Banner by Matt Stoss

Medicalizing Molly for PTSD

by Anna Dubnicka

Young adults associate ecstasy with imagery of  dark rooms lashed by beams of light, pulsing with repetitive beats of EDM music and dense with sweat and dancing. However, this generation may soon be displaced by a demographic twice as old.

Ecstasy, or MDMA, is not having an identity crisis or rebranding itself; if anything, it is returning to its roots. Before MDMA was classified as a Schedule I drug in 1985, psychiatrists and therapists drew on its disinhibiting effects to supplement their patients’ psychotherapy sessions. Today, it is being researched as a potential treatment for post-traumatic stress disorder (PTSD) in veterans.

Currently, selective serotonin reuptake inhibitors (SSRIs) are the approved pharmaceutical treatment for PTSD. SSRIs block the reabsorption and prolong the effects of serotonin, a neurotransmitter associated with mood and happiness. MDMA also has a similar reabsorption-blocking mechanism which additionally stimulates the release of serotonin. This flood of serotonin along with other neurotransmitters, including dopamine and norepinephrine, is responsible for the euphoria that recreational MDMA users seek.

The problem is that SSRIs have not seen sufficient success in treating combat-related PTSD in veterans. PTSD treatment incorporates a therapy component; however, many people with the disorder are impacted by their traumatic experiences to a degree that they are unable to discuss them, even in a psychiatric setting. Hypervigilance, fear and avoidance of recalling traumatic experiences, and emotional and social isolation, are predominant symptoms of PTSD. Researchers hope that MDMA’s effects of reducing fear and increasing relaxation, empathy and trust could offset the anxiety-inducing barriers to therapy. Unlike SSRIs which are prescribed daily, researchers intend for MDMA to be used as an adjunct to therapy. In order for therapy to be helpful in treating PTSD, a patient must be willing and able to engage with the therapist.

Research shows that MDMA quiets the fearful and avoidant behaviors of people with the disorder, which, along with the release of prolactin and oxytocin, may stimulate trust and bonding between the patient and therapist. In a small-scale trial by the Multidisciplinary Association for Psychedelic Studies (MAPS), 63 percent of participants with PTSD reported reduced anxiety and improved sleep; 68 percent reported fewer nightmares, flashbacks or intrusive memories and an increased ability to feel emotions; 79 percent reported less excessive vigilance and less avoidance of people and places; 89 percent of participants noticed a better general well-being and increased self-awareness. Currently, the FDA has approved phase III trials for treatment of PTSD with MDMA-assisted psychotherapy. Based on its success, it will proceed to phase IV, the post-marketing surveillance trial. Then, the drug will be available on the market while still being monitored for rare or long-term side effects that had not manifested in the earlier phases. These studies are underway on a global scale while more are in the planning stages.

MDMA is not without its problems. Because the drug releases an immense degree of serotonin, it depletes the brain’s serotonin reserves. Because of this, subsequent doses cannot reach the intensity threshold of euphoria experienced before. In fact, the desired effect becomes more unattainable as negative side effects increase. One of these post-high effects is a period of anhedonia, an inability to experience pleasure. Then again, we have all heard prescription drug commercials that ramble off a slew of side effects, not all of them minor, and the recreational dose of MDMA is larger than that being investigated for psychiatric benefits. Given the millions of people living with PTSD, it is about time for a more reliably successful treatment.