Summary: VolteFace investigates the benefits and risks of MDMA-assisted psychotherapy for treatment-resistant posttraumatic stress disorder (PTSD), highlighting published research results from multiple studies. “Recent clinical trials of MDMA-assisted psychotherapy have found that it significantly reduced symptom severity in PTSD patients and was more effective than for placebo controls,” writes Abbie Llewelyn. “The benefit has found to be enduring, which means that it is a credible alternative for treatment-resistant patients.”
Originally appearing here.
Living with Post-Traumatic Stress Disorder (PTSD) can be extremely debilitating. Sufferers experience intrusive flashbacks, nightmares and severe anxiety just trying to go about living their lives. The most common therapies for PTSD are Cognitive Behavioural Therapy and Eye Movement Desensitisation and Reprocessing, but nearly half the people receiving these therapies are not getting any better.
This means that there is a demand for new alternative treatments and there is promising evidence that MDMA-assisted therapy can significantly reduce the symptoms of previously treatment-resistant patients. Most of the research on this was done in the 80s before the clinical use of drugs like MDMA were banned, but research methodology has improved in leaps and bounds in the last 30 years, so the results gathered back then did not give a conclusive answer. However, permission has recently been granted allowing a small number of clinical trials to test whether MDMA-assisted psychotherapy could be an alternative to the standard treatment.
MDMA was originally investigated for its potential use in therapy because it is known for its empathogenic qualities and for producing feelings of emotional openness in its users. Patients who had used it in a clinical setting reported multiple cognitive benefits including expanded mental perspective, better insight into personal problems, improved self-evaluation, and improved “issue-resolution” skills after the dose. It was also found to inhibit the fear response, which allowed patients to openly talk about their experiences without being overcome with emotion – and discussing the trauma is key to recovery. There is also evidence that it strengthened the rapport between the patient and therapist, decreased avoidance behaviour in the patients and improved recall and processing of painful memories. All these things have the potential to aid the therapeutic process and improve the success rate of treatment.
As well as these self-reported benefits, there is also neuropsychological evidence that indicates MDMA could be beneficial in treating PTSD. Studies have found that MDMA decreases amygdala activity, which is related to emotionality and fear. It also increases activity in the medial prefrontal cortex, a region where activity is negatively correlated with symptom severity in PTSD. This means that MDMA could temporarily reduce the symptoms of PTSD and allow the patient to talk more openly about their experiences, as previously mentioned, and thus allowing for a more constructive therapy session.
Recent clinical trials of MDMA-assisted psychotherapy have found that it significantly reduced symptom severity in PTSD patients and was more effective than for placebo controls. The benefit has found to be enduring, which means that it is a credible alternative for treatment-resistant patients. A 2008 study investigated whether MDMA could help treat six women with treatment-resistant PTSD stemming from a sexual assault. They found that participants who had one MDMA-assisted psychotherapy session (50mg) in the middle of a six-session programme improved twice as much on a measure of PTSD symptom severity than those who just did six standard sessions. One participant, who took 75mg of MDMA, showed an even larger reduction in symptoms. A further study, in 2011, found that 83.3% of a group of PTSD sufferers who took MDMA during therapy showed clinical improvement, versus just 25% of those who didn’t. These studies indicate that MDMA-assisted therapy may be better at treating PTSD than psychotherapy alone.
However, it is important to consider that there is evidence of MDMA’s neurotoxicity. Serotonin is a neurotransmitter believed to be involved in cognitive processes, including learning and memory. When rats are given a high dosage of MDMA they experience 5-HT (serotonin) receptor depletion, which would lead to a reduction in serotonin uptake and potentially have an effect on cognition. However, this may not have the same effect on humans, so a study of human MDMA users was carried out. This study found that greater use of MDMA leads to greater memory impairment. In addition, it found that lower concentrations of 5-HIAA (which indicates a reduction in 5-HT receptors) were also associated with greater memory impairment. This suggests that MDMA causes 5-HT receptor depletion, resulting subsequent memory loss. Other cognitive deficits associated with MDMA use are deficits in sustained complex attention tasks, short-term memory tasks and tasks of semantic recognition and verbal reasoning. However, these studies were on recreational users, who would typically be using a higher dosage than what would be used therapeutically and no evidence of cognitive deficits were found in the studies on MDMA-assisted therapy. With this in mind it is very important that this is investigated properly to work out whether MDMA-assisted therapy would be a safe option.
Having said this, whilst it is important to consider the neurotoxicity of the drug, we need to put it into perspective and think about the priorities of PTSD patients. The level of anxiety they experience and the persistent intrusiveness of their disorder in terms of difficulty sleeping, frequent flashbacks to their trauma and avoidance behaviours meaning they may not even like leaving the house, it is likely that many of these people would happily take some memory loss to be free of their suffering. In other words, the increase in quality of life outweighs the risk of low-level 5-HT receptor depletion.
Standard therapies are known to be both safe and versatile, so should be the first port of call for someone with PTSD. However, if they are not responsive, MDMA-assisted therapy could be helpful for these patients, so it is crucial that more research is carried out on this and that it is at least considered for use in our healthcare system. Sadly, due to anti-drug rhetoric there is a history of resistance to using otherwise illegal drugs as a treatment – take medical cannabis for example! That is why it is so important that more data is gathered on this; if the benefits of MDMA use in therapy can be proven over and over, it is more likely to receive NICE approval and go on to help many many people.