MDMA (Ecstasy): A New Treatment for Depression and PTSD
Do illegal street drugs ever hold any medical value? People raised the same doubt about marijuana for a long time, and yet twenty-three states have now passed laws permitting its use for medical purposes. That change seems to have opened a door. If one banned substance can earn a place in medicine, why not examine others? One candidate drawing attention from researchers is 3,4-MethyleneDioxyMethAmphetamine, better known as MDMA. It acts as both a stimulant and a psychedelic, and it was first created as something psychotherapists could give their patients during treatment. Its reputation shifted once it spread through the party scene, where people came to know it by the name "Molly."
Molly built its popularity in American clubs, stripped of any medical setting, and that recreational wave is what led to the drug being outlawed years ago. In theory, Molly is pure powdered MDMA packed into capsules, and users describe a rush of euphoria after taking it. The reality is messier. Plenty of experts question whether street Molly and genuine MDMA are even the same thing, since seized batches often turn out to contain synthetic additives, unrelated drugs in powder form, or sometimes no MDMA whatsoever. Whatever Molly once was, the version sold on the street has drifted into something quite different.
The link between MDMA and therapy reaches back to the 1970s, a period when a number of psychiatrists saw real promise in the drug as a tool for treatment. That view did not survive the next decade. In 1985 the U.S. Drug Enforcement Administration placed MDMA on the Schedule 1 list, the category reserved for drugs judged to have no therapeutic use at all. Illegal status did not settle the question for everyone. Some researchers kept pushing, and recent work suggests that MDMA, paired with conventional psychotherapy, may help people living with post-traumatic stress disorder.
PTSD can take hold after a person survives something traumatic: sexual abuse, combat, and similar experiences. Those affected sometimes feel as though the event is happening to them all over again, and the disorder can bring on crushing anxiety and depression. Rachel Chason, writing for USA Today, reports that more than 5 million Americans deal with PTSD in a given year, with psychotherapy standing as the usual treatment. The problem is pace. Traditional talk therapy tends to move slowly, and that is part of why scientists are revisiting MDMA, hoping it can speed up the gains that therapy produces.
Early findings from MDMA-assisted therapy look encouraging. Chason points to a 2010 study run by psychiatrist Michael Mithoefer, M.D., in which PTSD patients were treated with both MDMA and psychotherapy. The contrast in results was sharp: 83 percent of patients who got therapy together with MDMA were cured, against only 25 percent of those given psychotherapy alone. By that measure, the drug moved recovery rates dramatically.
Why would it work? Supporters of the treatment argue that MDMA lowers a patient's guard. The euphoria it produces appears to loosen the psychological and emotional defenses that normally keep painful material at bay, which makes a person more willing to engage with what the therapist offers. Advocates also say the drug lets patients step back and view their own situation with more distance, giving them fresh insight into their symptoms.
On a chemical level, MDMA prompts the brain to release serotonin, norepinephrine, and dopamine. Serotonin carries a heavy influence over mood, and the surge of good feeling that users describe likely traces back to a jump in serotonin levels. More is not automatically better, though. Flood the brain with too much serotonin and the mood crash that follows, once the neurotransmitter runs low, can turn negative. That is one reason trained medical supervision matters when the drug is given. Users have reported chills, muscle tension, nausea, and other uncomfortable effects, and in certain people MDMA can trigger damage severe enough to cause liver, cardiovascular, or kidney failure, any of which could kill without a doctor watching closely. Others get off with little more than a mildly elevated pulse or a small rise in blood pressure.
For patients who tolerate it well, could MDMA turn out to be something close to a cure for PTSD? MAPS, the Multidisciplinary Association for Psychedelic Studies, which pays for clinical trials of MDMA-assisted therapy, notes that the drug can show results after just a handful of doses given alongside therapy. Compare that to SSRIs and similar mental health medications, which patients sometimes have to take for years. A treatment that works in a few sessions would be a striking departure, perhaps even a silver bullet.
None of this has settled the debate. The research hints that MDMA can help PTSD sufferers, but the studies carry plenty of open questions, and some people will object on moral grounds to any therapeutic use of a drug that remains illegal. Most scientists land in the same place: there is not enough evidence yet. The samples studied so far have been small, and a far larger group of patients will be needed before anyone can draw firm conclusions. Whether the benefits end up outweighing the risks is something only more research will answer.
Cathy Poley