MDMA treatment shows potential, but others lack evidence

Can psychoactive drugs be used to treat mental health problems? The idea has been around for years and has recently received some Warning in the media.

Interest in the potential of drugs such as MDMA (scientific name 3,4-methylenedioxymethamphetamine), ketamine, psilocybin and LSD (lysergic acid diethylamide) has increased among scientists and physicians, as well as in the community at large.

However, there is still debate among experts whether these drugs are safe and effective. In one new studywe reviewed the state of the evidence for the use of these drugs in the treatment of post-traumatic stress disorder (PTSD).

How is PTSD treated now

Up to 10% of people exposed to traumatic events such as a serious accident, physical assault, war, natural disaster, assault or sexual abuse will develop PTSD. Symptoms may include reliving the event through unwanted thoughts, flashbacks, or nightmares; feeling upset, having trouble sleeping, concentrating, or watching for danger; and avoid reminders of the event. These symptoms can last for years if left untreated.

Read more: Explained: what is post-traumatic stress disorder?

Psychotherapies such as trauma-focused cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) therapy are first-line treatments for PTSD. These types of treatments involve teaching patients to face and accept the painful memories, thoughts, and images that they have avoided. They also provide tools for patients to return to activities or places they have avoided and to relax when they begin to feel upset.

Although there is strong evidence that these treatments are effective, not everyone responds to them. Psychotropics are often presented as the solution to this problem. But does the science match the hype?

What do we already know about psychoactive drugs for PTSD?

Ketamine, MDMA, LSD, and psilocybin have all been considered potential treatments for PTSD:

  • ketamine was developed as a general anesthetic but is used recreationally due to its psychedelic and hallucinogenic properties. It primarily acts on the glutamergic system, which regulates large regions of the nervous system and has been implicated in forming traumatic memories and reducing the stress response

  • MDMA is a synthetic compound and is usually the main constituent of ‘ecstasy’. It induces changes in human emotions and it is possible that MDMA, in combination with psychotherapy, may increase a person’s ability to access and process painful or negative emotions, and increase positive emotions and interactions social.

Read more: Is psychiatry ready for medical MDMA?

  • LSD is a hallucinogen that produces psychosensory changes and impairs cognition, often increasing optimism and inducing feelings of well-being. By increasing prosocial behavior, it can strengthen the alliance between therapist and patient and thus increase the effectiveness of psychotherapy. It can also promote catharsis and relaxation

  • psilocybin occurs naturally in “magic mushrooms” and, like LSD, it increases a person’s sense of optimism and well-being and reduces negative mood. It may also be associated with an increased capacity for introspection, and research studies found that it can reduce levels of anxiety and depression in cancer patients.

But do these drugs make a real difference in resolving PTSD symptoms? And are they better than the treatments we already have?

What does the latest evidence say?

To find out what the current evidence says, my colleagues and I at Phoenix Australia led a Systematic review of published research.

We found two small random trials in which ketamine was used in combination with psychotherapy to treat PTSD. Overall, we found ketamine to be promising compared to placebo, but future research is needed to investigate how ketamine, in combination with psychotherapy, compares to standard treatment for PTSD.

The effect of using MDMA with psychotherapy was somewhat more encouraging, with four small random trials reporting positive effects in the treatment of PTSD. We found that MDMA is currently more promising than ketamine, based on the studies included in our review. It should be noted, however, that none of these four studies compared MDMA, in combination with psychotherapy, to a typical treatment for PTSD.

Better known as the recreational drug ecstasy, MDMA can also play a valuable role in treating PTSD and other mental health issues.

The review’s MDMA studies found that improvements in clinician-rated PTSD symptoms and self-reported physical responses to stress were ‘significantly greater’ for those who received MDMA and psychotherapy compared to a placebo . A little trial showed that 17 to 74 months after administration of MDMA and therapy, on average, improvements were still being felt.

Another one slightly larger trial involved military veterans, firefighters, and police officers with chronic PTSD and found a significant reduction in symptom severity. Of 24 participants who completed a 12-month follow-up, 16 did not have a diagnosis of PTSD.

We also searched for research on the use of LSD and psilocybin in the treatment of PTSD, and were surprised to find that no randomized controlled trials had been conducted.

Where to go from here?

Attitudes towards psychoactive drugs for the treatment of PTSD are changing. Some promoters to suggest they provide a “chemical safety net” for patients.

However, our review highlights the fact that, scientifically, this field is still in its infancy. There is a clear need for continued high quality research, to provide us with a better understanding of these treatments and how they might fit into treatment options for PTSD.

Alvin J. Chase