MDMA and PTSD: Dangerous Mix or Potential Help?
Once known as a club drug, MDMA – commonly referred to as Ecstasy or Molly – is being studied as a potential treatment for post-traumatic stress disorder (PTSD). PTSD is a psychiatric disorder that results from a traumatic experience, like experiencing or witnessing an especially life-threatening, horrifying, or dangerous event. In addition to combat veterans, there are several other groups (for example, rape victims and emergency responders) who are at higher risk for this condition. PTSD can be characterized by flashbacks to the traumatic event, frightening thoughts, angry outbursts, and exaggerated feelings of guilt or blame, among other symptoms.
It is estimated that eight million adult Americans suffer from PTSD. Around 37 percent of all cases of PTSD are considered severe, which means they are typically resistant to traditional therapy and medications, such as cognitive behavioral therapy (CBT), and antidepressants.
In November 2016, as a response to treatment-resistant cases of PTSD, the U.S. Food and Drug Administration (FDA) approved large-scale Phase 3 clinical trials with MDMA – the last step before a drug can be approved by the FDA for medical use. This represented a major move by the FDA to test the effectiveness of a substance that had been deemed illicit for over 30 years as a pharmaceutical therapy for a very difficult condition to treat.
The background story
MDMA was first synthesized in 1912 by German chemist Anton Köllisch. However, he never experimented with it. In 1976, American chemist Alexander Shulgin also synthesized the chemical without prior knowledge of Köllisch’s discovery. Shulgin tried MDMA – and though he found its effects unremarkable, he began to encourage psychotherapists to utilize it with patients as a conduit to deeper emotional experience.
This experimentation by therapists and their patients increased the prevalence of recreational use or misuse of the drug. At the time, most people’s understanding of MDMA and its effects was limited. By the early 1980’s, MDMA was widely used as a club drug, associated with dance parties and electronic music. Yet MDMA has proven to be a dangerous substance for some users, potentially leading to high blood pressure, heart problems, hyperthermia, loss of consciousness, and seizures. The drug was frequently mixed with alcohol or stimulants, increasing its health risks. In 1985, the drug was officially designated by the FDA as a Schedule 1 substance – “an illegal drug with no recognized medicinal use.”
Today, MDMA is still used among those participating in “clubbing” or rave party scenes. In 2015, approximately one percent of Americans – primarily young adults – reported using MDMA.
The potential to help
There are now four FDA-approved studies underway to explore MDMA’s effectiveness in treating severe PTSD. When administered, MDMA is taken in a quiet, secure room, with therapists present. Patients are guided through the experience, and asked to explore issues surrounding their PTSD.
Chemically, MDMA appears to work with severe PTSD by increasing levels of brain chemicals (neurotransmitters) like serotonin, dopamine, and oxytocin which increase feelings of well-being and emotional closeness, while decreasing depression. Indeed, the chemicals in MDMA seem to let patients think of their traumatic experiences from a different, less threatening perspective.
So far, the test results have been encouraging. In one study from 2008, 83 percent of participants with chronic PTSD saw a significant reduction in their symptoms after two therapeutic MDMA sessions. A 2012 study also demonstrated a decline in symptoms, though it recommended three sessions of MDMA for the greatest effectiveness. MDMA appears to have none of the negative, long-term side-affects that antidepressant and anxiety medications have, like lack of energy, weight-gain, and suicidality.
The future of PTSD treatment?
Experts and health officials suggest caution with this new approach, as more data is needed to better understand the effectiveness and long-term side effects of MDMA for treating PTSD. Although the FDA is working towards making MDMA an accessible medication, this move has drawn concern about normalizing its use and reigniting the popularity of a drug with known risks and abuse potential.
While initial tests of the effectiveness of the drug for treating PTSD are promising, MDMA should not be used recreationally, or for medical purposes without the close supervision of a trained physician and therapist. Still, if properly regulated, MDMA may end up playing an important role in helping those who suffer tremendously from severe PTSD who would otherwise be unresponsive to treatment.
Max Dorfman, MA
Max is a Science Writer at Center on Addiction