REPORT:

Personal Experience with MDMA and PTSD

April, 2004

I am a 38 y.o. dentist, married +3.

In March 2002 I was in a cafe across the road from my office in Jerusalem, Israel when a suicide bomber exploded next to me. Amazingly I survived (although eleven others did not) with permanent damage only to my hearing. I was later diagnosed with PTSD. The presentation of PTSD can be complex with many possible expressions, and my symptoms indicated the "arousal" type.

In my personal search to fulfill new psychological needs, I began to use MDMA at parties. MDMA use in this very social and very stimulatory context enabled me to reach profound and satisfying levels of emotional experience. At the same time I was getting psychological support from a National Insurance sponsored psychologist (interestingly, she felt that my MDMA self-medication was a way of my attempting to gain control of the original traumatic incident).

However, beyond these immediate effects of MDMA, it was the effect that lasted up to 48 hours following MDMA ingestion, that intrigued me. A cognitive exercise that I did under the guidance of my psychologist, that involved logging all my PTSD occurrences, revealed consistently zero PTSD manifestations for the 2 days following MDMA use. This discovery is what prompted me to survey the literature on MDMA in PTSD therapy, find MAPS and prepare this report at Dr Doblin's request, in the hope it will help with his effort to further study in this area. I must point out that I have no experience with MDMA as part of psychotherapy, nor do I have any reason to think it would be beneficial in that context.

I am not happy using MDMA because as production and distribution of the material is both illegal and unsupervised, I don't know exactly what composition I'm ingesting, the effects vary according to the batch, and there is also a negative social stigma.

I should point out that I tried SSRIs on 2 separate occasions (paroxetine and sertraline) but had to abort because of side effects on my problematic GI system.

I would be happy to be able to use MDMA in a legal and supervised context, and I therefore support Dr Doblin in his project.

See below for Rick Doblin's report for the MAPS Bulletin with discusses his meeting in Jerusalem with the author of this report, on May 2, 2004.

MDMA-assisted Psychotherapy in the Treatment of War and Terrorism-Related Posttraumatic Stress Disorder (PTSD): The Israeli Pilot Study

Update

By Rick Doblin, Ph.D, rick@maps.org

Shortly after MAPS' US MDMA/PTSD study was fully approved and underway, I scheduled several meetings with Israeli Ministry of Health officials to work on starting in earnest the protocol design and approval process for MAPSÕ proposed Israeli MDMA/PTSD pilot study, for which MAPS has budgeted $75,000.

On April 30, 2004, I met with Israeli psychiatrist Dr. Moshe Kotler, the Principal Investigator of MAPS' proposed study which will include subjects with war and terrorism-related PTSD (subjects with war- related PTSD are excluded from the US MDMA/PTSD study). Dr. Kotler has previously been the chief psychiatrist for the Israeli Defense Forces (IDF). Dr. Kotler indicated a strong interest in seeing the study conducted and suggested we use a dose-escalation design. He stressed the need for patience and outlined a timetable that will hopefully result in the study being reviewed and approved by an IRB (called Helsinki Committees in Israel) by Fall 2004. Review and approval by the Ministry of Health would occur sometime after that.

On May 2, 2004, I met in Jerusalem with Ministry of Health official Dr. Miki Reiter, who also expressed support for the study. We discussed practical issues such as obtaining an Israeli translation of our primary outcome measure, the Clinician Administered PTSD Scale (CAPS).

While in Jerusalem, I also had the very moving experience of meeting with an Israeli dentist who contacted MAPS in April 2004 after he conducted an internet search on MDMA and PTSD. He had PTSD as a result of a suicide bombing in a cafe in March 2002 that killed 11 people. He has permanent hearing damage but no other serious persisting physical injuries.

After the bombing, he had been treated for PTSD with psychotherapy and SSRIs with limited benefits. He subsequently used Ecstasy (MDMA) in a recreational setting and found that it helped reduce his PTSD symptoms. He spoke to his therapists about this and they had never heard of MDMA being used to treat PTSD.

I found him to be sincere and emotionally open. He was able to laugh at times and talk clearly about what happened and about the consequences in terms of nightmares, hyperarousal and other symptoms. When we were getting ready to leave our meeting place, he asked if I had realized that it was the same cafe in which the explosion took place. I hadn't and immediately saw the entire conversation in a more vivid light.

On a walk to his office a few blocks away, he pointed out where a more recent explosion had taken place in a bus, killing several people. He heard the explosion, rushed out and was among the first on the scene. Due to his medical training, he decided to go inside the bus. He carried some people out and, until the rescue squad arrived, helped provide medical care to some of the people still alive inside. He was initially retraumatized but shortly afterwards felt that helping others and being in control of his actions, as contrasted to his loss of control over his personal safety when he was in the cafe explosion, was an important part his healing process.

I returned home from Israel with renewed hope for the eventual approval of MAPSÕ Israeli MDMA/PTSD pilot study and a greater sense of the contribution that this research can make toward developing new methods to heal the terrible trauma of war and terrorism-related PTSD suffered by people on all sides of numerous violent conflicts around the world.