Post-traumatic stress disorder (PTSD), as the name suggests, is an anxiety disorder that occurs following a major trauma.
Affecting up to 17.1 percent of veterans and up to one third of first responders, the symptoms include intrusive memories of said stressful event, flashbacks, nightmares, and intense distress.
To date, finding effective treatments for PTSD has proven difficult; psychotherapy and other talking therapies are normally the first port of call, but they do not work for everyone.
Medications such as antidepressants and antipsychotics are typically used, but, again, they do not work for everyone, and side effects can be significant.
Though researchers are keenly investigating ways to improve treatment, running effective studies can also be challenging; there are often high drop-out rates.
Often this is due to the nature of PTSD’s symptoms, but sometimes it is because the condition has worsened, and perhaps the person has been hospitalized.
Also, some believe that patient characteristics might play a role, as might homelessness and drug use disorders.
These difficulties are mirrored in real-life situations; people with PTSD often drop out of therapy, limiting how useful it can be.
MDMA and PTSD
In an attempt to get around these problems, scientists are approaching the treatment of PTSD from innovative directions. Recently, a study funded by the Multidisciplinary Association for Psychedelic Studies in Santa Cruz, CA, investigated the potential use of MDMA — the active ingredient in the controversial party drug, ecstasy.
This might, at first, seem to be an odd choice, but this is not the first time that MDMA has been used in this way.
MDMA was synthesized for the first time in 1912 by scientists looking for drugs to stop bleeding, but no significant use was made of it for many years. But, from the 1970s onward, MDMA was tested for use in depression, relationship problems, substance abuse, premenstrual syndrome, and autism, among others.
The latest study involved just 26 service personnel (22 veterans, three firefighters, and one police officer). All had experienced a traumatic experience and developed PTSD no less than 6 months earlier. All participants had failed to respond to earlier medical or psychological treatments.
They were split into three treatment groups, each receiving different quantities of MDMA: 30 milligrams, 75 milligrams, or 125 milligrams. There was no placebo group.
The researchers wanted to explore whether taking MDMA alongside psychotherapy could increase its effectiveness. Because the drop-out rates from therapy are so high for individuals with PTSD, maximizing every session is key.
Initially, the participants went through three 90-minute psychotherapy sessions without MDMA, so that the therapists could establish a working relationship and prepare them for the experience. Then, they received the MDMA dose during an 8-hour session of tailored psychotherapy.
After the experimental session, the participants stayed the night and were followed for 7 days by telephone contact. Lastly, there was a final 90-minute psychotherapy session. The findings were recently published in The Lancet Psychiatry.
Positive early findings
Although this was a small-scale study with no placebo group, the results offer hope. One month after the final session, 58 percent of the participants in the 125-milligram group no longer met the criteria to be classed as having PTSD, compared with 86 percent in the 75-milligram group and 29 percent in the 30-milligram group.
These findings will, of course, need to be confirmed in large phase III studies. It is also worth noting that more than three quarters of the participants relayed adverse events — including, most frequently, “anxiety, headache, fatigue, muscle tension, and insomnia.”
The researchers believe that, in the right setting, MDMA could be useful in the treatment of PTSD.
[O]ur study suggests that MDMA might help augment the psychotherapeutic experiences and may have a role to play in the future treatment of PTSD.
- Study author Dr. Allison Feduccia
But, Dr. Feduccia is quick to remind us that this must be conducted under strict supervision. “[W]e would certainly not recommend that individuals try these drugs for the treatment of psychiatric disorders without the support from trained psychotherapists.”
This project builds on earlier studies, including one that compared MDMA-assisted psychotherapy in 12 participants with eight people in a placebo group, and another that compared two doses of MDMA using 12 participants.
In total, six phase II trials provided positive results, which led the Food and Drug Administration (FDA) to declare MDMA-assisted psychotherapy as a “Breakthrough Therapy.”
While this title does not necessarily mean that there is high-quality evidence to back up MDMA’s efficacy, it does mean that the FDA will give priority to MDMA research.
This means that, hopefully, more large-scale, in-depth studies will follow soon, finally confirming whether MDMA truly can help in the treatment of PTSD.