Medically prescribed love: MDMA assisted psychotherapy
“I’m called the Godfather of Ecstacy because I published for the first time information about its effects in man. I feel content with the title. MDMA is a beautiful drug…”
3,4-Methylenedioxymethamphetamine (MDMA) also known as Mandy, Molly, Ecstasy or ‘E’: it’s the class A ‘Love Drug’ and one of the many psychoactive substances which people are fed horror stories about from the moment they learn of its existence. This drug is known for inducing feelings of happiness, chattiness, liveliness, and overall feelings of ecstasy. It’s perfect for enhancing raves, clubs and parties, or even for smaller rolls with friends and loved ones to spark that intense connection. Many consider it a highly dangerous, deadly drug taken by rebellious teens. However, very few know about its original purpose; its purpose which is currently being revived.
In 1912, MDMA was first synthesised by a German pharmaceutical company who aimed to create a medication to regulate bleeding but instead ended up with MDMA. Soon after, the pharmaceutical company Merck patented the compound as one with potential pharmaceutical value. For the next few decades there wasn’t much development in MDMA until the 1950’s when the project MK-Ultra was initiated. MK-Ultra was a CIA operation in which a series of psychedelic experiments were undergone to assess the potential of drugs such as MDMA, LSD, and psilocybin amongst others for psychological torture and mind control. Participants were often unwitting and unaware. Although many files were omitted, MDMA is not believed to have been tested on humans, but the project did produce the first toxicology report of MDMA. The operation officially ended in 1973. Around the same time, the drug began piquing an interest in psychiatrists and scientists who had been studying psychedelic drugs. George Greer was a psychiatrist who, administered both himself and his wife a dosage of this drug: it wasn’t long until he realised the enhanced communication as a result of MDMA could have many useful applications – he went on to carry out one of the first MDMA studies.
George Greer took advantage of the legal grey area this drug was in at the time and alongside a chemist, Dr. Alexander Shulgin, Greer gained his own batch of clinically pure MDMA. He administered 75-150mg of the drug to 29 participants who would then undergo the MDMA session either individually or alongside a therapist. All 29 participants reported a positive change to their attitudes or feelings and all participants with prior diagnoses described the experience as having provided relief. Many also reported having found a deeper insight into their lives. These results persisted during the follow up period which varied between two months and two years subsequent to the study. However, experiments such as Greer’s soon came to a halt when the drug was made illegal in the 80’s.
At a chemical level, MDMA works by affecting the nervous communication within the brain. Nerves communicate using neurons which pass signals to one another, in between each neuron is a gap called a synapse. To pass a signal from one neuron to the next, chemicals called neurotransmitters are released from the first neuron, entering the synapse before binding to receptors on the neighbouring neuron. MDMA works primarily on neurotransmitters such as serotonin (associated with regulating mood, specifically related to happiness) and dopamine (associated with motivation and motor function amongst other things). MDMA causes the release of both serotonin and dopamine as well as additionally blocking the reuptake (removal) of serotonin in the synapse – this creates an abundance of both neurotransmitters in the synapse and causes strong neuronal signals, which result in the extreme heightened emotional affects caused by the drug.
Dr. Alexander Shulgin was a medicinal chemist and early researcher in experimenting with various phenethylamines such as MDMA; he shared his findings with a psychotherapist, Leo Zeff. It wasn’t long until MDMA started being used to assist in psychotherapy. Despite research having been halted by the DEA’s MDMA ban, in the recent years MDMA has begun to re-emerge with its useful
applications in treating anxiety, PTSD, addiction and depression amongst many others of which some studies will be overviewed.
Firstly, and most famously, MDMA has been prominent in treatment for PTSD. PTSD is an anxiety disorder caused by a traumatic experience or event of some form; it can cause flashbacks, nightmares, emotional numbing and hyperarousal as well as being highly comorbid with other disorders such as depression or substance abuse. A double-blind study of MDMA-Assisted Psychotherapy for PTSD found that in the MDMA group 83% of participants no longer met the criteria for PTSD after the study compared to only 25% in the control.
This therapy is significantly efficient as the MDMA-induced increase of the neurotransmitter, serotonin, results in a reciprocal increase of oxytocin production. The heightened levels of oxytocin causes a section of the brain known as the Amygdala – associated with the bodies fear and stress responses – to have a decreased stimulation and thus decreasing the distress caused by the trauma. This decrease in the fear response can reduce the repression of traumatic memories and allow participants to discuss their trauma more openly; many also found that even after treatment these repressed memories caused less distress than before and they were able to address them in the long term.
These initial treatments for PTSD effectively provide a basis for future research into treating a wider range of disorders with MDMA:
Dr. Ben Sessa is a consultant child and adolescent psychiatrist who also carried out work in adult addiction services. He expanded on these treatments for PTSD with his study of MDMA assisted psychotherapy for substance use disorder. Sessa acknowledged the clear correlation between a history of psychological trauma (often in childhood) and addictions in adulthood and hypothesised that there was potential for MDMA to be used as a treatment method addressing these past traumas for those with alcohol use disorder. Participants attended eight sessions over eight weeks; on two of the sessions, participants were also administered a dosage of MDMA (These two sessions lasted approximately 7 hours). Participants were followed up for a further 9 months after the therapy to assess long term affects or any negative implications.
Following this study, one patient said in reference “A weight has been lifted off my shoulders. I haven’t felt like that for a long time. There are no nagging doubts. I’m getting my life back on track”
Another said: “It’s not about the drinking, the MDMA healed me inside and the drinking looks after itself … I’m seeing things anew, nature for the first time … I’m in control of my decisions, I’ve got control back … Life is just good!”
In a separate observation study in which Sessa analysed standard alcohol treatments being offered for detox in the UK compared to his MDMA sample he found that at six months the relapse rates
were 76% and 6% respectively.
There are plans to further expand this research.
Further applications still can be seen in relationship counselling. When Greer and his wife first consumed the drug, he noticed a previously unknown barrier had been lifted. MDMA allowed himself and his wife to talk and communicate issues freely – they noticed suddenly it was easier to open up and listen.
Again, this revelation was applied to patients of PTSD. Candice Monson recently carried out a trial of MDMA-facilitated cognitive-behavioural conjoint therapy (CBCT) for patients of post-traumatic stress disorder. Participant couples, of which one partner had a PTSD diagnosis, underwent 15 sessions of CBCT over 7 weeks with 2 sessions involving both partners receiving a dosage of MDMA. The study found both significant improvements in the diagnosed patients PTSD symptoms but also an increase in relationship satisfaction. This study was the first of its kind and, similarly to Sessa, there are intentions to soon begin a phase 2, randomised trial.
So what about the dangers of consuming this drug?
David Nutt, a neuropsychopharmacologist specialising in drugs and their consecutive effects on the brain has spent much of his career studying psychedelics. Nutt famously claimed drugs such as
MDMA or LSD to be less dangerous than alcohol and even compared the consumption of illicit drugs to riding a horse – an evidenced claim which resulted in him being asked to resign from his position as chair of the Advisory Council on the Misuse of Drugs; following this he founded the non-profit organisation ‘drug science’. Nutt also illustrates the high levels of newsworthiness of MDMA related deaths: every single death caused by ecstasy is reported whereas only one in every 250 deaths caused by paracetamol stands a chance of making the news.
An MDMA overdose is highly uncommon. It is typically the result of recreational street drugs not having been tested prior to consumption and containing more dangerous, potentially fatal substances. In Psychedelic-assisted Psychotherapy, the used MDMA is synthesised in a controlled environment therefore allowing researchers, scientists and psychotherapists to trust the product
being used and significantly reduces any risks associated with MDMA.
A second risk of MDMA is predominantly controlled in the exclusion criteria for these studies which typically rules out participants with hypertension, cardiac disease, diminished liver function and possible pregnancy. This is because MDMA can affect body temperature and increase blood pressure – this could potentially cause strain on the heart of a person with cardiovascular diseases. This risk is further controlled by carefully monitoring patients during their sessions to ensure they do not result in unsafe conditions.
In the follow up of each named study, no serious adverse effects have been reported further evidencing MDMA assisted psychotherapy as a highly effective, low risk treatment.
MDMA is a drug with significant applications which have been restricted by laws preventing further research. Only in recent years are scientists and researchers becoming able to again study the potential of this drug and utilise it to help those who need it. Despite the stigma surrounding it, the drug is not as dangerous as certain other legal substances such as alcohol. 1 in 350 people suffer acute harm from sports such as horse riding every year compared to 1 in 10000 People who do so from Ecstasy consumption. With the potential life changing benefits this drug holds, its time to start moving passed the long held stigma and consider the impact MDMA could have on both these
individuals, and on society as a whole.
Berke, J. D. (2018). What does dopamine mean? Nature Neuroscience, 21(6), 787–793. https://doi.org/10.1038/s41593-018-0152-y
Gina Martin, Kate Vallance, Scott Macdonald, Tim Stockwell, Andrew Ivsins, Clifton Chow, Warren Michelow & Cameron Duff (2014) Nonfatal overdose from alcohol and/or drugs among a sample of
recreational drug users, Journal of Substance Use, 19:3, 239-244, DOI: 10.3109/14659891.2013.784369
Greer, G., & Tolbert, R. (1986). Subjective reports of the effects of MDMA in a clinical setting. Journal of Psychoactive Drugs, 18(4), 319–327. https://doi.org/10.1080/02791072.1986.10472364
History (2017 June 16) MK- Ultra. https://www.history.com/topics/us-government/history-of-mk-ultra
Holland, J., (Ed.).
(2001) Ecstasy: The Complete Guide: A Comprehensive Look at the Risks and Benefits of MDMA. (1 st ed.) Park Street Press
Mithoefer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L., & Doblin, R. (2011).
The safety and efficacy of ±3,4-methylenedioxymethamphetamine- assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: The first randomized controlled pilot study. Journal of Psychopharmacology, 25(4), 439–452. https://doi.org/10.1177/0269881110378371 Monson, C. M., Wagner, A. C., Mithoefer, A. T., Liebman, R. E., Feduccia, A. A., Jerome, L., Yazar-Klosinski,
B., Emerson, A., Doblin, R., & Mithoefer, M. C. (2020).
MDMA-facilitated cognitive-behavioural conjoint therapy for posttraumatic stress disorder: an uncontrolled trial. European Journal of Psychotraumatology, 11(1). https://doi.org/10.1080/20008198.2020.1840123 NHS.
(2018, September 27) Post-Traumatic Stress Disorder. https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/ NIDA. 2020, April 9.
What is the history of MDMA? Retrieved from https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-is-the-history-of-mdma on 2021, April 1
Nutt, D. J. (2009).
Equasy – An overlooked addiction with implications for the current debate on drug harms. Journal of Psychopharmacology, 23(1), 3–5. https://doi.org/10.1177/0269881108099672
Passie, T., & Benzenhöfer, U. (2016).
The history of MDMA as an underground drug in the United States, 1960–1979. Journal of Psychoactive Drugs, 48(2), 67–75. https://doi.org/10.1080/02791072.2015.1128580 Rogers, G., Elston, J., Garside, R., Roome, C., Taylor, R., Younger, P., Zawada, A., Somerville M.
(2009) The harmful health effects of recreational ecstasy: a systematic review of observational evidence, Health Technology Assessment, 13, (5), 1-315 https://doi.org/10.3310/hta13050. Sessa, B., Sakal, C., O’Brien, S., & Nutt, D. (2019).
First study of safety and tolerability of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in patients with alcohol use disorder: Preliminary data on the first four participants. BMJ Case Reports, 12(7), 1–4. https://doi.org/10.1136/bcr-2019-230109
Talk to Frank (2021, April 22) Ecstasy. https://www.talktofrank.com/drug/ecstasy