The Therapeutic Potential of MDMA
What’s the first thing that comes to mind with MDMA? Illicit drugs often bring out polarised opinions. However, this Class A drug has incredible therapeutic potential that is at the forefront of psychiatric reform.
Psychiatry has a pretty good understanding of the causes of mental disorders, which largely stem from trauma. However, corresponding treatment is poor and psychiatry knows this. The root problem of trauma is not targeted.
The answer? MDMA might be a match made in heaven for trauma treatment.
Dr Ben Sessa states “MDMA is psychiatry’s antibiotic” as there is finally a potential to cure mental illness.
MDMA has particular potential to treat post-traumatic stress disorder (PTSD), which is characterised by high levels of anxiety, hyper-vigilance and driven by trauma avoidance. A vast majority of patients are treatment resistant due their trauma not being targeted.
There is a similar issue for PTSD psychotherapy. Although talking therapy can be extremely effective, many patients are unable to discuss their trauma due to the severe flashbacks and anxiety it brings.
What is the fascinating potential behind MDMA? The drug improves mood. Whilst stimulating the patient, it also relaxes them to an optimal arousal zone where it is possible to engage in psychotherapy. MDMA directly targets the amygdala (responsible for emotional reactions and that fight or flight response). This reduces fear response and boosts an ability to see things in a new and positive light. This altered state gives patients a sense of warm containment when discussing memories due to the release of oxytocin.
This makes MDMA an effective tool for accessing trauma in a clinical setting.
But how effective is it in treating PTSD? A recent placebo-controlled study found that after a single course of MDMA-assisted psychotherapy in treatment-resistant PTSD patients, 85% no longer met the diagnostic criteria for the disorder. This is huge. Not only did they get better, they no longer had the disorder. They were cured.
And, it gets better. These astonishing results were maintained at a 3.5 year follow up without any additional MDMA therapy. The drug shows some incredible improvements in treatment-resistant PTSD.
Let us appreciate how striking these findings are. The current state of psychiatry accepts that in order to treat mental illness you must take medication and go to psychotherapy for the rest of your life. But what if mental illness doesn’t have to be a life-long condition? We have got change the way we tackle trauma.
You’re probably thinking, this is a recreational, harmful, illegal drug — why should we be investing research into such treatments?
Of course the way we approach drug policy is flawed, read about that in my other article (shameless self-promotion).
Moreover, ecstasy and MDMA are not the same thing. Recreational drug use in the real-world is very different to administering a drug in a medical setting. Illicit drug use brings a ton of harm as you don’t know what you are taking. So, it isn’t the recreational drug that is the issue but what it is mixed with and not knowing how much is in it.
So, we cannot look at the risks of recreational MDMA use in the same light as clinical-grade MDMA — it is something else entirely.
It is important to highlight that people aren’t just given MDMA, it isn’t a take-away prescription or a miracle drug without any context. Although powerful, it isn’t the full therapy. There is a lot preparation and discussion around the drug-induced experience, both before and after. In a 12 session therapy course, the patient receives MDMA approximately 3 times under medical supervision. So, only a few sessions are drug-assisted. MDMA isn’t a miracle dose, rather a tool to enhance current psychotherapy when talking is not possible.
The concept of curing is not part of psychiatry’s language and it ought to be. Making people permanently better is something that should no longer be alien.
MDMA also isn’t a new concept in psychiatry. In the 1970s it was used legally in couples therapy to target traumatic memories but it was banned in the 1980s and entered a ‘dark age’ for clinical research.
The way we currently view recreational drugs in society limits research due to a political agenda to demonise them. We should never ignore the potential that recreational drugs have for treatment as given the astonishing results, it is unethical to not conduct this research.
Perhaps MDMA is the antibiotic we have all been waiting for.
