Arguably, illicit drugs deserve their bad reputation because they are dangerous to those who abuse them and cause significant harm to society. But, this is not necessarily so for other drugs that at one time showed promise of being highly beneficial in treating various illnesses and psychological disorders. There is perhaps no better example of this than the potential benefits of administering MDMA in the treatment of post-traumatic stress disorder (PTSD). MDMA, the party drug, invented as a way of developing other drugs it would go on to eventually become the go-to choice of ravers and, as a result, would be banned in the United States regardless of any potential it may have had as a viable therapeutic tool. This paper explores the history and chemistry of MDMA, as well as the research that has been conducted in efforts to address symptoms related to PTSD. As such, MDMA not only show promise, but has been proven to be highly effective, especially when treating PTSD that is treatment resistant.
Being at the scene of the World Trade Center directly after the terrorist attack on September 11, 2011 is an impossible thing to imagine. But a 33-year-old construction worker named Sean, who just happened to be working at the World Trade Center on that tragic day, he actually found himself at Ground Zero assisting in the search for coworkers and other victims amongst the rubble and debris (O’Neill, 2014). Caring deeply for what had happened and wishing to continue helping in any way that he could, Sean decided to remain on site for six more weeks, where he not only continued to sift through the wreckage but also responded to question posed by others who were desperate to learn about the ones they come to know were lost. At the end of six weeks Sean left, but shortly after he began to experience a great deal of anxiety, depression and night terrors (O’Neill, 2014). Upon seeking help Sean was informed by a therapist that he was suffering from PTSD. For two years he was treated by means of traditional psychotherapy but his symptoms did not ease or go away, that is until he sought out a new therapist who prescribed 3,4-methylenedioxyamphetamine, or MDMA, which is known on the street and by law enforcement as “Ecstasy” (O’Neill, 2014).
MDMA is listed by the federal government as a Schedule 1 drug, meaning it is currently illegal no matter the application or circumstances surrounding its use. It was determined as such in 1985 after a series of hearings in Texas where it was ultimately decided that the drug’s potential neurotoxicity combined with the risk of it being illicitly used warranted placement at the top of the Food and Drug Administration’s (FDA) schedule of controlled substances (McDowell & Kleber. 1994). MDMA was developed in and patented in 1914 by Merck Pharmaceuticals as a parent compound which would be used in the synthesis of future drugs. But once receiving a patent little is apparently known about its use until the 1950s, when the United States Army ran a series of animal experiments which would not come to light to the general public until the 1970s. MDMA appears to have been initially used by humans in the late 1960s primarily through people involved in the so-called New Age movement. In the middle part of the 1970s psychiatrists in California began using MDMA as a therapeutic adjunct for their clients, but the drug didn’t gain in notoriety until the mid-1980s when it widely used as a party drug because of it inducing a feeling of euphoria and the fact that, up until its federal classification, it was perfectly legal to take the drug (McDowell & Kleber. 1994).
Because of its reputation for being a party drug MDMA was not only classified by the FDA as a prohibited substance but it also became a casualty of the War on Drugs. As a result, psychiatric research into its potential benefits was halted, but not before it was widely noted for its psychological effects, reported as a “profound feeling of attachment and connection” (McDowell & Kleber. 1994, p. 127). Research since then has found that MDMA produces a mental state reported to be pleasurable in almost every subject administered the drug, which in terms of other drugs, including psychotropic substances used to treat mental illnesses, is said to be quite unusual (Sessa & Nutt, 2007). Something else that was found to be interesting about MDMA is that the effects of the drug diminish when used consistently over time, the implication being that MDMA is non-addictive yet highly efficacious as a short-term therapeutic tool. MDMA is usually administered orally with the usual dosage reported to be 100 to 150 mg. Its effects begin between 20 and 40 minutes after ingestion and are reported to last from 3 to 4 hours (Sessa & Nutt, 2007). Prior research has found that while under the effects of MDMA, subjects report higher levels of empathy, understanding and closeness, while others have reported its benefits as a tool for exploring repressed memory states because it inhibits fear responses to perceived emotional threats (Sessa & Nutt, 2007). These findings hold profound implications to those suffering from PTSD, something that will be explored later in this paper.
MDMA is recognized as an indirect serotonin agonist, meaning it enhances the release of serotonin but does not act as an agonist, a chemical that would otherwise bind to the serotonin neurotransmitter at the receptor. As a result, MDMA acts to prevent a decrease of serotonin which is known to be caused by the depletion of tryptophan, known to reverse the affective benefits of selective serotonin reuptake inhibitors (SSRI) commonly used in the treatment of depression (Sessa & Nutt, 2007). MDMA is also referred to as a “messy drug” because it also affects dopamine-containing neurons and other neurotransmitters. The drug is suspected to travel through the brain with the assistance of carriers that are sensitive to fluoxetine, the same substance used in the SSRI anti-depressant Prozac (Nash & Meltzer, 1990). The delivery of MDMA releases endogenous 5-HT (serotonin at its origin) which then interact with 5-HT2 receptors, receptors that bind 5-HT, suspected of occurring in the hypothalamus, part of the limbic system and responsible for the production of hormones, and resulting in the secretion of corticosterone (known to be affected by stress) and the adrenocorticotropic hormone (ACTH), recognized as having a role in how the body responds to stress (Nash & Meltzer, 1990). At the end of their study on the effects of MDMA on rats, Nash and Meltzer (1990) concluded that most studies during the time that showed the potential of MDMA as an anti-depressant were unfounded because it was difficult to prove its beneficial role in the production of 5-HT, but this was well before research got underway looking at the potential benefit of the drug in the treatment of PTSD.
While it’s natural for people to experience feelings of fear as something traumatic is happening or afterward, people suffering from PTSD continue to have similar feelings long after a traumatic event. PTSD develops when individuals have either witnessed or experienced an event that was either shocking or dangerous. According to the National Institute of Mental Health (NIMH), PTSD can be either acute, meaning short-term, or chronic, which means ongoing and for a long-time, but symptoms usually emerge within 3 months but can also become present years after a traumatic event (NIMH, 2016). In order to be diagnosed with PTSD individuals must meet the following criteria: They must experience symptoms for more than a month; re-experience feelings associated with the traumatic event; experience flashbacks, bad dreams or frightening thoughts, all of which are referred as re-experiencing symptoms; have avoidance symptoms, meaning they avoid places or object that serve as reminders; are emotionally numb or experience strong feelings of worry, guilt or depression; being easily startled or constantly on guard, or can have outbursts of anger; have memory problems concerning the event or have a loss of interest in activities that use to be enjoyable (NIMH, 2016). PTSD is typically treated with anti-depressant or anti-anxiety medications combined with some type of therapy that may include: psychotherapy, behavioral treatments, electroconvulsive shock treatments, and even yoga or meditation (Cukor, Spitalnick, Difede, Rizzo, & Rothbaum, 2009). The reason so many treatments have been developed is that PTSD is extremely treatment resistant and research continues to look into other interventions that may actually work. Enter MDMA.
As stated previously, PTSD is typically treated with some type of medication, usually an SSRI or an SNRI, or serotonin-norepinephrine reuptake inhibitors that act to block the absorption of serotonin and norepinephrine (Oehen, Traber, Widmer & Schnyder, 2012). But thus far, such medications have had little effect on PTSD so efforts continue to find promising psychotropic medications that will provide relief. Prior to PTSD research, MDMA was explored as an adjunct to psychotherapy before it was placed on the FDA’s list of banned substances. As such, it showed promise in treating an array of mental health issues including adjustment disorders, depression, bipolar disorder and mixed personality disorder (Parrot, 2007). However, most research into the potential benefits of MDMA came to a halt in 1985, a situation complicated even further by the fact that it was banned in England as well as most countries throughout Europe (Sessa & Nutt, 2007). But more recently, science has made efforts to look at MDMA, but this is occurring well beyond the shores of the United States, for example, in Spain researcher found MDMA to be highly effective at reducing symptoms experienced by females with chronic PTSD (Bouso, Doblin, Farré, Alcázar, & Gómez-Jarabo, 2008). In another study conducted in Switzerland, researchers found that both males and females suffering from treatment-resistant PTSD reported significant relief when taking MDMA and attending psychotherapy, and that such improvements would increase over the course of a year (Oehen, et al., 2012).
Surprisingly, research has taken place here in the United States quite recently which has led to hopes that MDMA will be made legal within the next five years for treating PTSD. The reason for this good news is that the limited number of studies that have occurred here in this country have shown extremely positive results. They include research that have used adult subjects whose symptoms resulted from war as well as childhood sexual abuse and rape (O’Neill, 2014). This is great news given the strong correlation between PTSD and suicidal ideation as well as events (Hudenko, Homaifar & Wortzel, 2016). The most effective means of administering MDMA with patients suffering from PTSD is when it is combined with some form of psychotherapy. Used alone MDMA is limited to short-term benefits that allow sufferers relief from symptoms that are known to cause fear and anxiety. But as a therapeutic adjunct, MDMA shows promise as having lasting treatment effects, especially for those who have been identified as suffering from treatment-resistant PTSD (O’Neill, 2014). It seems only obvious that it is time to do away with the “boogie man” viewpoint of MDMA that was created by fear-mongering politicians during the height of the so-called War on Drugs, and recognize that MDMA is an extremely viable treatment option for people suffering from PTSD.
Using MDMA combined with psychotherapy had a radical effect on Sean who reported experiencing fast relief as well as feeling more open, “I was able to start talking about it, walking through my memories of what it was like in a way I hadn’t been able to do before, without being overcome by emotions” (O’Neill, 2014, par. 12). Such promising anecdotal evidence would be much more common had not MDMA been banned in this country decades ago. In fact, thousands of people who have suffered from PTSD and continue to do so might now be living far more productive and positive lives only if MDMA was a legally prescribed medication. While it is great news that it may become so within the next 5 years or so, it seems only right that the FDA
expedite research and place MDMA on a fast track because, in simple terms, it is the right thing to do.
- Bouso, J. C., Doblin, R., Farré, M., Alcázar, M. Á., & Gómez-Jarabo, G. (2008). MDMA-assisted psychotherapy using low doses in a small sample of women with chronic posttraumatic stress disorder. Journal of Psychoactive Drugs, 40(3), 225-236. doi:10.1080/02791072.2008.10400637
- Cukor, J., Spitalnick, J., Difede, J., Rizzo, A., & Rothbaum, B. O. (2009). Emerging treatments for PTSD. Clinical Psychology Review, 29(8), 715-726. doi: 10.1016/j.cpr.2009.09.001
- Hudenko, W., Homaifar, B., & Wortzel, H. (2016, February 23). The relationship between PTSD and suicide. Retrieved from http://www.ptsd.va.gov/professional/co-occurring/ptsd-suicide.asp
- McDowell, D. M., & Kleber, H. D. (1994). MDMA: It’s history and pharmacology. Psychiatric
Annals, 24(3), 127-130. Retrieved from http://www.maps.org/images/pdf/1994_mcdowell_1.pdf
- Nash, J. F., & Meltzer, H. Y. (1990). Neuroendocrinological effects of MDMA in the rat. In S. J. Peroutka (Ed.), Ecstasy: The clinical, pharmacological, and neurotoxicological effects of the drug MDMA (pp. 225-240). Boston, MA: Kluwer Academic Publishers.
- NIMH. (2016, February). Post-traumatic stress disorder. Retrieved from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
- Oehen, P., Traber, R., Widmer, V., & Schnyder, U. (2012). A randomized, controlled pilot study
of MDMA (3,4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD). Journal of Psychopharmacology, 27(1), 40-52. doi:10.1177/0269881112464827
- O’Neill, S. (2014, May 19). Using ecstasy to treat Post Traumatic Stress Disorder. Retrieved from http://www.scpr.org/news/2014/05/19/44147/psychedelic-science-using-ecstasy-to-treat-post-tr/
- Parrott, A. C. (2007). The psychotherapeutic potential of MDMA (3,4-methylenedioxymethamphetamine): an evidence-based review. Psychopharmacology, 191(2), 181-193. doi:10.1007/s00213-007-0703-5