clinical trial. Louisa Kamps of Elle Magazine also interviews MAPS-sponsored MDMA researchers Marcela Ot’alora, M.A., L.P.C. , and Annie Mithoefer, B.S.N., about their personal experiences providing psychedelic therapy to help participants process trauma.“Researchers working on the new MDMA trials think that the drug provides relief by helping people deal directly with the emotional fallout of their trauma,” says Kamps. “We think MDMA removes obstacles and catalyzes recovery by helping people start to access their own healing capacity,” explains Mithoefer. “Rather than trying to avoid triggers, they’re “able look at them in a different light, communicate about them, and begin to let them go.”

Originally appearing here.

Julie Nelson learned at an early age to keep her younger siblings quietly entertained whenever their parents locked them up in the basement of their derelict Kansas City home. Her mother and stepfather didn’t want to hear a word from them while they were getting high on cocaine and methamphetamine upstairs—whether their parents left them any food was “a maybe thing.” Usually it was just Nelson and her two siblings in the basement, but sometimes other neighborhood kids would get trapped down there, too, if their parents were joining the party upstairs.

Nelson’s stepfather was a drug dealer who kept freezers full of coke in the house. Once, when she was about five, a group of dealers stormed through the front door, brandishing guns and looking for money they were owed. Her stepfather was out, so they lined up Nelson, her mother, and her sister on the couch, threatening to kill them if her stepfather didn’t come home soon. “We sat there,” she says, “completely silent, not moving, not crying,” until her stepfather returned and promised to pay back the money he owed.

An intensely violent man, Nelson’s stepfather threatened to kill her mother on numerous occasions. He hated Nelson, too, she says. He would “go into the closet and pray in tongues, then yank me around by my hair and my neck, yelling, ‘Get out of her, Devil!'” His taste for fire-and-brimstone religion didn’t seem to clash with his drug dealing, or violence, but it did seem to give him an excuse, almost as if he was trying “to justify” forcing himself on Nelson while her mother was out of the house or high and passed out: Until Nelson (not her real name—she asked not to be identified) reached high school, and her mother finally took out a restraining order, he also abused Nelson sexually.

Her mother and stepfather didn’t want to hear a word from them while they were getting high on cocaine and methamphetamines.

A straight-A student in elementary school, by the time she reached high school, Nelson was almost failing out. Her anxiety steadily increased, she says. “From the time I was really small, I was terrified of everyone.” To make sure no teachers or classmates ever detected how dangerous her stepfather was—”the threat [from him] was: ‘You don’t talk,'” Nelson says—she kept mostly to herself. But when her stepfather finally left the house for good and Nelson no longer had to clench against his actual physical presence, it “kind of broke a dam.” Her fear flooded her. Her anxiety became so overpowering she often couldn’t get out of bed. Once, when she did make it into school, she slit her wrist in a girls’ bathroom: her first suicide attempt. “I thought I was evil and hated everything about myself,” she says.

Growing up under near constant threat left Nelson, now a 32-year-old mother of two living in Colorado, with severe post-traumatic stress disorder (PTSD). For years, flashbacks, nightmares, and extreme anxiety over any perceived flaw (childhood abuse often leads to crippling self-criticism in adulthood) plagued her daily. She slept sitting upright in bed and had “panic attacks like nobody’s business.” She went on to attempt suicide again—”honestly, I don’t know how many times.” At one point, her weight dropped to 78 pounds. “It wasn’t that I wasn’t eating,” she explains; rather, her normally 120-pound petite body was so “torn up by trauma” that she couldn’t digest food properly.

Nelson found little to no relief in the panoply of treatments various doctors prescribed. Plagued by a constant feeling of being “a wrong thing, a woman who shouldn’t exist in the world,” she depended on her husband, a man she’d met when both were in kindergarten, to defend her from the world: to answer the phone or door (the storming of her childhood home had stayed with her), to order her food in restaurants (“I was completely sure that I was unworthy of being in that restaurant, even if it was just McDonald’s”), to help her flee when she happened to spot a guy in a grungy baseball cap who even remotely resembled her stepfather. “I didn’t go anywhere by myself. I was afraid of everything and everyone,” she says.

The fact that Nelson can describe all of this now, with remarkable openness and ease, is, she says, testament to the power of MDMA, the active ingredient in the club drugs Ecstasy and Molly. Three years ago, Nelson joined a small clinical trial of MDMA-assisted psychotherapy in Boulder, Colorado, open to people with treatment-resistant PTSD. All participants entering the 12-week study—which included talk therapy before, during, and after the three separate eight-hour sessions when the patients took MDMA—had lived with chronic PTSD for an average of 17 years; along with other victims of sexual, child, and ritual abuse, the study included war veterans and accident survivors.

The experience, she says, enabled her to “fight back and kind of reset” when painful reminders of her past arose. “I was able to completely start over,” she says. To wit: Nelson started college shortly after finishing the drug trial, and today, two years into a bachelor’s/master’s neuropsychology program through which she’ll eventually earn a PhD, she’s getting straight As again. “It was, like, Yeah, okay, life: Here I am,” she says.

So far, 77 percent of the participants who have received MDMA in the Boulder pilot no longer meet the diagnostic criteria for PTSD, according to Marcela Ot’alora, the study’s lead investigator. After another clinical trial in Charleston, South Carolina, a similar effect was seen in 83 percent of the group that received MDMA treatment (compared to just 25 percent of the group who received talk therapy alone). Perhaps most encouragingly, three and a half years after the Charleston study was completed, the benefits largely held: Three-quarters of the MDMA-treated patients who’d been deemed clinically free of PTSD remained free of it, according to Annie Mithoefer, a psychiatric nurse who served as the study’s co–principal investigator with her husband, psychiatrist Michael Mithoefer. Last November, the Food and Drug Administration approved a large-scale trial of MDMA-assisted psychotherapy for chronic PTSD. The trial could eventually compel the FDA to reclassify MDMA, banned since 1985, as a legal drug with a recognized medical use.

Ever since Richard Nixon signed the Controlled Substances Act in 1970, prohibiting the use of almost all psychedelics for any purpose, most scientists have regarded consciousness-altering drugs warily, if they thought about them at all. But as the war on drugs wanes and failures of U.S. drug policy become increasingly clear (witness the opioid epidemic), scientists are revisiting research on psychedelics. There are the studies of MDMA for PTSD, and scientists have also begun explor
ing the drug’s potential to treat addiction, depression, and severe anxiety in adults with autism. Other psychedelics are also yielding promising lab results, including psilocybin (the active ingredient in so-called magic mushrooms), which teams of researchers from Johns Hopkins and New York University found can reduce anxiety and depression in cancer patients.

The idea that we would treat patients by sending them on a chemically controlled trip, that we would radically reboot a person’s head with a mind-altering drug, can seem wild and strange, anathema to the clean, streamlined way we often think twenty-first-century laser-targeted medications ought to work. But more than 20 million Americans suffer from PTSD at some point in their lives, and at least one in three patients don’t fully respond to existing approved therapies. And given the tremendous health burdens, personal and public, caused by trauma, most experts agree it’s essential to find more effective ways to treat PTSD. For people, like Nelson—”afraid of everything and everyone,” exhausted from failed treatment—MDMA might be the last hope. And better yet, it might just work.

Before Ecstasy became famous in the 1990s as the street drug of choice among ravers and curious college kids, a loosely knit network of psychiatrists and psychologists experimented with giving patients medical-grade MDMA, a synthetic compound originally developed by a Merck chemist in the early 1900s, to treat anxiety and depression. The practice, promoted most prominently by Bay Area chemist and pharmacologist Alexander Shulgin in the 1970s and early ’80s, never hit the mainstream. But the patients who tried MDMA often described feeling dramatically better post-treatment. The drug also earned a reputation for helping alienated couples reconnect—a benefit that author Ayelet Waldman, who conducted her own marital experiment, describes in her recent memoir, A Really Good Day.

Treating trauma with MDMA is different from using it to revitalize a relationship, of course, but experts say that the drug’s capacity to help people simultaneously experience calm, closeness, empathy, and euphoria is still central to the process. Although most people recover from trauma without medical intervention, patients with PTSD get stuck in a feedback loop of exaggerated fear. It can also make them prone to detaching, numbing out, and dissociating, hence the frequent occurrence of alcohol and drug abuse among veterans and rape survivors with PTSD.

Researchers have found that psilocybin, the active ingredient in so-called magic mushrooms, can reduce anxiety and depression in cancer patients.

Researchers working on the new MDMA trials think that the drug provides relief by helping people deal directly with the emotional fallout of their trauma. Among other effects, MDMA triggers the release of hormones associated with trust and bonding, and dampens activity in the amygdala, the part of the brain that detects threats. “We think MDMA removes obstacles and catalyzes recovery by helping people start to access their own healing capacity,” says Annie Mithoefer. Rather than trying to avoid triggers, they’re “able look at them in a different light, communicate about them, and begin to let them go.”

Nelson approached her first day-long session on MDMA with trepidation—her stepdad was a drug dealer, after all. But after Nelson took her first dose, brought to her by an attending psychiatrist in a small earthenware bowl, she relaxed and reclined on a soft bed. A recording of rhythmic drumming created a soothing backdrop. Being on MDMA made her feel like something was holding her, she said. When Ot’alora later played Nelson a lullaby, her reaction was more profound. “It was like stepping off a burning tightrope,” she says. “I always felt shredded internally, and this was the first time I felt whole and soft, and that the world wasn’t trying to eat me.”

As the effects of her carefully calibrated trip began to fade, Nelson felt fear rising again. But her therapists reminded her that she could sustain her peaceful state. And so, she told herself, “I’m going to throw everything I have at this, every day, to be okay: I’m going to maintain this feeling of peace.” She spent the night at the clinic and slept her deepest sleep in years.

“I always felt shredded internally, and this was the first time I felt whole and soft, and that the world wasn’t trying to eat me.”

A couple of days after her first MDMA session, standing in her kitchen, Nelson noticed that one of her socks had a stain on it—something that “before would have just destroyed me,” she says. “I would have felt I’d ruined something good and, silly as it sounds, [felt] a lot of immediate self-hate.” This time, the spot barely bothered her. “My husband was like, ‘Look, you’re not crying because you’ve ruined your sock!’ We called that ‘the sock victory.'”

During her second session on MDMA a month later, Nelson had another big epiphany. She’d just come through “a rough patch” in the session—revealing details about her abuse that she’d never told anyone—when Ot’alora gave her a hug. And in that moment, small and intimate yet cosmically profound, Nelson says she was able to feel love coming toward her for the first time. “I always knew intellectually that my husband loved me, but I couldn’t actually feel it,” she says. All of a sudden, “I just felt love from him.”

What minimal criticism there has been so far of MDMA’s clinical use has centered around wanting to see more rigorous exploration of the compound’s specific neurologic effects. The idea is that studying these effects will allow for potentially harmful or inactive molecules to be subtracted from the formula. (Although it’s possible that short-term, carefully monitored therapeutic MDMA use may not have significant deleterious effects: According to a paper published last year, none of the 1,133 patients who have received pure MDMA for research purposes to date have experienced any severe adverse reactions to the drug. Ecstasy, which is often cut with other street drugs and consumed along with alcohol, causes death from overdose only on rare occasions but was linked to more than 22,000 emergency room visits in 2011.) And then there are those, such as Rachel Goldsmith Turow, a clinical psychologist at Seattle University and author of Mindfulness Skills for Trauma and PTSD, who want to see studies comparing MDMA-assisted therapy to other evidence-based treatments.

But the effect of MDMA may be that it accelerates and integrates benefits commonly associated with other therapies. Ot’alora and Annie Mithoefer think one of the ways MDMA helps people with chronic PTSD improve is by enabling them to blend pivotal insights and skills that can take years to accrue with more traditional therapies. With MDMA treatment, says Ot’alora, “You bring in your story, you bring in your body, you bring in the feelings and sensations, you bring in the present moment—and that allows you to view trauma from a different perspective.” MDMA seems to make people more porous, she says, and have better capacity to love others and themselves. “It’s not that they won’t have fear again, or that they won’t experience traumatic symptoms again.” But the experience of a psychedelic journey—about which, she readily admits, science still has much to learn—can have a beautiful and uncanny way of helping them get to “the other side of the anxiety.”

At times, hearing about Nelson’s experience on MDMA feels a bit like stepping inside a Peter Max print: a vivid space where people are suddenly straddling planets, seeing the universe spread befo
re them, clear and bright. Toward the end of her second MDMA session, lying on Ot’alora’s couch, Nelson says she felt as if multiple pieces of her own person were swooshing back toward her, being pulled through space by a powerful magnet and reassembling coherently, solidly, back in her own body. She began singing a little song in which she welcomed back all her parts. “I was like, ‘Okay, these are my feet. Good job, legs, you made it here. I’m going to take care of you!’ It was childish, but it I think it needed to be, because my childhood was when it all began.”

Nelson says one of her greatest joys now is being able to be present and relaxed around her own young children, rather than projecting her old fears onto them. In the past, just holding her first child’s hand made her deeply uneasy because there was “so much crossing of the parent-child boundary” in her own childhood. “In my third session on MDMA, I went through the hardest part of my therapy, the hardest stuff I hadn’t ever told anybody about,” she says. “But I also happened at the same time. I came out. And I felt like that’s where I was born.” She pauses, her voice catching with evident joy as she recalls the moment, then continues: “All of us were just sitting on the couch at the end of the session,” her therapists embracing her from both sides. “And I was, like, Wow. Here I am. I made it. I looked them in the eyes and said, ‘Heyyy. I’ve always been here, I didn’t know it. It’s so nice to meet you.'”