So there are some really interesting things going on the treatment of Post-Traumatic Stress Disorder (PTSD). There has been a lot of research done in the past mostly around veterans but our understanding has expanded with a deeper knowledge of trauma, how it forms, and how it is carried in those that are affected. Methods to treat trauma include cognitive therapies, EMDR, and exposure protocols to desensitize the effects that cause distress. There is a new pharmacotherapy that is being tested in a number of places and yielding interesting results.
National Public Radio did a piece last year on their All Things Considered show about the promising results of using 3,4-Methylenedioxymethamphetamine (MDMA, or ecstasy) to treat PTSD (you can listen to it here). This was one of the jumping off points for me to do some more research. I find this topic particularly interesting because MDMA is an illicit drug that is categorized as a Schedule I drug in the same category as heroin. Schedule I drugs are labeled as highly addictive and having no medicinal properties. New research is challenging that.
What is MDMA?
MDMA (seen below in its chemical form from an image on Wikipedia) was developed in 1912 by a German pharmaceutical company with the hopes that it would be a drug used to control bleeding. It was later banned in the United States in 1985 and designated a Schedule I drug. You may know MDMA better by its street names of molly and ecstasy.
MDMA (3-4 methylenedioxymethamphetamine)
You can see that it shares some of the same chemical makeup of methamphetamine
and mescaline (peyote).
What is PTSD?
This brings us to what MDMA is being used to treat. PTSD is a disorder that is recognized by the American Psychological Association in the Diagnostic and Statistical Manual (DSM-5), as well as globally as a disorder in the International Classification of Diseases (ICD10). There are five main symptoms of PTSD in the DSM: exposure to a traumatic event, intrusive symptoms that occurred after the event, persistent avoidance of things (stimuli) that are associated with the trauma, changes in thoughts that are negative and occur after the traumatic event, changes in arousal and reactivity after the event. In order to be diagnosed with PTSD, these symptoms have to have lasted longer than one month, be distressing enough to impact someone’s life, and the symptoms cannot be attributed to drug use or a medical condition.
What is Going on With The Research?
The newest research on MDMA treatment involves trained clinicians working with clients before the dosing session to help prepare the client so that traumatic memories can be accessed and addressed during the session. Researchers from Johns Hopkins University found that MDMA helped strengthen the bond between clients and their therapists, a critical component in the successful treatment of PTSD.
Another study conducted between 2004 and 2017 randomly assigned 103 participants to take either MDMA or a placebo, and both groups participated in psychotherapy sessions. The study results showed that the active group (given the MDMA) had significant reductions in PTSD scores compared to the placebo group. After two sessions, 54.2% of the group that took the MDMA no longer met the diagnostic criteria for PTSD, compared to 22.6% of the control group. The study can be read in its entirety here.
This is mostly speculative, but it appears that MDMA research has been ongoing and occurring in a number of iterations since the 1960s. The use of pharmacological treatment for psychological conditions is certainly not new, and MDMA may be added to the growing options of treatment, particularly for PTSD.
It is also reasonable that some people may be uncomfortable with this budding treatment option due to the classification of MDMA as a Schedule I drug. It is important to distinguish, however, between unsupervised use of the drug and directed, supervised treatment. Clinical use of MDMA differs from self-medication and drug abuse, however, in that the dosing occurs in the presence of a trained therapist after an introductory and structured period of treatment. MDMA may be a way to assist individuals with addressing the distressing, intrusive, and sometimes crippling thoughts associated with PTSD.
The use of MDMA as a treatment approach for PTSD and other conditions continues to be studied in research trials but is by no means mainstream or widespread. I would encourage everyone to be curious and keep an open mind about the news and results of these research trials.