MDMA-assisted psychotherapy

PTSD inhibits a subject’s ability to respond appropriately to trauma-related stimuli.[8] The current model of PTSD proposes that it results from amplified and uncontrolled responses from the amygdala to trauma-specific cues.[7] Treatment with MDMA has been shown to reduce blood flow to the amygdala, while increasing blood flow to the occipital cortex and ventromedial prefrontal cortex.[2] This state reduces fear while enhances consciousness.[11] MDMA also increases levels of the hormones serotonin, oxytocin, prolactin, and cortisol.[12] Serotonin helps to regulate mood,[13] while oxytocin has been found to increase trust and emotional awareness and reduce amygdala response.[2] It has been proposed that these effects foster memory reconsolidation by allowing the patient to access the traumatic memory while feeling detached from the sense of imminent threat.[9]

MDMA reduces the activity of the amygdala

In current studies of MDMA therapy a 125mg capsule of MDMA is orally administered.[2] The subject is monitored, listens to emotionally provocative music, and engages in conversation with the therapist. After 2 hours, a supplemental 62.5mg dose of MDMA is administered orally. The therapist works with the patient for 6 hours, or until the psychedelic effects of the drug have worn off.[2] Therapists encourage the patients to reach their own introspective conclusions, punctuated by discussion and collective reconsolidation of the memory.[9] The patient stays in the clinic overnight to be monitored.[2]

The following morning, the patient and therapist hold an integration session where they discuss the experimental session and process emotions. Three 90-minute integration sessions are held in the subsequent month. This process is repeated two or three times.[2]

In 2017, the treatment was granted breakthrough therapy status by the FDA, a designation that indicates that there is preliminary evidence that an intervention offers a substantial improvement over other options for a serious health condition. In the Phase II trial, 61% of the 107 participants no longer qualified for PTSD two months after they underwent three sessions of MDMA-assisted psychotherapy, according to MAPS. The participants had all suffered from chronic, treatment-resistant PTSD for an average of 17.8 years.[4] MAPS and the FDA have agreed on the design for the Phase III trial, and if the trial is successful the treatment could be approved as early as 2021.[3]

In trials, the drug has been administered solely in clinics designed for MDMA psychotherapy. If the drug is approved, decisions will need to be made on what qualifications physicians will need in order to prescribe and administer the drug, and how the drug will be produced and stored.[14]

Currently MDMA is being looked at for the treatment of other diseases. Things like anxiety related to life threatening diseases, and other psychological diseases.

MDMA was first synthesized by German pharmaceutical company Merck KGaA in the early 1900s as an intermediate in the synthesis of another compound.[13] Its psychedelic effects were not noted until the early 1960s.[7] In the 1960s and 1970s, the drug was used in psychotherapy, although it was not an approved drug and no clinical trials had been performed. The drug was studied in Switzerland for use in individual, couple, and group therapies until 1993.[19]

In 1985, MDMA was given Schedule I status in the United States due to its high potential for abuse, and most research was stopped.[8][20] Researchers interested in MDMA for use in psychotherapy founded and funded the Multidisciplinary Association for Psychedelic Studies (MAPS) in response.[3] The US Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) granted approval for researching MDMA’s efficacy as an adjunct to psychotherapy in 2004, and the first trial was carried out in 2011.[8]

In society the drug has been looked at as a rave drug. Something for concert goers, ravers, and people just looking for a good time. As research has devolved it seems the drug can also be good for crippling psychological diseases.

MDMA is unpredictable and produces different responses in different people. The drug causes neurotransmitter activation across the main neural pathways (including serotonin and dopamine, noradrenaline) that can result in large mood swings and changes. The memories that emerge under the influence of MDMA can evoke unwanted emotions.[21] Side effects of MDMA use by recreational users include appetite fluctuations, food cravings, and disordered eating.[21]

Once the effects of MDMA wear off, there is a "period of neurochemical depletion" that invokes anhedonia, lethargy, anger, depression, irritability, brooding, greater everyday stress, altered pain thresholds, changes in sleep, and bad dreams, especially in female participants.[21] The symptoms are thought to be due to depletion of serotonin, as a result of the large release of serotonin triggered by MDMA,[13] and have been called "neurotoxic in terms of causing serotonergic dysfunction".[21]

There are also concerns surrounding "drug-dependent learning" — the theory that patients will return to the drug to access the state they were in when on the drug in therapy. [21] However, MDMA is described as a “self-limiting” drug as the intensity of the positive effects decreases with increased use, while negative effects increase.[13] Dependency rates are low compared to other illicit drugs, at 1% of users.[13]