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Why MDMA-Assisted Therapy May Be the Future of PTSD Treatments

by Kyla Trkulja

Graphic design by Michie (Xingyu) Wu

Post-traumatic stress disorder (PTSD) has been estimated to affect 6-10% of individuals.1 However, experts predict that the prevalence of this disorder will rise sharply as a result of the COVID-19 pandemic.2 Throughout the pandemic, experiencing and witnessing serious illness, suffering, death, social isolation, unemployment, and burnout, combined with the rise of racist hate crimes, has contributed disproportionate amounts of stress to individuals around the world. As a result, the associated trauma undergone by many becomes an obstacle that will be difficult to overcome. 

Despite the several treatment options available for individuals with PTSD, their efficacy is substandard. Psychotherapy, which is a first-line treatment, is effective in only 44% of individuals after 40 months; this statistic is specific to those that are willing to dive deeply into their traumatic experience.1 This form of treatment is also hindered by its high drop-out rates. Additional treatments for PTSD include medications such as selective serotonin reuptake inhibitors (SSRIs), which are effective in only 20-30% of users.1 Benzodiazepines, which are another form of drug therapy, are even less effective and carry the risk of addiction. These existing therapies are designed to treat symptoms but do not address the underlying cause of the disorder. Therefore, individuals with PTSD are left to live with unresolved trauma, putting them at a higher risk of relapse. 

It is clear that new treatment options are needed, especially with the prevalence of this disorder expected to rise and a limited number of therapists to match. These gaps in existing treatments motivate researchers to explore novel approaches to address PTSD, with some scientists favouring a controversial option – MDMA, also known as “molly” or “ecstasy”. 

MDMA was first synthesized by Merck pharmaceuticals in 1912 and has been used alongside psychotherapy since the 1970s, before street use resulted in its prohibition in 1985.3 It causes the release of serotonin in the brain, leading to a positive mood. MDMA also upregulates dopamine, adrenaline, and oxytocin to increase pleasure, energy, and feelings of closeness to others, respectively.4 This combination of biological effects induces euphoria, extroversion, and empathy in the user, as well as a reduced sense of fear.4 While this can be harmful when used recreationally, research is finding that these effects can be effective to combat PTSD when combined with therapy. 

Although it is not a new concept, MDMA-assisted therapy has recently been found to have several benefits over traditional treatment options for PTSD. The drug places the patient into an “optimal arousal zone” for psychotherapy such that they are able to address their traumatic memories due to being alert and motivated, but also relaxed and empathetic.4 By simultaneously reducing the fear response and increasing trust, the patient is able to gain clarity and acceptance of the past, see their problems in a new light, and focus on how to recover. This is in contrast to psychotherapy alone, where the patient is often frightened, closed-off, hesitant, and too distressed to make progress during their sessions. This further supports MDMA-assisted therapy as not only more effective than traditional therapy, but also more efficient, with many patients only needing 2-3 sessions instead of 20-40.5 

While medications such as SSRIs merely mask the symptoms of PTSD, MDMA-assisted therapy facilitates more direct coping strategies, leading to sustained positive effects.5 In addition, MDMA is less addictive, more tolerable, has less side effects, and needs to be used for shorter periods in comparison to existing drug therapies.5 Together, these features make MDMA a more attractive option for patients. 

The promise of this treatment has been observed in several early-phase clinical trials, with 72% of patients positively responding to MDMA-assisted therapy, and responses lasting longer with a lower risk of relapse.5 In one study, more than half of the participants who underwent MDMA-assisted therapy improved such that they no longer met the diagnostic criteria for PTSD, compared to only 23% of those who underwent therapy alone.3 The results from these trials were so positive that the first ever large-scale Phase 3 clinical trial is currently underway at 16 research sites across the United States, Canada, and Israel, with more sites expected to open across Europe.5 

MDMA-assisted therapy is providing hope for the future of treating PTSD in a way that is safe and effective by assisting patients in targeting the cause of their trauma. The fact that only 2-3 sessions are needed makes this treatment option more affordable compared to weeks of therapy or months of medications. This will also place less burden on therapists as the incidence of PTSD rises in the coming years. Despite the benefits, it will be a challenge to decriminalize MDMA, and great efforts will need to be made to minimize its recreational use. With some planning and creativity to safely reform prohibition policies, PTSD patients will finally have a chance at recovering and living normal lives. 

References

  1. Thal SB, Lommen MJJ. Current Perspective on MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder. J Contemp Psychother. 2018;48(2):99-108. doi: 10.1007/s10879-017-9379-2. Epub 2018 Jan 6. Erratum in: J Contemp Psychother. 2018;48(2):109. 
  2. Bridgland VME, Moeck EK, Green DM, Swain TL, Nayda DM, Matson LA, Hutchison NP, Takarangi MKT. Why the COVID-19 pandemic is a traumatic stressor. PLoS One. 2021 Jan 11;16(1):e0240146. doi: 10.1371/journal.pone.0240146. 
  3. Mithoefer MC, Feduccia AA, Jerome L, Mithoefer A, Wagner M, Walsh Z, Hamilton S, Yazar-Klosinski B, Emerson A, Doblin R. MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology (Berl). 2019 Sep;236(9):2735-2745. doi: 10.1007/s00213-019-05249-5. 
  4. Sessa B. MDMA and PTSD treatment: “PTSD: From novel pathophysiology to innovative therapeutics”. Neurosci Lett. 2017 May 10;649:176-180. doi: 10.1016/j.neulet.2016.07.004. 
  5. Bahji A, Forsyth A, Groll D, Hawken ER. Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2020 Jan 10;96:109735. doi: 10.1016/j.pnpbp.2019.109735.