MDMA – a cure for PTSD?

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  PTSD (post traumatic stress disorder) is a psychiatric disorder that most frequently presents itself in those who have experienced trauma as a result of many events ranging from natural disaster to sexual violence. The disorder often presents with 4 main symptoms, including: intrusive thoughts, avoidance, negative altercations in cognition and mood and alterations in arousal and reactivity.  In the moment of trauma, the hippocampus attempts to cope with the events occurring whilst consecutively trying to calm amygdala’s stress system. In doing so the hippocampus is sometimes damaged. In someone suffering from PTSD, the damaged hippocampus cannot store the memory of the traumatic event properly, meaning the amygdala is in a constant state of stress and the prefrontal cortex cannot override the reactions to this stress.  As a result, those with PTSD have frequent flashbacks and often react negatively to small stimuli that relate to the event as they trigger the amygdala’s stress circuit. In patients with PTSD these symptoms occur for a month or longer. [1]

   Despite the worryingly high percentage of 70% of people in the world being exposed to trauma, only 5.6% meet the criteria for PTSD. On top of that, 44% of the patients with a PTSD diagnosis recover without focused treatment. However, those who do not recover independently undergo trauma-focused psychotherapy as a first line of treatment. Nevertheless, many require even more medication on top of this despite the response rates being disappointingly low. [2] [3]

   MDMA is widely referred to as ‘ecstasy’. However, it is important to note that the pure, active drug itself (3, 4 – methylenedioxymethamphetamine) is seldom in the club-drug ‘ecstasy’. Instead, it contains adulterant versions of MDMA as well as a combination of other harmful drugs. MDMA has also proven non-addictive in some clinical studies and is only ever provided in limited doses, unlike ecstasy; the drug that often leads to addiction as a result of excessive use. Despite initial therapeutic discovery about the drugs abilities in the 1970s, it was banned in 1985 as a result of the abuse its recreational counterpart received. As a result it is not frequently used. However, clinical studies being undertaken are on the way to changing this. [4]

   Whilst psychotherapy including prolonged exposure and cognitive-processing therapy have been proven effective, many patients drop out due to the mental strain which they undergo. Cognitive-behaviour therapy is trauma-focused to allow the identification and understanding of the event that occurred to change their thinking and behaviour patterns. As it requires the patient to recall the traumatic event, it can be extremely difficult – resulting in the large amount of patients dropping out. [5]

   In order to ease this process, MDMA has been administered to patients with PTSD in clinical studies to relax them. It appears to facilitate recall without the patient feeling overwhelmed by the memories they re-experience. This is suggested to be due to the drugs effect on reducing anxiety, and hyper vigilance whilst still keeping the patient engaged in the therapy. This calming effect is related to the drugs biochemical properties; MDMA affects serotonin (in a similar manner to antidepressants) and dopamine, to positively impact the user, whilst also increasing the release of oxytocin. This increase in oxytocin release improves the patient’s well being whilst also facilitating empathy understanding; a step in overcoming the emotional trauma. MDMA would be a better alternative to the SSRIs (antidepressants) being used currently as they target multiple neurotransmitters compared to the sole serotonin impacted by SSRIs. [6]

   A phase II clinical trial consisted of three day-long psychotherapy sessions over three months, following 28 patients of chronic PTSD. Whilst the initial data showed 43% of the group did not meet the definition of PTSD after the first two sessions, this number rose to 76% a year after the trial began. This proved the drug to act as a potentially durable treatment since the few sessions lasted for several following months. These long-term results are said to be significantly better than previous studies. It was discovered that efficacy increased over time.  [7]

   Another combination of 5 studies including a total of 106 participants showed 72% of the participants in the MDMA group achieving a clinical response in comparison to the 19% in the control group. It was concluded that MDMA-assisted psychotherapy resulted in a significant reduction in the number and intensity of PTSD symptoms. This improvement was maintained for up to 74 months after treatment. [8]

   As a collective, the studies prove MDMA-assisted psychotherapy has the ability to be an effective, durable and safe treatment for patients with chronic PTSD in both the short and long term. However, the likelihood of being used as an official treatment seems unlikely due to public perception of the club-drug version of MDMA as well its government bans. Subsequently, it would prove to be very difficult to make available for prescription.  


References

  1. Paul S. Hammer, “DCoE Director Explains Science Behind PTSD”, Brainline, May. 29, 2013 https://www.brainline.org/article/dcoe-director-explains-science-behind-ptsd
  2. Ralph J. Koek, “Treatment-Resistant PTSD”, Psychiatric Times, Nov. 27, 2017 https://www.psychiatrictimes.com/ptsd/treatment-resistant-ptsd
  3. “Treatment-refractory Posttraumatic Stress Disorder (TRPTSD): A Review and Framework for the Future”, National Library of Medicine https://pubmed.ncbi.nlm.nih.gov/26854815/
  4. Ben Sessa, “MDMA and PTSD treatment: “PTSD: From novel pathophysiology to innovative therapeutics””, Science Direct, Jul. 6, 2016 https://www.sciencedirect.com/science/article/abs/pii/S0304394016304906
  5. “PTSD Facts & Treatment”, Anxiety and Depression Association of America, May. 5, 2020 https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/treatment
  6. Naveed Saleh, “Can MDMA Be Used to Treat PTSD?”, Verywell Mind, Feb. 10, 2020 https://www.verywellmind.com/can-mdma-ecstasy-treat-ptsd-1123858
  7. Matt Smith, “‘Ecstasy’ Study Results Promising for PTSD”, WebMD, Oct. 30, 2018 https://www.webmd.com/mental-health/news/20181030/ecstasy-study-results-promising-for-ptsd
  8. Anees Bahji, Asleigh Forsyth, Dianne Groll, Emily R. Hawken, “Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: A systematic review and meta-analysis”, Science Direct, Aug. 19, 2019 https://www.sciencedirect.com/science/article/pii/S0278584619301484#bb0030

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