July 20, 2010 -- The street drug known as ecstasy may play a role in treating severe posttraumatic stress disorder (PTSD) when used in conjunction with intensive therapy in a very controlled setting, according to preliminary new research in the Journal of Psychopharmacology.
When used in this manner, MDMA, also known as ecstasy, was so effective that 80% of participants had resolution of their PTSD symptoms after the end of the trial. And some participants who had been unable to work because of their symptoms were able to rejoin the workforce. The new work was funded by the Multidisciplinary Association for Psychedelic Studies, a nonprofit group based in Santa Cruz, Calif., that studies the use of psychedelic drugs and marijuana in difficult-to-treat conditions.
PTSD is an anxiety disorder that occurs after a traumatic event. It is marked by persistent thoughts and fears of the event, flashbacks, and sleeplessness. Some people with PTSD withdraw from society as a result of these debilitating symptoms.
31 Hours of Therapy in 2 Months
The new study included 20 people with chronic PTSD lasting an average of more than 19 years. They took part in two, all-day therapy sessions spaced about three to five weeks apart. Twelve participants received MDMA, while eight received a placebo pill during these sessions. They also had a prep session before therapy, a debriefing session afterward, and spent the night in the clinic on treatment days. In addition, participants were in phone contact with their therapist for the week after therapy. All in all, they spent about 31 hours in therapy during the two-month study.
Eighty percent of participants who took MDMA were no longer classified as having PTSD after two months. After two months, participants in the placebo group were offered the study drug. Seven of eight opted to add the MDMA, and did equally as well as their counterparts who took the medication initially.
“We don't yet know what role MDMA may play in PTSD treatment, but the encouraging results of this pilot study suggest that it may play an important role in treating patients who have not responded to other treatments,” study author Michael C. Mithoefer, MD, a psychiatrist in Mount Pleasant, S.C., says in an email interview. “More research is needed to see if these results can be replicated elsewhere and in larger studies.”
Exactly how MDMA helps treat the symptoms of PTSD is not clear. “We are a long way from having a complete answer to that question,” Mithoefer says. In general, PTSD therapy involves revisiting trauma. “Often people with PTSD have difficulty revisiting their trauma without either being overwhelmed by emotions or being emotionally detached,” he says. Both of these can become obstacles to successful treatment, but “our impression is that MDMA catalyzes therapy by helping to overcome those obstacles.”
The drug appeared safe in the new study. That said, the jury is still out on the risks of MDMA.
“Our research is aimed at establishing the risk/benefit ratio, which appears favorable in this early study, but further research is needed to establish this,” Mithoefer says. “MDMA elevates blood pressure and heart rate, which can be a risk to people with cardiovascular disease.” MDMA has also been linked to death from heat stroke or excessive fluid in the substance of the brain (cerebral edema).
“There can also be psychological risks, which is why our study used MDMA doses only under direct supervision of therapists with close follow-up in non-drug therapy sessions to help integrate the experience and process any emotions and insights that arose from the sessions,” he says.
The next step is to study this treatment on veterans with PTSD, using three different doses of MDMA rather than placebo.
Ecstasy's Role in Treating PTSD
“It is an interesting approach, and this is a well-conducted clinical trial showing positive effects,” says Charles R. Marmar, MD, chair of psychiatry at the New York University Langone Medical Center in New York City. “MDMA appears to be reasonably safe and effective and requires more trials."
Even if further research validates these findings, this treatment would not be for everyone with PTSD, he says. People with a history of addiction and people with a family or personal history of serious mental illness would not be candidates for this therapy. This drug increases risk of psychotic-like symptoms in people who are vulnerable.
But “the fact of the matter is that these are difficult-to-treat patients, so having another tool in the armamentarium would be helpful,” Marmar says. “Assuming it is done under highly professional conditions and patients didn't have history of abuse, there is no reason to believe it would be dangerous - yet.
“We need more work to find out what the risks are,” he says.
Still, Harriet deWit, PhD a professor of psychiatry and behavioral neuroscience at the University of Chicago, says that “the results were quite dramatic and it is proof of concept and very good early evidence.”
But “we have to be careful that somebody doesn’t take this and say ‘we can use the drug at any time, in any circumstance in higher doses,’” she says.