Early last month, the results of a US trial into the effects of MDMA as a treatment for post-traumatic stress disorder (PTSD) were released. Initial findings seem overwhelmingly positive, indicating two thirds of those in the trial no longer qualified for a PTSD diagnosis after the MDMA treatment. But UK experts have cautioned to not get too excited just yet, as much more research is needed.
MDMA was used and experimented with by famous chemist, Alexander Shulgin who also discovered LSD. After finding the drug in low doses to have disinhibiting effects Shulgin thought it would be helpful in therapy and so for a time in the 1970s was used as an aid in psychotherapy.
Why would alternative therapies work for treating PTSD?
PTSD is a disorder that is particularly hard to treat as it has many facets and is often part of a multiple diagnosis with other disorders such as anxiety disorders, depression, bipolar, personality disorders, obsessive compulsive disorder etc.
As well as PTSD, which is a diagnosis that usually comes as a result of one traumatic experience, there is also the diagnosis of complex post-traumatic stress disorder (CPTSD). In the case of CPTSD there are multiple traumatic events or adverse childhood experiences (ACE’s) such as long term neglect, exposure to domestic violence, physical abuse and sexual abuse, which makes it even harder to treat.
Part of why this kind of trauma is so difficult to treat is that the therapist must ensure that revisiting traumatic events, particularly if they have happened in a persons childhood, won't be be re-traumatising.
In the worst case scenario, re-traumatising can destabilise a patient to the point where their mental health worsens.
Cardiff University’s Traumatic Research Group states that for many people with PTSD and CPTSD especially, “conventional methods of treatment are not improving their symptoms…These people have what we call treatment resistant PTSD”. It is at this point, when traditional treatments are not proving to be effective that, as The Traumatic Research Group states, “MDMA assisted psychotherapy comes into play.”
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The amygdala, the area of the brain that allows us to prepare for threat, danger and that is activated when we feel fear is calmed by MDMA.
With PTSD and CPTSD this part of the brain is constantly turned on, or turned on too often. This creates ‘hypervigilance’ which means people with PTSD and other anxiety disorders misread the level of threat present in small, every day occurrences such as: loud noises, changes in volume of someone’s speaking voice, changes in facial expressions and gestures.
The scientists involved in the US trial believe that MDMA could possibly allow adults, who have experienced trauma in their past, to access a brain state where brain plasticity increases and therefore new connections and associations can be formed.
The trial, keenly awaited by many, has been conducted by US charity, The Multidisciplinary Association for Psychedelic Studies (Maps) and spearheaded by Rick Doblin who has been invested in making psychedelic therapy accessible and legal since the early 2010s.
How did the trial work?
In order to test just how much MDMA assisted therapy boosted the recovery from PTSD symptoms, a control group where participants received trauma informed talking therapy alone was implemented. In this group, a significant number showed 60% decrease in negative symptoms and 32% of people had remission of a PTSD diagnosis all together.
These findings prove that when someone suffering with PTSD accesses therapy, the severity of their symptoms decreases substantially, which is key in understanding that the therapy is the most important function.
Those with MDMA-assisted therapy had a 88% decrease in symptoms and 67% had a complete remission of PTSD diagnosis, 18 weeks after the therapy. Those in the MDMA-assisted therapy group all had three sessions.
Although these results seem overwhelmingly positive, the trial didn’t address whether or not MDMA-assisted therapy was more successful than commonly prescribed talking therapies used in the UK.
Dr Bloomfield from UCL spoke to the BBC about the gaps in this research, he stated that the type of talking therapy administered in the trial was “closer to counselling” and not akin to the psychotherapy used in the UK where a therapist works through traumatic memories with a patient, eventually having them “relive” them in order to re-process them effectively.
Dr Bloomfield also reiterated that it is near impossible to rule out “positive expectations” or a placebo effect since all participants volunteered. The control/blind group also would have had difficulty actually blinding the participants to the fact they’d taken a drug as well know, and potent as MDMA.
Guy Goodwin, professor of psychiatry at the University of Oxford spoke to us about the promise of these findings but also aired on the side of caution, stating:
“While correctly described as a phase 3 clinical trial, it is still a relatively small sample size and the recruitment of patients was opportunistic so it is difficult to know where, in a treatment pathway, this approach will eventually be best offered. It is also impossible to blind studies with drugs having marked effects on subjective experience so the positive expectations of both patients and staff are likely to inflate the impact of the active treatment.”
It's clear that for those in the field of psychiatry and psychotherapy not involved with Maps, there is an air of tentative positivity, where most experts and professionals acknowledge the need for more research that can find ways to further prove MDMA-assisted therapy’s effectiveness over already existing modes.
Guy Goodwin finished his comments to us by saying “This is the appropriate first step in re-medicalising drugs of this kind, which for too long have been placed out of reach for medical research by restrictive legislation. More work is needed to compare MDMA with other treatments and to adopt more objective outcomes to evaluate its true success.”