Confronting trauma – How MDMA may be helping patients with severe PTSD
Photo by: Toe Heftiba on Unsplash
Content warning: PTSD, drug use, mentions of sexual assault.
This article does not constitute medical advice, diagnosis, or treatment.
The following article describes a potential treatment option for PTSD using pharmaceutical-grade drugs in a controlled therapy environment under the supervision of trained psychotherapists. This article also includes anecdotes from individuals who have undergone this treatment; one of these individuals does mention (but does not describe) some experiences that lead to her PTSD, including abuse and sexual trauma/violence, and how this treatment helped her in her therapy sessions.
On July 1, 1985, as part of the War on Drugs, the U.S. Drug Enforcement Administration (DEA) placed 3,4-methylenedioxymethamphetamine (MDMA/ midomafetamine) as a Schedule I drug – meaning it was believed to have no accepted medical use and a high potential for abuse. However, prior to this classification, MDMA was a fringe therapy drug used by a few dozen psychotherapists before it became a party drug under the more common name of ecstasy. To this day, MDMA continues to be under this classification, alongside cannabis, despite countries like Canada, and many American states allowing for recreational or medical use of cannabis.
Over the last decade, many of these typically considered “party drugs” have gone through a renaissance. Study after study reveals that there is more than meets the eye when it comes to the potential therapeutic benefits of these drugs. Notably, many scientists have begun testing how pharmaceutical-grade MDMA when combined with intense psychotherapy may help individuals who are dealing with treatment-resistant post-traumatic stress disorder (PTSD) – to a greater extent than any other available option.
PTSD is a serious and prevalent psychiatric condition that occurs in people who have experienced a traumatic event. PTSD is often the cause of significant morbidity and mortality. Many different types of traumatic experiences cause personal distress that can lead to substance abuse and impair relationships. Individuals with severe symptoms may not be able to hold jobs, may draw blinds and stay indoors, and are at increased risk of developing other conditions like depression and suicide. There is a need for effective treatments and MDMA-assisted psychotherapy has begun filling that void in providing a breakthrough treatment option for severe PTSD.
Many studies, clinical trials, and patient testimonials have shown MDMA’s efficacy in treating PTSD, however the underlying psychological and neurobiological mechanism for why this intervention is so effective is not yet known.
While the plural of anecdotes is not data and anecdotes do not constitute scientific evidence, they provide personal recounts of how patients felt after undergoing MDMA-assisted psychotherapy. They provide insight into each patient’s emotional health and beliefs under the biopsychosocial model of medicine.
“I was able to just talk about things I had never talked about before without having a physical response to it. Doing therapy and feeling like you’re being hugged by everyone on the planet who loves you, and a load of puppies are licking your face.” – Jonathan Lubecky (from Pharmaceutical Journal)
“It’s like doing years of therapy in one day. It’s not scary, I never felt out of control, and didn’t feel ‘high.’ Though there was a bit of visual vividness when I opened my eyes, and I did have these metaphorical ‘visions’ in my mind while lying there feeling deeply connected to the music, everything was always in my control. If I started to see something I didn’t want to look at I could (and did) easily move away from it. For me, that was the sexual abuse. And I will be revisiting that for sure. The great thing is that I was able to take the principles that I have intellectually known after decades of therapy and make a huge gut connection that feels permanent…in part due to the medicine, and partially due to the gentle and supportive way the therapists were with me on the journey. It’s like a big AHA! moment happens and is reinforced by the medicine and the therapy style. What I experienced during the active treatment, is what I always kind of knew, but what I now not only know, but believe. Amazing!” – Karen Diamond (From her letter to The Multidiscplinary Association for Psychedelic Studies)
Karen also went on to elaborate on her letter: “As I mentioned in my letter, MDMA didn’t create hallucinations, but more something I would call “felt metaphors”—a way of seeing events and feeling emotions with a new perspective that allowed me to explore the traumatic events and the impact they had on me in a way that I was unable to do with traditional therapy and antidepressant drugs.
MDMA-assisted psychotherapy helped me to see my parents and sexual perpetrators as their own people on their own journey with their own issues. To realize that the ways in which they were not there for me, were not capable of being there for me, the ways in which they were horrible to me and could not control their behaviors, had nothing to do with me—that it wasn’t personal—not so much to forgive them, but to let go of them, to move on.”
MDMA is often labeled an “empathogen-entactogen” – a drug that increases feelings of empathy and interpersonal closeness (i.e., prosocial). This label is supported by research in cephalopods, rodents, non-human primates, and humans.
A 2019 collaborative study by scientists in Canada, USA, and the UK investigated the prosocial effects of MDMA and how it may be responsible for its therapeutic benefits. The researchers investigated this by comparing it to a pharmacologically related stimulant, methamphetamine (MA) - a drug that produces a similar bodily sensation. They also had a placebo group that did not receive any psychoactive drug. Specifically, the authors focused on two types of responses to social stimuli: 1) Response to socially relevant “pleasurable” touch for example, how you would respond to getting a hug from a loved one, and 2) Visual attention to emotional faces, which relates to how much we focus on negative or positive looks from others.
The researchers found that MDMA increased the pleasantness of pleasurable touch with increasing dosage. Furthermore, there was increased activation of the brain region responsible for pleasurable touch processing, suggesting that MDMA may act on the brain circuits that process pleasant touch. The study also showed that MDMA increased the activity of the muscle responsible for smiling, in response to touch.
Beyond pleasurable touch, MDMA enhanced attention towards happy faces. This latter finding is especially important because many psychiatric disorders, including PTSD, produce a negative processing bias – meaning individuals tend to respond and dwell on negative events more intensely. With MDMA, patients were seeing the glass as half-full, instead of half-empty.
It has been suggested that MDMA produces these prosocial effects through the control of many signaling molecules in the brain, such as serotonin and oxytocin, which are often referred to as our “feel good molecules” and are essential for regulating mood. This was supported by increases in oxytocin found in the blood after administration of MDMA. Other studies have also found that administration of oxytocin itself was capable of producing a prosocial effect, albeit to a much lesser extent than MDMA – highlighting why MDMA might be so effective.
Serotonin, which promotes feelings of well-being, has also been implicated in how MDMA may be improving patients’ social activity. For example, disrupting the availability of serotonin in the brain reduced the positive effects from MDMA treatment. More recent research has also suggested the involvement of many other brain signaling molecules; however, their specific role with MDMA is still an ongoing field of research.
Pharmakon is the Greek word for drug and has two paradoxical meanings – “remedy” and “poison”. Drugs have the capacity of great benefit and great harm, and MDMA is no exception to this. Despite MDMA showing long-term efficacy in treating PTSD, not all mental illnesses may see the same benefit.
There are a number of risk factors that need to be taken into consideration because the strong activity of MDMA may worsen disorders like depression and anxiety without proper precautions. MDMA can have several drug interactions with commonly prescribed medication for obsessive compulsive disorder, major depressive disorder, and even PTSD, which increases the risk of severe negative mental and physical health outcomes.
Furthermore, MDMA outside of a laboratory setting is often mixed with harmful contaminants. This especially dangerous with the limited capabilities of consumer-grade testing kits. While MDMA on its own may not pose significant harm to the average individual and others, many hard-to-detect and harmful adulterants will. MDMA on its own is not the treatment. It is pharmaceutical-grade MDMA in association with psychotherapy, with specialized psychotherapists, in a very controlled environment, that is the treatment.