Analyse This: MDMA May Soon Be Used in Psychotherapy

MDMA has shown to be a highly promising treatment for PTSD in clinical trials. Gavin Tracey takes a look at its potential use in therapy.

 

Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder which affects those who have lived through traumatic events, whether it be abuse, sexual assault, war, or another trauma. These devastating events leave those who experienced them with effects that can last long after the event. Sufferers of PTSD endure flashbacks, nightmares, and a sense of shame and guilt. They also experience panic attacks when faced with situations that remind them of the traumatic event, known as triggers.

Current methods of treatment are Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE). In CPT, the patient attends regular therapy, and attempts are made to change unhealthy and dysfunctional thought processes. PE involves facing whatever it is that has caused the PTSD, and attempts to desensitise the patient to allow them to live without fear. While both can work, the vast majority of those who undergo treatment find that the treatments do not cure them of PTSD.

“Sufferers of PTSD endure flashbacks, nightmares, and a sense of shame and guilt.”

As well as CPT and PE, sufferers of PTSD usually undergo Cognitive Behavioural Therapy (CBT). The drugs available to these people only treat the symptoms of the condition, and are similar to drugs used to treat depression in that they increase the quantity of neurotransmitters relating to good mood in the brain.

In recent years, many studies have been published to show that the illegal drug MDMA (methylenedioxymethamphetamine), also known as ecstasy, can have hugely beneficial, and importantly, permanent effects for those suffering from PTSD.

Clinical trials that have been tried so far have shown the drug to be hugely beneficial. Most of these trials have been run by the non-profit organisation Multidisciplinary Association for Psychedelic Studies (MAPS). They stress that MDMA is not a be an end all cure; it is no magic pill, but rather a tool in a long process that allows people suffering from PTSD to begin to recover.

“the data on the usefulness of MDMA for psychotherapy is far from conclusive.”

In these trials, patients took the drug, were blindfolded, and had headphones placed over their ears. During the long (up to eight hour) sessions, the therapist guided them through their ‘trip.’ The assessment used by clinicians working with those suffering from PTSD is known as the CAPS scale. It uses a numerical system to measure how the severity of the disorder. A score greater than 60 signifies that the person suffers from severe PTSD. In a trial done by MAPS, one patient’s CAPS score dropped from 160 down to 2, and then reached zero after only three sessions.

Many of those working with MDMA say that it allows the patient to open up in a way that they would normally be unable to without the use of the drug. However, it is still not known why the drug is so beneficial. What is known is that after taking MDMA, the brain is flooded with neurotransmitters; notably serotonin, dopamine, oxytocin, and norepinephrine. These neurotransmitters return to normal levels in the space of a few hours, however. There is no explanation yet as to why MDMA has such long-lasting effects.

“This is the highest classification for drugs in both countries; legally-speaking, it sits among drugs such as heroin and cocaine.”

There are many roadblocks facing the use of MDMA for treatment. It is still classified as a Class One drug by the Drug Enforcement Administration (DEA) in the United States, and as a Class A drug in the UK. This is the highest classification for drugs in both countries; legally-speaking it sits among drugs such as heroin and cocaine. Despite this, companies in the UK have developed the drug for medical trials. In the U.S.A next year, stage three trials will commence. This is the final step in the process, which, if successful, would pave the way for the legalisation of MDMA for medical use.

Stage three is the most difficult stage for new medical treatments to pass: about half of all medical treatments do not stage 3.

While many are hopeful, and the findings from the few studies undertaken so far are positive, the data on the usefulness of MDMA for psychotherapy is far from conclusive. Ben Checinski, a consultant psychiatrist at St. George’s University, London, has raised issues over the potential bias of MAPS, and believes that “a confounding placebo effect and bias towards reporting positive changes is to be expected.” The empirical evidence is simply not sufficient to call it one way or the other.

In the future, if the results from the small scale tests can be replicated in larger ones, the way PTSD is treated could be forever changed, and the lives of those who suffer from it could once again return to normal.