People Have Been Using MDMA to Treat PTSD for Decades
Last month, the FDA granted researchers permission to move forward with clinical trials studying the effects of MDMA on treating PTSD. Though the development may seem surprising, the so-called "party drug" was used in therapy years before it was banned...
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Roslyn Talusan, a freelance writer in Toronto, Canada, developed PTSD after she was raped. Four months of counseling didn't do much, nor did other coping methods, like yoga. "I was still having flashbacks to the attack, I was still paranoid, and just really wasn't living in my body," she says.
Then a friend gave her molly at a concert, and she immediately felt a weight lift. "I wasn't thinking about the assault at all," she recalls. "I wasn't thinking about my attacker or the process or anything. I was just in the moment, enjoying the music." This wasn't just a momentary escape: After that night, "the flashbacks weren't as vivid or consuming," she remembers. "I wasn't paranoid that my attacker would pop up wherever I was, so I wasn't always anxious, scanning my environment for him. It reminded me how to not think about the attack."
Because MDMA has been most closely associated with raving and other recreational uses, it may seem strange that some people, like Talusan, credit it with curing or alleviating their PTSD symptoms. However, as the FDA moves towards potentially legalizing it for therapy, it's worth noting that psychiatrists and therapists have used it as psychotherapeutic tool for years; it was originally developed in 1912 by a German pharmaceutical company, Merck, in order to synthesize dextroamphetamine, a drug used in ADHD medications. It was literally shelved for decades, with the exception of a short-lived animal trial by the US Army to investigate its potential use for interrogation.
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In 1965, psychedelic drug designer Alexander Shulgin synthesized MDMA himself, according to his autobiographical book, PiKAL. Throughout Shulgin's life, he tested the effects of over 200 potentially psychoactive substances, often by administering them to himself or a friend. MDMA was no exception: He tried it for the first time in 1976, and first noticed an effect at 81 mg, around the amount in an ecstasy pill, describing the effects as a ''low-calorie martini.''
Unlike the other drugs he'd studied, MDMA ''opened up a person, both to other people and inner thoughts, but didn't necessarily color it with pretty colors and strange noises,'' he told the New York Times magazine in 2005.
In 1977, Shulgin gave some to psychotherapist Leo Zeff to offer his patients, and it spread like wildfire through the psychiatric community. Therapists were amazed by its ability to provoke immediate realizations that typically took patients many months to arrive at. Psychologists also noticed that people under MDMA's influence were more loving and communicative. (Supporting this observation, a 2015 study in the Journal of Psychopharmacology found that MDMA makes people more likely to talk about emotional and social subjects.) By the 80s, MDMA-assisted couples' therapy had become a fad. It was also a common treatment for anxiety, phobias, and trauma.
"MDMA basically started out as a therapeutic tool," explains psychopharmacologist Julie Holland, MD, author of Ecstasy: The Complete Guide. "Leo [Zeff] basically turned into the therapeutic Johnny Appleseed, traveling around the country and turning on his therapist friends."
As word spread, patients started taking pills home and offering them to their friends so they could conduct their own informal sessions, explains James Giordano, PhD, a professor of neurology and biochemistry at Georgetown University Medical Center who researches MDMA's effects on the brain. The next step, of course, was to use it as a social aid in group settings. It began to appear at raves in LA and Dallas in the 80s.
As MDMA made its way out of therapists' offices and into clubs, the DEA took notice, officially making it a Schedule I drug in 1986. Few efforts were made to reintroduce it to clinical settings amid the drug wars. Studies using animals, large doses, and the entirely different drug MDA became the basis for anti-drug propaganda, and research on MDMA's risks was far more likely to get funding than research that examined its potential benefits, explains Holland.
But this hasn't stopped a rare few therapists from continuing to use it underground, she says. And it certainly hasn't stopped people from using MDMA for mental health purposes informally.
I had the solutions the entire time—I just wasn't able to hear them.
Mel, a medical marijuana entrepreneur in Sherman Oaks, California, who requested that we use a pseudonym to protect his identity, suffers from anxiety and depression. Every summer, he joins a friend for a camping trip in the hot springs. He packs books, games, and MDMA, and he leaves the experience stress-free. "It shows me what is possible for me personally and for my future," he says. "The goal for me is to take away these feelings of hope and optimism for a brighter future and apply them to my everyday life."
Ryan McCormick, the host and executive producer of Outer Limits of Inner Truth Radio, similarly used MDMA "medicinally" when he was suffering from depression. He'd take two pills, drink lots of water, light candles, and sit alone in his room with a notepad to document his drug-induced insights. Sometimes, he'd lose himself in self-help books, spiritual songs, or the woods on a Long Island nature preserve.
"I was able to tune into that gut feeling with a much longer period of concentration, and I was almost listening to my subconscious," he recalls. "I had the solutions the entire time—I just wasn't able to hear them." When he took MDMA alone, he says, "I was looking at the pain and suffering and shame, but because my physical body was in a different state, I was looking at it from a perspective of joy. If you look at pain and suffering normally, you shut down."
Dr. Giordano believes MDMA has the ability to "reset" the brain in patients with depressive disorders. While the substance was previously thought to only work on certain neurotransmitters, he says it actually changes the structures of entire neural networks, the firing rates of neurons throughout the brain, and brain cells outside the nervous system called glia. "It's sort of like flipping a circuit breaker."
For this same reason, he believes, MDMA offers people the potential to alleviate trauma. It lets PTSD patients like Talusan, who often get so emotionally absorbed in their memories that they're unable to process them, take a step back. "Patients who have PTSD have a variety of environmental triggers, and then triggers have a host of symptoms: withdrawal, agitation, profound anxiety," Giordano explains. "What MDMA seems to do is to reset a mechanism for patients' responsiveness to these triggers."
That's been the latest focus of scientists interested in MDMA's medicinal potential. In 2000, the first clinical trial for its use in therapy gained FDA approval. The subjects in the trial would take a tablet before talking through their traumatic memories with two therapists during two six-to-eight-hour sessions, in addition to 10 additional sessions without the drug. The first completed study, conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS), found that 83 percent of PTSD patients who took MDMA before therapy—compared with 25 percent who took a placebo—had their symptoms alleviated after the sessions.
According to MAPS, three of the subjects who had been unable to work because of PTSD were able to return to work.
When recalling my memories under the influence of the MDMA, I felt as though I was safe to remember them.
The most common pharmaceutical PTSD medications currently on the market are Paxil, Prozac, and Zoloft, which typically take years to help patients overcome the disorder, according to clinical pharmacist Nicholas C. Nowak, PharmD.
According to the second phase of the MAPS trials, the effects of MDMA are not just quick but also lasting: They found that 66 percent of patients in six studies spanning four countries didn't qualify for PTSD after a 12-week course of MDMA-assisted psychotherapy, in which the drug was taken twice, according to MAPS spokesman Brad Burge. The third phase just received FDA approval. If it shows promising results, taking MDMA in therapy could be legal by 2021.
War veteran C.J. Hardin says participating in a second-phase study in 2013 was what finally allowed him to overcome years of debilitating PTSD. "When recalling my memories under the influence of the MDMA, I felt as though I was safe to remember them," he explains. "Before, I might not say everything because I was scared, ashamed, or shy. With the MDMA, I was an open book, and I wasn't afraid to read it."
The drug didn't only help him face his memories but also let him see them in a more positive light. "The therapists listened intently and provided understanding and smiles, and helped pick out parts of the stories that were good and made me happy, as in the silver linings of really dark clouds," he remembers. "It allowed me to feel happiness for the first time in ages. I had only focused on the bad parts of my experiences when, in reality, there were good parts of my time during that period."
Before starting the therapy, Hardin's PTSD and depression prevented him from interacting with anyone. He worked night shifts as a baker so that he could be alone. Now, he's happily married, working, excelling in school, and surrounded by friends. "Essentially, I went from not seeing a light at the end of the tunnel and constantly having suicidal thoughts to now, where the world is bright and my options are limitless," he said.
Ben Rutt, PhD, a clinical psychologist specializing in PTSD, is reserving judgment until the study is finished, however. He points out that PTSD patients are at a higher risk for substance abuse than the general population, which could lead to abuse of MDMA. He's also concerned that if we're too hopeful, the psychiatric community could make the same mistake it made with benzodiazepines, anxiety medications used for PTSD that ended up worsening many patients' problems. "Our veterans deserve better than that," he says.
And even if MDMA proves effective in therapy, that won't make ecstasy or molly a good way to self-medicate, warns Giordano. The subjects of these studies are sleeping over in the hospital so they can be closely monitored, their doses start off small and are carefully adjusted as needed, their environment is meticulously controlled, and they're not getting what you'd get at an EDM festival. Even when not mixed with other drugs, ecstasy and molly frequently contain filler or binding substances, with unknown doses and purity. And without supervision, MDMA can carry side effects like depression, overheating, dehydration, and overhydration.
"There are many risks in the recreational model, and so far, those risks have hampered medical research from moving forward," says Holland, "when it's obvious that what's needed is more research, not less."
It may be a while before MDMA revisits its glory days as therapists' drug of choice. But the good news is that, if it does get the government's go-ahead, people can benefit from it without risking their health or safety.