Ecstasy active ingredient supports PTSD therapy

Ecstasy active ingredient supports PTSD therapy

The active ingredient MDMA is found in drugs such as ecstasy, but can also help treat post-traumatic stress disorder. © Bacsica/ iStock

The active ingredient MDMA, contained in ecstasy, may help people with post-traumatic stress disorder (PTSD) benefit more from psychotherapy. This is shown by a clinical study that also included people from ethnic minorities. After 18 weeks of psychotherapy and three accompanying MDMA treatments, the symptoms of 71 percent of those treated had improved so much that they no longer met the criteria for PTSD. In the placebo group that received psychotherapy without MDMA, it was only 48 percent. Together with a previous study, the results form the basis for MDMA to be approved in the USA for the treatment of post-traumatic stress disorder.

The active ingredient MDMA (3,4-methylenedioxy-N-methylamphetamine) influences the brain's serotonin system and, among other things, ensures a more intense perception of one's own emotions. After the synthetic amphetamine derivative was used in psychotherapy in the 1960s and 70s, it became widespread in the 1980s as an ingredient in the party drug ecstasy and was banned by the Narcotics Act in 1986. In addition to MDMA, preparations available on the black market often contain numerous other substances that can cause serious side effects and even death.

Ethnically diverse study population

However, new studies indicate that MDMA can provide valuable services in psychotherapy. A team led by Jennifer Mitchell from the University of California in San Francisco has now proven in a clinical phase 3 study that the active ingredient supports psychotherapy in people with post-traumatic stress disorder (PTSD). The team had already published a study in 2021 in which the participants received psychotherapy over 18 weeks and received either MDMA or a placebo three times under therapeutic supervision. It was shown that the people in the MDMA group benefited significantly more from the treatment than the placebo group and that the treatment was well tolerated.

However, predominantly white people took part in the study at the time, so it remained unclear whether the treatment would also be beneficial for people of other ethnicities. “Due to differences in exposure to trauma, ethnic minorities are at a disproportionately higher risk of developing PTSD,” the research team explains. “However, they are traditionally underrepresented in clinical studies.” Mitchell and her team therefore repeated the study with as diverse a group of test subjects as possible. 27 percent of the 104 participants in the current study were Hispanic, eleven percent had Asian and eight percent African roots. All people suffered from moderate to severe PTSD at the start of the study and had often already had various attempts at therapy.

Basis for approval in the USA

“Psychotherapy combined with MDMA significantly improved symptoms compared to placebo treatment,” reports the research team. From the MDMA group, 86.5 percent of those treated benefited significantly from the therapy, 71.2 percent benefited so much that they no longer met the clinical diagnostic criteria for PTSD after 18 weeks. This applied to 47.6 percent of the placebo group. The most common side effects included muscle tension, nausea, decreased appetite and excessive sweating. However, these usually disappeared quickly, so that the researchers classified the treatment as well tolerated.

“Based on the available data, it is expected that the American Medicines Agency will approve MDMA for PTSD in 2024,” says Gerhard Gründer from the Central Institute for Mental Health in Mannheim, who was not involved in the study. In his opinion, however, it will take longer before this form of therapy becomes available in Europe, as relevant study programs have been temporarily stopped due to a lack of funding. In Switzerland, MDMA has been tested in PTSD therapy for eight years under strict conditions.

What about abuse and addiction?

But what about possible abuse? “Unregulated consumption of MDMA can occur regardless of approval and has been happening for years,” says Matthias Liechti from the University Hospital of Basel in Switzerland. “It is assumed that in the absence of regulated medical access to MDMA, patients could also obtain this substance for self-treatment. This can only potentially be prevented or reduced by offering medical MDMA within medical studies, quality-controlled application programs or through approval.”

This is also relevant in view of the fact that preparations from the black market are associated with significantly higher risks because the ingredients can hardly be controlled. The content of real MDMA, which is usually less stimulating than the mixture in ecstasy, is often low. But could the MDMA administered in therapy become a gateway drug? “Whether patients could privately consume MDMA after therapy depends on the choice of patients,” explains physician Gregor Hasler from the University of Freiburg in Switzerland, who was not involved in the study. “In general, as you include more and more people with addiction problems, you have to carefully examine whether the addictive behavior is increasing or decreasing. If you take patients who have no drug experience at all and no addiction problems at all, the risk is extremely low.”

Source: Jennifer Mitchell (University of California, San Francisco) et al., Nature Medicine, doi: 10.1038/s41591-023-02565-4

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