Summary: PBS NewsHour calls MDMA and psilocybin research “the forefront of a revolution in neuroscience and medicine.” Science journalist Miles O’Brien of PBS NewsHour investigates the results of clinical research into the potential benefits and risks of MDMA-assisted psychotherapy as a treatment for posttraumatic stress disorder (PTSD). Study participant C.J. Hardin shares how the experimental treatment helped him overcome PTSD, and MAPS-sponsored MDMA researcher Michael Mithoefer, M.D., details the process of administering MDMA-assisted psychotherapy.
Originally appearing here.
JUDY WOODRUFF: Now: why some psychiatrists and researchers are giving psychedelic drugs a second look as a possible way of treating depression and some mental illnesses.
The idea had been shunned for years, but now some say a time for larger trials with the drugs is due.
Miles O’Brien has the story for our weekly segment on the Leading Edge of science.
SGT. C.J. HARDIN (RET.), U.S. Army Veteran: I was diagnosed with post-traumatic stress disorder in Fort Campbell.
MILES O’BRIEN: C.j. Hardin is a former Army helicopter mechanic and machine gunner who faced imminent death in Iraq, and also after he got home.
C.J. HARDIN: The way that my emotions ran, and how it felt uncontrollable, I didn’t trust myself having a weapon around me, because I was suicidal, very suicidal at that point.
MILES O’BRIEN: Years of pills and talk therapy failed to help his post-traumatic stress disorder. So, he turned to a surprising alternative at the center of a revolution in neuroscience and medicine.
DR. MICHAEL MITHOEFER, Therapist: So, this is the MDMA that we use for the current study.
MILES O’BRIEN: Hardin took MDMA, more commonly known as Ecstasy, under the watchful eyes of therapists Michael and Annie Mithoefer, a husband-and-wife team based in Charleston, South Carolina.
DR. MICHAEL MITHOEFER: This is where we do the MDMA sessions.
We don’t know how this works, but we have ideas about it.
MILES O’BRIEN: In one study of 19 subjects, more than 80 percent reported significant improvement, after carefully guided sessions like this.
SGT. C.J. HARDIN: Which I knew was the PTSD. I was never feeling comfortable at home.
I was still lucid, but it just felt like I had opened up a new avenue of thinking.
MILES O’BRIEN: C.J. Hardin says the difference for him was like night and day.
SGT. C.J. HARDIN: I had three experiences at full dosage, but the effects after the first treatment were profound. I would have said a 60 percent reduction in my symptoms immediately. I felt a mighty change had occurred.
MILES O’BRIEN: The fact that these studies are happening at all represents a mighty change in the scientific community, a renaissance in thinking about psychedelic drugs like MDMA, LSD and psilocybin, the drug found in magic mushrooms.
STEPHEN ROSS, NYU Langone Medical Center: Psychiatrists are really yearning to have something that works differently, that works quickly, that lasts longer to add to their toolbox. It’s really important to do that.
MILES O’BRIEN: Stephen Ross is a psychiatrist and addiction specialist at NYU Langone Medical Center. He is exploring the medical uses of psilocybin, a close cousin of LSD. He says the drugs are safe, but only in a carefully controlled setting.
Can you overdose?
STEPHEN ROSS: There are no known overdoses with psilocybin. It’s not known to have a toxic dose. It’s considered safe physiologically.
But, psychologically, that’s where the potential damage and danger is. And that’s why these drugs, in uncontrolled settings, can create anxiety, they can create paranoia, they can create dangerous behavior.
MILES O’BRIEN: Skeptics say the studies are relatively small, and it’s extremely difficult to compare these drugs with a placebo.
Concerns notwithstanding, researchers across the nation are tuning in and turning on to psychedelics a few generations after psychologist Timothy Leary unintentionally stigmatized them. In the 1960s, Leary conducted a series of valid experiments with LSD and psilocybin, but as he devolved into an infamous psychedelic poster boy, the drugs escaped the lab.
MAN: The natural state of the brain is chaos.
MILES O’BRIEN: In 1970, the federal government made the drugs illegal, in the same category as heroin. The mainstream medical community tapped out, even though there was a lot of data suggesting the drugs might help people with certain mental illnesses.
STEPHEN ROSS: I was fascinated that, how could this have been such a big part of a psychiatry and that I never heard about it, completely buried in my training? And that just made me really curious to look further into it.
MILES O’BRIEN: Much remains a mystery, but advanced neuroimaging has provided some new clues. Psilocybin seems to quiet brain areas known as the default mode network, essentially our autopilot mode.
And this might help break the chains of addiction, or lift the fog of depression.
STEPHEN ROSS: So it’s plausible that sort of deactivating that network can take someone away from a stuck pathologic rhythm into something else.
MILES O’BRIEN: The Mithoefers are working on a similar hypothesis as they study MDMA and its effects on PTSD. They too suspect the drug helps break a cycle.
DR. MICHAEL MITHOEFER: We know that people with PTSD have increased activity in the amygdala, the fear center, and they have decreased activity in the prefrontal cortex.
MILES O’BRIEN: The amygdala is at the center of our brain. It is what creates our emotional reactions, pleasant and unpleasant, including sadness, anxiety and fear.
The prefrontal cortex, our executive brain, is where we temper those emotions through rational decision-making. MDMA decreases activity in the amygdala and increases activity in the prefrontal cortex. So it tamps down the negative emotions in the first place and also increases the brain’s ability to keep those feelings in check.
Researchers aren’t sure whether the drug works by causing direct changes in brain chemistry, or simply by making trauma easier to talk about and process.
DR. MICHAEL MITHOEFER: What we see in the sessions is that it seems to kind of bring people down from being overwhelmed by emotions, but also kind of bring them up from being numbed out or disconnected from emotions. That’s when the therapeutic change happens.
MILES O’BRIEN: With both drugs, doctors use a similar approach. Dr. Ross showed me the room where he and his team conduct therapy Sessions for subjects under the influence of psilocybin.
STEPHEN ROSS: We walk over to them, give them the pill, some water, they take it, and then they will essentially sit here for about half-an-hour. We will turn the music on, the pre-selected music, give them some art books, or they will meditate a little bit.
And then after, about half-an-hour, when they’re feeling something, we will instruct the
m into the default position. Lie down on your back, eye shades, music. And the two therapists sit here for many hours.
MILES O’BRIEN: In December, Ross and colleagues published a paper on the impact of psilocybin for people with severe anxiety or depression due to a grave illness.
They found that a single dose of psilocybin reliably helped 60 percent to 80 percent of them feel better immediately, and for as long as six months. Researchers at Johns Hopkins reported similar results.
ESTALYN WALCOFF, Psychotherapist: My name is Estalyn Walcoff and I work as a psychotherapist.
MILES O’BRIEN: Estalyn Walcoff was a subject in the NYU study.
ESTALYN WALCOFF: It was as if this spirit that I had hoped to connect to was so much bigger and stronger than I had ever imagined. I was quaking in my boots.
MILES O’BRIEN: Ross and Mithoefer say it’s important to temper the enthusiasm.
DR. MICHAEL MITHOEFER: This seems to be a very powerful tool, but it is only a tool. And it’s the person’s own healing process and their relationships, the therapeutic relationships, that support that that are very important. I think there is the danger of people thinking of it as a magic bullet.
STEPHEN ROSS: We’re following the data. We don’t think that this is going to cure anything or change the world. We are focused on helping sick people and just doing more science and following the data, seeing where it leads.
MILES O’BRIEN: Both drugs may soon be put to a bigger test. Researchers are asking the government to approve some major trials, with hundreds of subjects, some time this year.