Summary: The Washington Post explores the benefits and risks of MDMA-assisted psychotherapy through the lens of the author, Sarah Hogate Bacon, who undertook various alternative treatment methods for anxiety and depression symptoms associated with her life-threatening illness, including MDMA-assisted psychotherapy. The article highlights published data from completed clinical trials of MDMA-assisted psychotherapy for PTSD, an update on ongoing FDA-regulated Phase 3 clinical trials, and a brief interview with study participant Ed Thompson. “Like any therapy, MDMA-guided psychotherapy is a process, not a quick fix,” explains Sarah Hogate Bacon of The Washington Post.
Originally appearing here.
There’s nothing like a scary disease to ruin one’s emotional balance. I’m a lifelong athlete with an ultrarare condition that is destroying my lungs. I have run the gamut of therapies for depression and anxiety — from Western to far out with varying degrees of success, including talk therapy, antidepressants, meditation, Qigong, astrology, ayahuasca and core energetics. Nothing helped — or helped completely. But when my lung function recently dropped to 37 percent (the threshold for a transplant is 30), I was open to anything.
And anything turned out to be MDMA, the psychotropic drug known as ecstasy or molly and commonly used by ravers and music festival mavens to attain euphoric, communal bliss.
Ecstasy and I had partied together just once, after college, in combination with pot and alcohol to little effect and I’d forgotten it. But then I picked up Michael Pollan’s “How to Change Your Mind,” which is a painstaking investigation-turned-quest-for-self-discovery of therapeutic applications of psychoactive drugs that alter brain functions such as perception, mood, behavior and consciousness. Using recent studies at UCLA, Johns Hopkins, New York University and elsewhere, he wrote about how hallucinogenics, specifically LSD and psilocybin, had had profound results in conjunction with psychotherapy with suicidal depressives, the terminally ill, addicts and PTSD patients.
After reading Pollan’s book, I was ready to try.
Synchronicity struck a month later when a healer I see from time to time to quell my anxiety suggested I try MDMA-guided therapy. The drug, which was banned in 1985, does have risky side effects. In 2017, however, the Food and Drug Administration granted MDMA-assisted psychotherapy a breakthrough-therapy designation for post-traumatic stress disorder, setting it on a fast track for review in clinic trials and potential approval.
Phase 3 clinical trials are now underway across 16 sites in the United States, Canada and Israel. Participants have included first responders, military vets, and flood and sexual assault victims.
Ecstasy could be ‘breakthrough’ therapy for soldiers, others suffering from PTSD
During previous, smaller-scale phase 2 clinical trials, for which the data are complete, 68 percent of patients no longer “qualified” for PTSD diagnosis after 12 months, according to the Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit research group that has funded the trials and worked with the FDA on the program.
I was not eligible for the clinical trials (participants must be currently diagnosed with PTSD, whereas I had acute anxiety). So I turned to a “tripping guide” who provided pharmaceutical-grade ecstasy and would shepherd my experience after first discussing with me at length what I was hoping to get out of it. My intentions would guide both of us.
I wanted to let go of fear around my lung decline and anticipated eventual loss of autonomy to a life tied to supplemental oxygen. I wanted to accept my trajectory toward a double lung transplant unburdened by my dread of death and the 50 percent survival rate five years out. And finally, I wanted to try to resolve lingering grief around my beloved father’s death so that I could be trusting of, and vulnerable in, relationships again.
In a womblike office with mauve couches, back chairs, plush carpeting and Zen music, the guide told me the drug would take over like a rising tide and that “what is relevant to you will appear.” I took 120 mg of white powder in an outsize capsule, a dosage calculated to be somewhat conservative. Not knowing what would come, I didn’t want to push it.
That was a good decision. My first MDMA-guided therapy session was among the more intense days of my life.
Gradually, something like a low electrical current took over my body, as if each cell was lit. Usually fidgety, I became still as stone. My muscles and fascia felt fluid and weightless, and I told the guide that I had a sense of safety, trust and gratitude for my body, which had betrayed me with illness and orthopedic calamities. Trusting myself and my body, she said, was the first step in trusting other people.
My breath felt fuller than any time I could remember since my diagnosis five years earlier with lymphangioleiomyomatosis, or LAM. It felt like oxygen was filling every cubic millimeter of my damaged lungs, turning them from antagonists to a supportive life force. And at that moment, the existential fear that always seemed to dog me dissipated.
I talked about death as nothingness, which the guide helped reframe as a total lack of awareness and therefore absolute peace — a simple psychic shift, but it felt revelatory. And when my mind turned to my father, whom I trusted most, my heart swelled as if with his love — and his absence turned to presence.
The “trip” lasted six hours, cresting between the second and fourth hours, then tapering into a fizzy, observant feeling. My guide said I’d be in a “raw state” for the next 72 hours, which registered in me as heightened alertness as I feverishly scribbled reflections and epiphanies percolating from the residual effects of the drug.
Because MDMA can linger in the system for up to a month, the guide encouraged me to stay off antidepressants for as long as possible, which I did.
That was a mistake.
After the predicted, postpartum-like emotional flood from the norepinephrine, dopamine, and serotonin subsided, anxiety seized me. One month after my trip, in desperation, I went to a psychopharmacologist and reengaged with a psychologist I’d seen in the past. Within a month, SNRI antidepressants and more traditional psychotherapy had coaxed my equilibrium back.
My takeaways from the MDMA-guided therapy were significant: I was no longer crippled by anxiety about the progression of my disease, or by the fear of potential treatment outcomes. With the sorrow over my father’s death lifted, I could engage in happier, healthier relationships.
But I should have involved my mental health team at the outset. In planning a follow-up session, I was more careful. Three guided therapy sessions are generally recommended, staggered over six- to 12-week intervals, but because of my SNRI balancing act, I waited nine months for another round — and planned for pre- and post-therapy support.
My second round, interestingly, was wholly different.
The guide and I were friends by then, having bonded over the first shared experience and subsequent Skype chats. Thinking I knew what to expect, I took the maximum dosage of 160 mg and, with the blessing of my psychologist, hoped to tackle an ongoing therapy theme: a tendency to sabotage my driven, competent, reflective self with procrastination, excessive drinking and impulsiveness.
As the drug kicked in, I saw two identical Sarahs in a grassy field playing tug of war. We pulled mightily at either end of the rope, it broke in half, and both of us fell to ground. Though I was pitted against myself, I couldn’t see my face. The guide suggested I approach myself. I came to my feet, walked across the field, circled myself in a cocky strut and then stopped and saw my blue eyes. Then an insight hit: Until that moment, I had despised myself for not living the conventional life I had expected since childhood of a healthy, married woman with children. As clear as day, the resilient, independent, complex woman I’d become warranted compassion and respect.
Like any therapy, MDMA-guided psychotherapy is a process, not a quick fix. But for me, my crushing anxiety remains more manageable and my reflex to self-undermine is less overwhelming.
When former firefighter Ed Thompson, whom I had met through MAPS, enrolled in the MAPS phase 2 trial, he scored second most severe of all participants in the Clinician Administered PTSD Scale; at the time, he “didn’t want to be around anymore.” But a year after his third and final MDMA therapy session, Thompson no longer met the diagnostic criteria to be in the study. Thompson said he went from “feeling I was the problem to realizing my trauma was the problem.”
For some participants in the phase 2 trials, there was no trauma reduction at all, and MAPS researchers have yet to ascertain why. Thompson, however, claims MDMA-assisted therapy “definitely saved my life and that’s underselling it big time.”
For me, and many other hurting people out there, that sounds like progress.