By Katharina Grotsch
At first glance, the words “therapy,” “post-traumatic stress disorder,” and “MDMA” don’t sound like they belong in the same sentence.
However, after decades of research to find a cure for post-traumatic stress disorder (PTSD) have proven less than fruitful, it seems that this might just be the magic formula. In the midst of the “psychedelic revolution”, a recent study published in Nature Medicine has demonstrated the safety and efficacy of MDMA-assisted psychotherapy in patients with severe PTSD.
Colloquially known as “molly” or “ecstasy,” the drug has been appreciated amongst dance music lovers since the emergence of rave culture in the late 1980s. Initially synthesized in 1912 by the pharmaceutical company Merk, 3,4-Methylenedioxymethamphetamine, or MDMA, was patented as an intermediate for the synthesis of methylhydrastinine, a drug that was intended to help stop abnormal bleeding.
It was the American chemist Alexander Shulgin, known as the “godfather of ecstasy,” who rediscovered the molecule as part of his work on psychedelic phenethylamines and suggested that its ability to produce an easily controllable altered state of consciousness and heightened sense of empathy could be useful in therapy. As a result, MDMA gained popularity amongst psychiatrists and psychotherapists. However, it was soon categorized by the DEA as a Schedule I drug with no medical use, restricting researchers from further exploring its potential.
In 2017, the Multidisciplinary Association for Psychedellic Studies (MAPS), was given breakthrough therapy designation by the US Food and Drug Administration (FDA), allowing for an expedited drug development process for MDMA-assisted psychotherapy. Four years later, the first of two phase III clinical trials has confirmed the drug’s potential as a treatment for PTSD.
We know that the acquisition, storage, and retrieval of fear-related memories happens in a brain region called the amygdala, said Jennifer Mitchell, associate professor at UC San Francisco and lead author on the study. When a patient is administered MDMA, it can “flush out these fear-related memories,” allowing the subject to feel more comfortable in addressing past trauma.
MDMA “creates this sort of social feeling of closeness that allows for the subject to feel more comfortable with their therapist,” she continued. It seems that MDMA acts as a sort of catalyst for the healing process, rather than healing trauma on its own. As such, the therapeutic environment plays an important role in the patient’s success.
In the study, each of the ninety participants underwent three eight-hour long therapy sessions where they were given a 80-180mg dose of MDMA or a placebo. PTSD symptoms were measured at baseline and two months after the final session.
The sessions themselves are delegated by the patient. “As therapists, we’re there in supporting them by being available for whatever they need,” said Joseph McCowan, a licensed clinical psychologist who participated in the trials. He explained that each individual has an inherent capacity to overcome anything that presents itself as an obstacle to their healing and suggests that MDMA can help create the conditions under which healing can occur. “It’s just like applying a cast to a broken bone or stitching up an open wound,” McCowan said.
The results of the study found that 33% of participants in the MDMA group and 5% of participants in the placebo group met the criteria for remission after three sessions. At the primary study endpoint, 67% of the participants in the MDMA group no longer met the criteria for having PTSD, compared to only 32% of those in the placebo group.
So what makes MDMA so special?
“It’s this social aspect, something about the effect of the drug on social interactions,” said Harriet De Wit, Professor of Psychiatry and Behavioral Neuroscience at the University of Chicago who was not involved in the study. De Wit has devoted her life to the study of psychotropic drugs on humans. She points out that MDMA therapy is remarkable in that it produces its desired effects after just two or three sessions, as compared to standard PTSD medications which are typically administered once-daily.
Despite the large amounts of promising data in favor of using MDMA in a clinical setting, strict government regulations and a lengthy approval process present a roadblock in making this type of treatment readily available and accessible to the public. Following the promising results of this study, a second confirmational study is underway to reinforce safety and efficacy of MDMA-assisted psychotherapy for PTSD.
The next questions after that are to determine individual differences in reaction to the drug, Mitchell said. “What makes some people have a great effect, and some people have a mediocre one? And how do we modify these differences, or how do we screen for them?”
It’s too soon to say whether or not MDMA-assisted psychotherapy will become a broadly available treatment, but the emerging scientific evidence is certainly changing the perception of this illustrious molecule.
Kathy Grotsch is a 4th year Ph.D. Candidate in Chemistry at the University of Southern California, where she specializes in organic synthesis. Her work revolves around using click chemistry as a tool to discover new ligands for important biological targets. Kathy is also the President of Biotech Connection Los Angeles where she co-produces Inside Biotech, a podcast that showcases the science behind SoCal’s most innovative biotech companies. Connect with her on LinkedIn or e-mail her at grotsch@usc.edu.
This story was produced as part of NASW's David Perlman Summer Mentoring Program, which was launched in 2020 by our Education Committee. Grotsch was mentored by JoAnna Wendel.
Main image: Since the emergence of the underground rave scene, MDMA is often associated with electronic dance music. Credit: Mark Angelo Sampan/Pexels.
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