MDMA
What is MDMA?
MDMA is a synthetic amphetamine with stimulanting and hallucinogenic properties. It is commonly known and used as a party drug due to its enhancement of prosocial feelings, but research also points to its potential for treating post-traumatic stress disorder.
MDMA is classified within the pharmacological substance class of entactogens. Entactogens are psychoactive substances that lead to a more intense and altered perception of emotions and potentially serve as a gateway to the consumer's unconscious mind.
From a neurobiological perspective, MDMA works by increasing the release of the neurotransmitters serotonin, dopamine, and norepinephrine into the synaptic gap.
At the same time, MDMA inhibits the reuptake of these neurotransmitters into the nerve endings and storage vesicles of the central nervous system (CNS).
The increased release of neurotransmitters activates the so-called "dopaminergic mesocorticolimbic system," which is responsible for heightened mood perception.
Sources: Nr. 26, 27, 28, 29, 30, 31, 32
Researching MDMA
Many studies involving MDMA are exploring its psychotherapeutic treatment for post-traumatic stress disorder (PTSD).
PTSD affects hundreds of millions of people and is often difficult to treat due to patient avoidance and/or a lack of effective therapist resources, as evidenced by approximately one-third of patients discontinuing therapy.
This would make a new, potentially effective method of treating this disorder a significant advancement for all of us.
Sources: Nr. 34
How can MDMA help?
MDMA, an entactogen, shows many effects that can be valuable for treatment.
These effects are being evaluated for their effectiveness in the study "MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial" by J. M. Mitchell et al. (2023).
MDMA promotes increased prosocial behavior and helps coping with emotionally challenging and frightening stimuli. These effects may increase the likelihood of effective therapy by reducing unhealthy feelings of anxiety, danger, and negative emotions.
Results of the study showed that 86.5% of the participants exhibited clinically relevant improvements in their PTSD symptoms 18 weeks after baseline, and 71.2% no longer met the criteria for a diagnosis of PTSD according to the DSM-5.
The conventional medication used, selective serotonin reuptake inhibitors (SSRIs), is ineffective in 35-47% of patients, making MDMA stand out as a more effective treatment option according to the study.
Doing just two to three MDMA-assisted therapy sessions over 12 weeks can lead to improvements, whereas SSRIs are typically taken daily.
The effects on anxiety are particularly important for the possibilities in psychotherapy. In individuals with PTSD, brain scans have revealed significantly increased activity in the amygdala, a part of the brain responsible for processing and reacting to fear. The influence of MDMA leads to a reduction in overactivity in the amygdala, resulting in a neutral activation, allowing for a transformation of fear.
This transformation can enable access to memories of traumatic events that are otherwise suppressed or avoided, providing the opportunity to better address and accept them in psychotherapy. Individuals with PTSD often struggle with trusting others and forming relationships. This issue can be addressed more easily through the increase in oxytocin levels (also known as the "love hormone") triggered by MDMA, along with its associated prosocial effects.
Sources: Nr. 33, 34, 35, 36, 37, 38, 39, 40, 41, 43
Results
MDMA could represent a significant advancement in the treatment of PTSD. Current psychotherapies have a dropout rate of 16%, while in seven studies involving MDMA-assisted therapy, this rate is very low, suggesting that MDMA fosters better patient engagement. Additionally, there is currently no medication specifically targeting PTSD; existing medications only treat coexisting or resulting psychiatric disorders. With MDMA, we could finally introduce an effective medication combined with therapy to the market.