MDMA May Have Role in Treatment of PTSD

Originally appeared at: MDMA, the drug commonly known as Ecstasy, may be beneficial in the treatment of post-traumatic stress disorder (PTSD). New research released this week suggests that MDMA, when used as an adjunct to psychotherapy, allowed patients with PTSD to more fully participate in therapy and achieve greater benefits from psychotherapy. Dr. Michael C. Mithoefer, a psychiatrist and clinical researcher in private practice in South Carolina, working with colleagues at the Medical University of South Carolina and the Multidisciplinary Association for Psychedelic Studies in Santa Cruz found that when patients with severe PTSD were given MDMA in addition to intensive psychotherapy, they improved significantly more than patients who were given the same therapy along with a placebo. MDMA (± 3, 4-methylphenylenedioxymethamphetamine) has been illegal in the United States since 1985, due to excessive recreational use, abuse, and concern that prolonged use may be psychologically and neurologically damaging.  Prior to 1985, it was sometimes used as an adjunct to psychotherapy; it was thought that MDMA could lower anxiety, reduce depression, increase a sense of intimacy, improve one’s introspective ability, and facilitate communication. Mithoefer and his colleagues enrolled 20 patients with severe PTSD, whose symptoms had not responded to traditional psychotherapy or medication.  12 patients were randomly assigned to a group that was given MDMA, and eight were given a placebo.  Neither the patients nor clinicians knew who was getting the active medication. Each group underwent two 8-hour psychotherapy sessions, an experimental PTSD treatment.  Both groups received psychotherapy before and after each session.  At the end of the trial, the placebo patients were offered opportunity to try the MDMA therapy as well. To assess for changes in PTSD symptoms, all participants were tested using the Clinician-Administered PTSD Scale and neurocognitive testing, once at the beginning of the study, again 4 days after each 8-hour session, and two months after the completion of the trial. Of the participants who had MDMA-augmented psychotherapy, their PTSD symptoms were significantly reduced compared to those who had psychotherapy alone, as measured by the Clinician-Administered PTSD Scale.  10 of 12 (83 percent) patients in the MDMA group had a reduction in symptoms, compared to 2 of 8 (25 percent).  Seven of the eight patients who initially received the placebo decided to try the MDMA treatment and all reported improvement. Three subjects at the beginning of the study reported they were unable to work due to PTSD symptoms, but were working by the end of the study The medication appeared to be well-tolerated, and no significant side effects were reported, specifically, no negative effects on neurocognition or blood pressure were seen. PTSD is a serious condition, and is on the rise, particularly with an increasing number of soldiers returning from active combat.  One form of psychotherapy that can be effective is exposure therapy, where the patient, in a safe environment, is exposed to triggers of their trauma and fear.  It is thought that MDMA may enhance exposure therapy by allowing patients to break down emotional barriers and become more easily involved in the treatment, while at the same time making the therapy less painful and easier to tolerate. “MDMA-assisted psychotherapy can be administered to posttraumatic stress disorder patients without evidence of harm, and it may be useful in patients refractory to other treatments,” writes Dr. Mithoefer. It is important to note that MDMA is still illegal in the United States, and some research suggests that there may be serious long-term neurological and psychological consequences from its abuse.  During this study, the use of MDMA was carefully monitored under close medical and psychological supervision, which Dr. Mithoefer emphasized was important for patient safety. “This method also involves patient preparation and close follow-up to support further processing of emotions and integration of cognitive shifts that may occur.” Dr. Mithoefer’s results are published in the July 19th edition of the Journal of Psychopharmacology. This thorough article covers the details and results of the MDMA PTSD study recently published in the Journal of Psychopharmacology.