For people with post-traumatic stress disorder, recalling memories of physical or sexual assault, fighting, or disaster-related events can cause intense anxiety or panic attacks as well as debilitating flashbacks. .
In the United States, about 7% of people suffer from PTSD and lose an average of about four days of work per month. Trauma-specific psychotherapy, such as cognitive therapy or talk therapy, is the cornerstone of treatment for PTSD. But for about half of people, these traditional approaches are ineffective in fully treating the symptoms of PTSD in the long term. Antidepressants are frequently used when psychotherapy has failed, or in combination with it, but the effects are usually modest.
MDMA (3,4-methylenedioxymethamphetamine) is an active ingredient in the illicit street drug known as ecstasy or molly. People in dance clubs and raves use illicit MDMA because it elevates mood and energy levels, induces a sense of connection with others, and produces a surreal psychedelic high. These same effects have been believed to support people with PTSD during psychotherapy sessions, as they can make people more willing and able to share and explore their traumatic experiences. Our new clinical trial meta-analysis confirms the benefits of MDMA-assisted psychotherapy in the treatment of PTSD.
We are a team of pharmacists and physicians who investigate the pros and cons of drugs of abuse like bath salts, phenibut, cannabis, and synthetic marijuana. Through this work, we have been intrigued by the therapeutic potential of certain psychedelic drugs in the treatment of a myriad of psychiatric disorders, from PTSD to major depression, in particular MDMA and psilocybin (hallucinogenic mushrooms).
It is important to clarify that the use of ecstasy or street molly products would not help the symptoms of PTSD, as MDMA must be used with carefully designed psychotherapy in a safe and controlled environment. Illegally purchased ecstasy or molly products never state the exact amount of MDMA they contain, so it is impossible to dose it correctly for PTSD. Taking too much MDMA or exercising while taking MDMA can cause heart attacks, strokes, seizures, and arrhythmias, and can damage muscles and kidneys.
What is MDMA-assisted psychotherapy?
In an MDMA-assisted psychotherapy session, patients take MDMA in pill form upon entering a psychiatrist’s office, then work with a team of therapists who help them disclose traumatic events or discuss aspects. of these events for several hours. They usually have non-MDMA sessions before the first MDMA session so they know what to expect. And they have at least one non-MDMA session after each MDMA session to work on the traumatic memories that have been revealed and to learn coping strategies. A standard course of treatment consists of two or three sessions of MDMA-assisted psychotherapy lasting several hours and several sessions without MDMA.
The MDMA products used in these sessions are pharmaceutical grade. This means that, unlike illegally obtained street foods, they do not contain other substances of abuse, such as methamphetamine, or contaminants such as heavy metals, bacteria or mold. People with hypertension or those at high risk of heart attack, stroke, or arrhythmia should not participate, as they can have dangerous elevations in blood pressure and heart rate. Additionally, patients are not allowed to go outside for eight hours, until the effects of MDMA have worn off completely.
To assess the effectiveness of MDMA-assisted psychotherapy
In 2014, we looked at the available animal data and the few preliminary human studies of MDMA-assisted psychotherapy, but at the time, the higher-quality clinical trials were not yet complete. But in recent years, larger and better trials have emerged that warrant further evaluation.
So we recently reviewed data comparing the use of antidepressants to placebos for patients with PTSD and performed a meta-analysis of six different clinical trials that assessed the usefulness of MDMA-assisted psychotherapy versus psychotherapy alone. All of the trials we analyzed included both men and women who had experienced a multitude of traumatic events leading to PTSD. The studies used the same point scale to determine the effectiveness of treatment, making it easier to compare data between studies. Scores greater than about 50 points mean that a patient has severe PTSD, and scores reduced by more than 10 points from baseline are clinically significant.
We found that daily antidepressant treatment reduced PTSD by 6 to 14 points compared to placebo, but a range of 27% to 47% of patients in the studies withdrew before the end of the trials. In contrast, MDMA-assisted psychotherapy reduced scores by 22 points compared to those receiving psychotherapy with placebo, and patients were twice as likely to no longer meet diagnostic criteria for PTSD at the end of the trials. In addition, only 8% of patients withdrew from MDMA-assisted psychotherapy trials. The main side effects included teeth grinding, nervousness, headache and nausea. One of these MDMA trials found that participants’ blood pressure and heart rate were elevated during MDMA treatment, but not to any level of concern.
For several of the trials in our meta-analysis, investigators sent participants a questionnaire 12 months after their last MDMA session to assess the long-term impact. Overall, 86% of participants reported receiving substantial benefits from MDMA-assisted combination psychotherapy. Eighty-four percent of participants said they improved their sense of well-being, 71% had fewer nightmares, 69% had less anxiety, and 66% had better sleep. The results of all the studies suggested that MDMA-assisted therapy helped relieve the PTSD itself, not just suppress the symptoms.
The United States Drug Enforcement Administration identifies MDMA and psilocybin as Schedule I controlled substances. According to the DEA, these substances currently have no accepted medical use in the United States and have a high potential for abuse. .
However, an important exception should be noted. Cannabidiol, or CBD, a chemical that comes from the plant Cannabis sativa, is classified as a Schedule I drug. But the Food and Drug Administration approved its use in 2018 for the treatment of two rare and serious seizure disorders in children. This doesn’t mean that the CBD in your lotion or seltzer has beneficial effects on most of the ailments people use it for, but its full therapeutic potential is still under investigation. Given the strong and consistent beneficial effects and manageable adverse events in the new trials designed with input from the FDA, we suspect MDMA-assisted psychotherapy will become an FDA-approved option for PTSD by the end of 2023. Psilocybin – commonly known as hallucinogenic mushrooms – also shows promise for the treatment of major depression, but more research is needed.
The DEA’s strict policies have made it exceptionally difficult for scientists to conduct research on Schedule I drugs for decades by criminalizing possession of the products, even in the course of research. But in 2018, the agency streamlined the application process for a research waiver. This made it easier for researchers to conduct trials on the pharmaceutical value of psychedelic drugs. Over the next decade, this change will almost certainly accelerate the discovery of new treatments for patients with mental illness.
C. Michael White, Professor Emeritus and Head of Department of Pharmaceutical Practice, University of Connecticut and Adrian V. Hernandez, Associate Professor of Comparative Efficacy and Outcome Research, University of Connecticut
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