MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD: what it is and what it isn’t

This review (2020) discusses current research into MDMA-assisted psychotherapy for patients with treatment-resistant PTSD. It proposed that while MDMA-assisted psychotherapy may help people who have experienced PTSD, the potential of MDMA has to be thoroughly investigated to pit MDMA as a ‘treatment for PTSD’.

Abstract

Background: PTSD is a chronic condition with high rates of comorbidity, but current treatment options are limited and not always effective. One novel approach is MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD, where MDMA is used as a catalyst to facilitate trauma processing during psychotherapy. The aim was to review all current research into MDMA-assisted psychotherapy for PTSD.

Methods: Articles were identified through PubMed and Science Direct for items published up to 31st March 2019 using terms “treatments for PTSD”, “drug treatments for PTSD”, “MDMA”, “MDMA pathway”, “MDMA-assisted psycho-therapy” and “MDMA-assisted psychotherapy for PTSD”. Articles were identified through Google Scholar and subject-specific websites. Articles and relevant references cited in those articles were reviewed.

Results: Small-scale studies have shown reduced psychological trauma, however there has been widespread misunderstanding of the aims and implications of this work, most commonly the notion that MDMA is a ‘treatment for PTSD’, which to date has not been researched. This has harmful consequences, namely dangerous media reporting and impeding research progression in an already controversial field.

Conclusions: MDMA-assisted psychotherapy may help people who have experienced psychological trauma and who have not been able to resolve their problems through existing treatments, however more research is needed. If this is to get appropriate research attention, we must report this accurately and objectively.

Author: Louise Morgan

Summary

PTSD is a chronic condition with high rates of comorbidity. MDMA-assisted psychotherapy is a novel approach for treating PTSD.

Background

After exposure to a traumatic event, people with PTSD develop four symptom clusters: re-experiencing, avoidance, negative alterations in cognition/ mood and alterations in arousal and reactivity. There are no PTSD-specific drug treatments, but antidepressants and antipsychotic medications can alleviate certain feelings associated with a PTSD diagnosis.

This paper describes how MDMA might assist psychotherapy in the treatment of PTSD, and highlights some of the negative consequences of misinterpretation of the research.

Method

This review identified relevant articles published up to March 2019 in PubMed, Science Direct, Google Scholar and subject-specific websites. All articles were in the English language and were reviewed for quality.

The possible role of MDMA in assisting psychotherapy for PTSD

There are a number of possible reasons why current PTSD treatments are limited, including the long-term commitment required to attend regular therapy sessions over a number of years, and the impact of psychological trauma on people’s ability to form trusting relationships.

MDMA is a monoamine releaser that increases serotonin, dopamine and noradrenaline, reduces amygdala activity, and enhances mood. It may be helpful in treating PTSD by decreasing the fear response and decreasing defensiveness without blocking access to memories, and enhancing the identification of and response to emotional states.

Clinical trials of MDMA‑assisted psychotherapy for people diagnosed with treatment‑resistant PTSD

The Multidisciplinary Association for Psychedelic Studies (MAPS) in the United States have reported six phase 2 clinical trials looking at MDMA-assisted psychotherapy for PTSD. The participants received preparatory, non-drug psychotherapy, two or three 8-h MDMA-assisted psychotherapy sessions and follow-up non-drug psychotherapy.

These studies showed that participants who took 75-125 mg of MDMA had reduced psychological trauma and long-term remission of PTSD, with no drug-related serious adverse events and no adverse neurocognitive effects. In collaboration with the US Food and Drug Administration and the European Medicines Agency, multi-site phase 3 clinical trials are being conducted to assess the effects of MDMA-assisted psychotherapy on people diagnosed with treatment-resistant PTSD.

Misinterpretation and its consequences

The MAPS research is controversial and misrepresentation of the research hampers progress in a field already fraught with legal and political challenges. The Home Office controls the use of Schedule 1 drugs, and requires special criminal records checks and regular police inspections of laboratories.

Aims and terminology

The MAPS studies are unique in the world of clinical trials, because they combine psychotherapeutic intervention and a catalysing psychopharmacological treatment to facilitate trauma processing. The MDMA is not just an augmenting add-on medication, but rather a catalyst that dramatically influences the psychotherapeutic process itself.

MDMA has been misrepresented as a treatment for PTSD, and as having a direct impact on PTSD. Multisite trials are necessary to see MDMA become a licensed medicine, and this phase of clinical MDMA research is now underway.

MDMA-assisted psychotherapy should always be referred to as MDMA-AP, and MAPS have not studied MDMA as a therapy.

MDMA has been used as a co-drug for therapy, as an enhancement to therapy, as an adjunct to therapy, as a treatment for PTSD, and as an adjunct to post-trauma psychological therapy.

MDMA has not been researched as a co-drug, associated to or paired with psychotherapy, supplementary to treatment or used as an adjunct. It is also not the same as ecstasy, which is often sold with unknown and/or dangerous additional components.

MAPS have not researched MDMA as a treatment for any condition, and it is not about treatment of a so-called ‘disorder’. It is a therapy for the person taking MDMA, and it has been particularly helpful for people living with psychological trauma-related problems.

Loss of objectivity

Researchers have suggested that MDMA-assisted psychotherapy may produce long-term benefits, but this does not fit with current models of pharmacotherapy. It is safer to undertake psychotherapy without using stimulant co-drugs, and further research is required to establish the safety and efficacy of this method.

Parrott [41] provides hypothetical examples of what might happen after MDMA-assisted psychotherapy, but these examples are not based on evidence and have never even remotely occurred in controlled trials of MDMA-assisted psychotherapy.

Sessa and Nutt highlight the challenges of getting this type of work approved, and draw attention to important evidence suggesting that MDMA could safely be re-classified as a Schedule 2 drug, making carrying out clinical research more straightforward.

MDMA-assisted psychotherapy studies have been carried out solely by one group of people, which has led to some questions about their impartiality.

The use of the terms ‘advocates’ and ‘proponents’ in the MAPS research is unwarranted, and we should not criticise the research because the team are ‘advocates’ or use hypothetical examples of what might happen if someone takes MDMA when it so far has not happened in the trials being referred to.

Conclusions

MDMA-assisted psychotherapy may be a promising approach to helping people who have experienced psychological trauma, but there is already a great deal of misunderstanding of its aims and findings in the academic literature.

Study details

Compounds studied
MDMA

Topics studied
PTSD

Study characteristics
Literature Review

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