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MDMA as a Potential Treatment for PTSD

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Experiencing death, war, persistent economic struggle or any other traumatic event imprints on the psyche, leaving a lasting impact. For some, traumatic events instigate posttraumatic stress: a state of persistent impairment after exposure to a stressor. Posttraumatic stress can affect anyone — from first responders to victims of sexual assault —  and medical practitioners need novel treatments in order to address the nuanced needs of each individual. Research surrounding the benefits of MDMA as a potential treatment for PTSD gives fresh hope to people in need of support. But how can a substance known for its place at the party help someone heal their trauma-inflicted wounds? First, let’s take a look at some of the neurological processes underlying posttraumatic stress.

PTSD

When something dangerous or scary happens, the human body reacts by releasing two major stress hormones: norepinephrine and cortisol. Norepinephrine is similar to adrenaline and lights up the sympathetic nervous system causing a “fight, flight or freeze” response. Cortisol, a steroid involved in metabolic and immune system function, plays an essential role in the stress response. Cortisol pushes the brain’s alarm buttons signaling: Danger! All systems go!  This response is intended to protect but can sometimes cause physiological changes resulting in overactivation of the sympathetic nervous system. Prolonged activation of the body’s fear response takes a psychological and physical toll, common in most anxiety disorders — including PTSD. Some research suggests that the interactions of cortisol and norepinephrine help strengthen memories, making events that triggered floods of these hormones particularly salient.  

PTSD differs from other chronic hyperactivated states like OCD or generalized anxiety disorder because of its diagnostic specificities. In order to receive a PTSD diagnosis, patients must have exposure to a traumatic event followed by prolonged distress and functional impairment. In order to fit the DSM diagnosis patients must present all of the following: intrusive thoughts or memories, avoidance of potential triggering stimuli, hypervigilance and negative alterations to mood or cognition. 

Over time, prolonged stress from PTSD can change the brain’s limbic system — the neurological system responsible for emotional and behavioral responses.  Emotional and behavioral dysregulation is one of the many challenges that people dealing with posttraumatic stress face. Other symptoms include: avoiding triggering places and activities, invasive upsetting memories and in some cases re-experiencing the traumatic event itself.

The diagnostic criteria for posttraumatic stress disorder continue to evolve. In recent years there has been a push towards renaming PTSD to posttraumatic stress injury in the effort to make seeking treatment less intimidating. Identifying with a disorder diagnosis comes with challenges and swapping the vernacular places the emphasis on the traumatic event rather than the lingering symptoms.

There is a real and researched connection between PTSD and military veterans, but any traumatic event can trigger posttraumatic stress. According to the National Center for PTSD, about 8 percent of people will experience PTSD at some point in their lives. Though people often associate PTSD with military service, the diagnosis is not exclusive and there are no comparative criteria barring civilians from accessing care 

As the cultural dialogue around psychedelics shifts, MDMA as a potential treatment for PTSD provides a new resource for people in need of support. Today’s application of MDMA harkens back to the pre-War on Drugs popularity of MDMA-assisted therapies.

History of MDMA Treatments for PTSD

In 1912, the German pharmaceutical company Merck first synthesized MDMA —  ​​3,4-methylenedioxymethamphetamine. Though there is debate over its initial proposed use as an appetite suppressant, MDMA was a facet of psychotherapy during the ‘70s up until its illegalization in 1986.

Before MDMA, psychotherapists explored the potentials of MMA — a similar mescaline derivative known for its ability to intensify emotion and aid patients in their ability to open up. In the mid-70s, the side effects of MMA led practitioners to the utilization of the less toxic and more powerful MDMA.

The Boston group, a collection of psychotherapists, spiritual healers and chemists, distributed MDMA to their patients throughout the ‘70s and witnessed a reduction in defensiveness, retrieval of lost traumatic memories and relief from emotional symptoms. The euphoria increased empathy and lowered inhibitions that popularized MDMA as a recreational substance provided patients with necessary relief and perspective.

The DSM — or the Diagnostic and Statistical Manual of Mental Disorders— recognized and added PTSD in 1980, just before the United States listed MDMA as a schedule one substance. Today as more and more professionals recognize the benefits of psychedelic treatments, private sponsors are exploring MDMA specifically for PTSD.

How Does It Work?

The full spectrum of MDMA’s effects on the brain is still unknown. However, researchers do know that it boosts levels of serotonin and oxytocin — two “feel good” neurotransmitters. 

Serotonin is essential for mood regulation, cognition and keeping the different brain regions communicating. People working through posttraumatic stress often have a marked decrease in serotonin.

Oxytocin is sometimes referred to as the love hormone and is an essential part of relational trust, intimacy and empathy building. While flooded with oxytocin, people with PTSD have the opportunity to experience increased feelings of safety and connection — two emotional states that can be challenging to access when constantly overactivated.

Apart from these chemicals, MDMA also dampens activation of the amygdala — the portion of the brain responsible for fear processing. When a person is in a state of posttraumatic stress, their amygdala is overactive — causing them to be in a state of hypervigilance. While in this state, emotional processing is altered and people have more difficulty controlling or even understanding their reactions to potentially stressful stimuli. MDMA helps quiet the panic of the amygdala, allowing people opportunities to process with less fear.

Similar to LSD, MDMA alters the function of serotonin receptors essential to the perception of meaning and memory processing. The increase of serotonin at these receptors allows people to alter their previous perceptions and facilitates the re-processing of old memories. MDMA takes the emotional trigger out of the memories plaguing people with posttraumatic stress, allowing them to process through their experience in a less-loaded headspace.  

The interplay of boosted feel-good chemicals, increased feelings of safety and potential for memory retrieval makes MDMA well-suited as a potential treatment for PTSD. Let’s take a look at how researchers and clinicians apply MDMA to their patients with posttraumatic stress.

MDMA Treatments Today

The community of people and practitioners coping with PTSD are in desperate need of new treatments. There are two evidence-based treatment approaches for posttraumatic stress: pharmacological and psychotherapy. Pharmacological therapy is the application of neurotropic medication aiming to control symptoms, whereas psychotherapy is a more traditional talk therapy option.

MDMA research combining the two approaches shows the greatest positive effects and most enduring benefits. A long-term study of the benefits of MDMA-assisted psychotherapy showed a reduction of PTSD symptoms in a majority of participants, both 2 months and a year after 2-3 sessions of MDMA-assisted therapy. Not only did the participants experience a reduction in PTSD symptoms, but they also reported increased well-being and improved relationships. 

In May of 2021, researchers released the results of an 18-week double-blind study examining the benefits of MDMA-assisted psychotherapy for severe PTSD. They found that participants experienced a significant decrease in PTSD and depressive symptoms with no increase in suicidality. These researchers also implemented a placebo to make sure the results of their study measured the effectiveness of MDMA for PTSD and not just psychotherapy. 

More research is needed in order to form conclusive answers about MDMA as a potential treatment for PTSD: a sentiment echoed by the researchers currently searching for answers. Living life in a perpetual state of alert is a reality for millions of people managing posttraumatic stress. MDMA could be the breakthrough treatment that allows them a window of time and a supportive environment to process their trauma.

What do you think about MDMA as a potential treatment for PTSD?  We would love to hear your thoughts in the comments below? 

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