The party drug "ecstasy" might be the key to helping people heal from post-traumatic stress disorder (PTSD), new clinical trial results indicate.
In a small study, PTSD patients treated with a powerful combination of the psychedelic drug, also known as MDMA, and talk therapy were much more likely to see an end to their recurring, nightmarish episodes of overwhelming stress than those who received therapy alone, researchers reported this week at the annual meeting of the American Chemical Society, in San Diego.
About two-thirds of people who received MDMA-assisted therapy no longer met the diagnostic criteria for PTSD by the time their sessions ended, compared with only one-third of people who received talk therapy along with a placebo (inactive) drug, the study results showed.
The patients treated with MDMA also had less disability and depression, and were less likely to abuse alcohol or drugs, said lead researcher Jennifer Mitchell. She is a professor of neurology and psychology at the University of California, San Francisco.
"All told, the group that received MDMA therapy did better than the group that received placebo plus therapy," Mitchell said.
An estimated 11.8 million Americans live with PTSD, the researchers said in background notes, and about half don't respond to standard therapies.
To help people with these and other psychiatric conditions, there has been a new surge of interest in psychedelic compounds like MDMA, psilocybin and mescaline, Mitchell said. MDMA, which is illegal in the United States, is also known as Molly.
Still no approval
The idea isn't a new one, Mitchell said. Some psychiatrists dating back to the 1970s have used MDMA to enhance psychotherapy, even though there have been no formal clinical trials and no U.S. Food and Drug Administration approval of its use for that purpose.
Mitchell and her colleagues decided it was time for a rigorous clinical trial of MDMA's potential usefulness in therapy. They recruited 90 patients suffering from severe PTSD, and randomly assigned them to receive either MDMA-assisted therapy or therapy with a placebo.
Once a month for three months, patients were given a heavy dose of MDMA intended to last eight hours.
A pair of therapists stayed with them during the eight-hour MDMA session, which "ensures that the subject is getting a lot of psychotherapeutic support during those periods," Mitchell said.
Between these day-long monthly sessions, the patients attended therapy once a week to sort out what they learned during their MDMA trips.
Two months after their final experimental session, patients treated with MDMA-assisted therapy were doing much better than the control group - so well that two out of three no longer had a clinical diagnosis of PTSD.
The MDMA patients scored better on tests measuring their work, social life and family life disability, Mitchell said. They also got better scores on a test that measures the potential for alcohol and substance abuse.
Feel-good hormones at work
MDMA floods the brain with serotonin, a mood-regulating brain hormone, in much the same way that an antidepressant medication would, Mitchell said.
"A selective serotonin reuptake inhibitor, or an SSRI, also works by increasing the amount of serotonin that's sitting around in these signaling areas of the brain," Mitchell said. "MDMA does that even more robustly, so when you administer MDMA to someone, not only does it allow the serotonin that's already been released to sit there and signal for longer, but it also induces all of this additional serotonin release."
MDMA also promotes the release of oxytocin, another neurotransmitter that's typically thought of as the "love hormone" or the "bonding hormone," Mitchell said.
This combination of feel-good hormones appears to help PTSD patients get past one of the toughest hurdles in their therapy, said Robert Motta, a professor of psychology with Hofstra University in Hempstead, N.Y.
"In order to treat PTSD, you have to get a person to re-encounter or re-confront their traumatic experiences. But when you do that, you arouse so much anxiety that unless you do it very judiciously and slowly, the person's going to flee. They get so overwhelmed they quit," said Motta, who was not involved with the study.
"MDMA quiets the amygdala, which underlies a lot of these fear reactions, and allows the person to confront their traumatic experience without incredible levels of anxiety that cause them to flee," he continued.
That's why people with PTSD shouldn't run out and start taking ecstasy they've purchased off the street, Motta said. They'll be missing out on the therapy, which is the heart of the treatment.
"If it were so easy to implement, then everyone who's taking ecstasy at parties would cure their PTSD, and that's not happening," Motta said. "It's MDMA plus therapy that gets them better, not just MDMA."
The researchers are analyzing long-term data from the trial to see if MDMA therapy produces lasting results, Mitchell said. They are also enrolling patients for a second trial to confirm their results
If all goes well, Mitchell anticipates that MDMA-assisted therapy for PTSD could gain FDA approval within a couple of years.
Motta isn't sure how popular MDMA therapy will prove in treating PTSD, given how labor-intensive it is, but believes it could be cost-effective compared to current treatment.
"Some of the more severe cases of PTSD at the Veterans Administration have been treated for decades with very little improvement, and yet you see dramatic improvements with MDMA," Motta said. "Even though the whole (MDMA) treatment procedure is pretty long, overall it can't be anywhere near as costly as what's going on right now for treating PTSD."
Results from the clinical trial verify this. Reporting recently in PLOS ONE, the researchers noted that MDMA therapy for PTSD could save the U.S. health care system nearly $133 million over 30 years compared to current therapy.
The U.S. National Institute on Drug Abuse has more about MDMA.
SOURCES: Jennifer Mitchell, PhD, professor, neurology and psychology, University of California, San Francisco; Robert Motta, PhD, professor, psychology, Hofstra University, Hempstead, N.Y.; PLOS ONE, Feb. 25, 2022, online; American Chemical Society annual meeting, March 22, 2022