Summary: Tonic explores how MDMA combined with psychotherapy could treat a whole spectrum of psychiatric conditions, including eating disorders. Natasha Preskey of Tonic speaks with MAPS Founder Rick Doblin, who says, “We have some good info suggesting that this could be one of the more important uses of MDMA. But because of the lack of funding, we have not actually started any formal studies.”
Originally appearing here.
MDMA became Lucy’s diet drug by accident. “I originally worked out during the week and used MDMA on the weekend and was pleased to lose lots of weight,” the 25-year-old tells me of her time in college. (Now a teacher, she prefers to use a pseudonym when talking about drug use.) “As the weekend usage increased, the come-down was harder and I didn’t feel physically strong enough to work out much so I started using during the week as well.”
Lucy’s then heavier drug use left her struggling to sleep, with loose and sore teeth, navigating come-downs that, at their worst, forced her to seek an emergency prescription of antidepressant citalopram “just to feel normal.”
Eating disorder forums are full of young people making similar discoveries about ecstasy’s ability to make us forget about food. Eating disorder patients have told Timothy Brewerton, clinical professor of psychiatry and behavioral sciences at the Medical University of South Carolina, that they’ve used the drug “specifically to help them not eat” but mostly, like Lucy, they discover this effect unintentionally.
“Bingeing, purging, and compulsive exercising alters your brain chemistry and that interacts with MDMA to make you more susceptible to the negative consequences,” Brewerton says. “It really can be a perfect storm for some people—one they sometimes don’t survive.”
If a person’s electrolytes have already been affected by diet restriction, losing more through sweating while on ecstasy (especially if the person is also dancing) can leave users more vulnerable to seizures, cardiac arrhythmia, and even brain damage, he adds.
While ecstasy use can be dangerous, Brewerton says that, in a controlled environment, clinical MDMA can be a powerful tool to assist therapy. He has co-authored papers on MDMA-assisted psychotherapy’s use as a treatment for PTSD, and the drug is currently in final-stage FDA trials to become legal for this purpose. Brewerton explains that it’s not an ecstasy pill or MDMA you’d buy on the street, but instead “a pharmaceutical grade, at limited doses, given within a very specified kind of psychotherapeutic environment.”
The non-profit funding these trials, the Multidisciplinary Association for Psychedelic Studies (MAPS), believes the treatment has potential to treat a whole spectrum of psychiatric conditions, including, ironically, eating disorders. This may seem counterintuitive given the drug’s potential for abuse, but those undergoing MDMA-assisted psychotherapy take the drug under controlled circumstances, and are never allowed to take it home with them.
“We have some good info suggesting that this could be one of the more important uses of MDMA,” says Rick Doblin, executive director of MAPS. “But because of the lack of funding, we have not actually started any formal studies.”
According to Brewerton, MDMA acts on several of the brain systems that are affected in people with eating disorders, including the serotonergic and dopamine systems. “What’s unique to MDMA is the oxytocin system,” he adds. “This has to do with social bonding and pro-social feelings and can enhance therapeutic alliance.”
During MDMA-assisted psychotherapy sessions, the drug, an empathogen, allows patients to talk and think about things that they find too painful to explore under normal circumstances. These sessions are unstructured and usually see patients bring up their trauma organically, without direction from the therapist.
“We encourage people to spend part of the time lying on a futon or they can sit up if they want to,” says psychiatrist Michael Mithoefer, who has worked as a therapist on MAPS’ PTSD trials. “They’re usually lying with eyes closed, often with eye shades and headphones, listening to music. They spend periods of time just focusing on their inner experience without talking and then alternating that with periods of talking to the therapist.”
There is a correlation between eating disorders and trauma, Mithoefer adds, which makes a strong case for the drug being a suitable treatment.
The unique difficulty of using MDMA for eating disorders specifically is that sufferers—especially those with anorexia—are sometimes not medically stable (they are sometimes dangerously underweight). This would preclude them from participating in the treatment. For this reason, Brewerton believes that binge eating disorder, the most common ED in the US, would be a good place to start research.
For the most physically unwell patients, Adele Lafrance, a clinical psychologist and associate professor in the psychology department at Laurentian University, envisions another solution. She has developed a technique called emotion-focused family therapy, where the patient’s parent or caregiver undergoes therapy then takes what they’ve learned and acts as their child’s “recovery coach.” It’s sort of like second-hand therapy, and would be particularly beneficial in cases where the person with an eating disorder is refusing treatment.
“I would love to combine emotion-focused family therapy with psychedelic use for parents because it would remove from the equation the need for the individual to be medically stable,” Lafrance says, “Instead, we could support the parents to support their child.”
Another way to open up MDMA-assisted psychotherapy to those who are malnourished, she suggests, would be to use the technique as a follow-up for physical treatments.
“We could combine the medical model of re-nourishment and interruption of symptoms in order to achieve medical stability, with the use of some of these substances like psilocybin, ayahuasca, and MDMA to facilitate the psychological healing,” she says.
Currently, there are only two medications which are FDA-approved for eating disorders: Fluoxetine (Prozac) for bulimia and amphetamine Vyvanse for binge eating disorder. Other drugs can be prescribed off-label. “Antidepressants and even antipsychotics are really much more ineffective when people are in a malnourished state,” says Stephanie Zerwas, clinical director of the UNC Chapel Hill Center of Excellence for Eating Disorders. “We don’t totally understand the reasons why but people just don’t get the same benefit from antidepressants when they’re at a very low weight.”
“There’s a need for better medicines for eating disorders,” says Russell Marx, chief science officer at the National Eating Disorders Association (NEDA). “The medicines we have are better than nothing, but I don’t think we should stop looking.