Subjective reports of the effects of MDMA in a clinical setting

This open-label study (n=29) is a summary report of the first people administered MDMA (75-150mg) in a clinical setting. The data is limited to phenomenological descriptions obtained from therapist observations and subject experiences before, during, and after the sessions.

Abstract

“The psychological effects of MDMA were first reported in 1978 by Shulgin and Nichols, Because it had originally been patented in Germany in 1914 and was no longer patentable, no pharmaceutical manufacturer could be found who was interested in sponsoring an Investigational New Drug application with the Food and Drug Administration or in supporting research (Shulgin 1980). In 1980, it was learned that, in California at least, drugs that were not yet available commercially could be used within a physician’s practice if they were manufactured by the physician or by a pharmacist (Younger 1978). The state medical board recommended that there be peer review, informed consent and supporting scientific literature when conducting experimental work (California Board of Medical Quality Assurance 1980). This article is a summary report of data gathered from the first 29 people administered MDMA in a clinical setting. Because the primary purpose of the project was to assist the subjects in achieving their particular and varied goals for having the sessions, the data available for analysis is limited. Only phenomenological descriptions were obtained of the therapists’ observations and of the subjects’ experiences before, during and after the sessions. Psychological evaluations by independent observers with testing before and after sessions, placebo control group data with double-blind assessment, and laboratory examinations of organ and metabolic functions were not conducted.”

Authors: George R. Greer & Requa Tolbert

Summary

Subjective Reports of the Effects of MDMA in a Clinical Setting

The following agreements were made before the session to ensure an atmosphere of security: everyone would remain on the premises until the session was over; no sexual activity would take place; and everyone would follow instructions.

Most sessions were held in the subjects’ homes, and they fasted for six hours before the dose was administered. The dose was 75-150 mg of MDMA, and the subject listened to instrumental music to facilitate the experience.

When the effect of MDMA began to subside, subjects were given a second dose of 50 mg or 75 mg. Some were also given propranolol or diazepam to reduce unwanted sympathomimetic side effects.

Data gathered from the questionnaires are presented in narrative form. Most information was gathered on the presession questionnaires, but only the subjects’ purposes for having the session are mentioned.

Fourteen of the 29 subjects reported psychological problems, two of which were of a severe nature. Two subjects had significant health problems, including essential hypertension and chronic macula edema.

MDMA made 27 subjects feel closer and more intimate with others, and 21 found it easier to receive compliments and criticism.

The 29 subjects reported positive changes in their attitudes or feelings, including warmer, fresher, more alive, euphoric or lovingfeelings, greater self-confidence or self-acceptance, lowered defenses, and transcendent experiences. Twenty-two subjects reported some cognitive benefit, including an expanded mental perspective, insight into personal patterns or problems, and issue resolution.

Sixteen subjects reported undesirable emotional symptoms. Two subjects experienced mild depression the day after their session, one subject felt lonely or sad for brief periods, and one subject felt more emotional for three to four days.

Four subjects reported undesirable cognitive symptoms, including a racing mind and confusion, as well as five to seven days of negative self-talk.

All but one subject had some purpose for having a session, and most had multiple goals. Four reported significant progress made toward all their goals.

Nine subjects wanted more cognitive understanding of themselves, and three felt they achieved this goal, one felt they made progress, and four reported no results at all. Eight subjects wanted a peak experience of a visionary or mystical nature.

Six subjects wanted enhanced communication with someone taking MDMA with them, five felt that this occurred, and one was less than satisfied.

Five subjects had low-dose sessions specifically for facilitating their creative writing, and all reported being satisfied with the results.

Three subjects wanted to change their personality or behavior patterns, one wanted to resolve inner conflicts regarding her husband, and two others wanted to experience a different state of consciousness. All four felt they realized their goals.

All nine subjects with psychiatric disorders reported significant relief from their problems, and two subjects reported full and lasting remissions.

Mood Changes

Eighteen (18) subjects reported positive changes in their mood or emotional state, lasting from several hours to several weeks, and averaging about one week.

Attitudinal Changes

Twenty-three (23) subjects reported positive changes in attitude that lasted from a week to a follow-up time of two years. Eleven (II) subjects specifically mentioned increased self-esteem, ten (10) subjects felt more acceptance of negative experiences or more patient in some way, four subjects felt more powerful.

Five subjects reported changing their attitudes toward death since their sessions, including one who thought more about death.

Belief Changes

Sixteen (16) subjects reported belief changes that persisted after the sessions, including greater self-acceptance, self-confidence, independence, self-control, or appreciation of being alive, as well as greater willingness to love, greater appreciation of others, and greater interpersonal warmth.

Relationship Changes

Two subjects reported negative changes in their interpersonal relationships after sessions. One subject felt more guilt around men and the other proceeded with a divorce.

Every subject reported positive changes in their relationships after sessions, and three of the five couples had continued changes at follow-up. In addition, 14 subjects reported the same changes with people other than their mates.

Ten subjects reported that soon after their sessions they resolved conflicts with others, and two subjects who both had solo sessions subsequently got married. Seven subjects reported an increase in acceptance and/or tolerance of others afterward, and six reported an increase in sexual enjoyment.

All subjects reported feeling closer to their mothers, seeking out like-minded people more often, and being able to state their beliefs more easily to others. They also reported feeling more compassionate, more free to have friends, and more forgiveness toward others.

Sixteen (16) subjects reported positive changes in their work since their sessions, including less driven, compulsive, tense, stressed, temperamental or burned out, more patience and tolerance, connectedness, acceptance or just getting along better with others.

Three subjects reported increased income, one graduated from school and began her professional career, and one switched jobs. One subject reported increased job satisfaction, while another reported a decrease, but neither attributed the change to their sessions.

Six subjects reported changes in their involvement with activities other than work. One subject took up woodworking, and another reported a decrease in political activity.

Fourteen subjects reported positive changes in their regular practices for improving their spiritual or physical well-being. Six subjects began some sort of meditation or spiritual practice, three subjects started new exercise programs, and one subject increased her prior exercise routine.

Fourteen of 28 subjects reported decreasing their use of mind- or mood-altering substances, and three reported increasing their use. Six reported decreasing their alcohol intake, and one reported increasing their consumption.

Six subjects decreased their marijuana intake: one stopped entirely, another reported a decrease in desire for marijuana, and one increased his marijuana use by follow-up time at nine months.

Five subjects reported decreased caffeine intake, one of whom stopped drinking coffee completely. One subject increased his use, but not soon after his session.

Two subjects continued to smoke less tobacco, one other reported a greater urge to smoke after sessions, and two others reported decreased desire for cocaine.

One subject reported less LSD use, one desired all psychedelics less, one desired them more, and one had a more enhanced experience after MDMA sessions.

Fifteen (15) subjects reported changing some of their life goals after sessions, including a shift from avoiding the negative to seeking the positive in life, greater desire to communicate and bond with husband, and greater interest in intellectual activities.

Nine subjects reported desirable changes in the kinds of experiences they seek out in life, including more trust, honesty, openness, closeness, or direct communication in their relationships.

Nine subjects described positive changes in the kinds of experiences they avoided in life. Two subjects avoided “sloth” or boring things, and one subject chose to face problems rather than avoid them.

Thirteen (13) subjects reported changes in this area, all for the better. Seven reported gaining lasting insight into psychological problems, three reported experiencing less guilt, two reported a decrease in limiting beliefs about their possibilities, one reported feeling less self-defeating, and one reported accelerating her psychotherapy.

MDMA was apparently safe for all 29 subjects in this study. There were some increased blood pressure and heart rate in two subjects, but these were normal.

Only one subject experienced psychological difficulties after the session. He had been briefly disabled by the same symptoms of anxiety a few years earlier, and felt that other events in his life were the causes of his postsession anxiety.

Future studies should inform subjects in detail of possible risks in taking MDMA and emphasize them. People who want to use MDMA to cure their problems should be excluded.

In regards to the efficacy of MDMA for treating psychiatric disorders, all nine subjects reported significant benefit, with two reporting lasting remission. MDMA might also be useful in other medical conditions involving a psychological factor.

MDMA can be used to facilitate more direct communication between people involved in a significant emotional relationship. This can help resolve existing conflicts and prevent future ones due to unexpressed fears or misunderstandings.

MDMA seems to have a therapeutic value in treating mild alcohol and other drug abuse by helping people learn how to prevent conflicts in their everyday life.

MDMA has diminished pleasurable effects and markedly increased side effects when taken in either large doses or with greater frequency, which distinguishes it from most drugs of abuse. Sixteen subjects began or increased their meditation practices or exercise programs, which supports this conclusion.