The world can be a scary place for people with PTSD. Modern medicine has tried many ways to treat the disorder, from drugs to therapeutic tactics, but they don’t always work. Evidence build-up shows alternative remedies like the psychedelic MDMA might be a better long-term response to PTSD treatment.
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What is PTSD?
Post-traumatic stress disorder is a psychiatric disorder, meaning that it is diagnosed subjectively. It affects people who have had a traumatic experience, whether they were actually part of it or are just witnessing it. This can be things like physical assault, witnessing war atrocities, living through natural disasters, or being the target of bullying or psychological abuse. PTSD is diagnosed separately from other anxiety-based mental illnesses that result from experiencing a traumatic event.
PTSD was known as “Grenade Shock” during World War I and “Battle Fatigue” after World War II. It is associated with disturbing and often very intense thoughts about past traumas. This may include reliving the event in flashbacks or nightmares, fear, sadness, anger, and feelings of distancing and alienation from other people. People with PTSD often react very negatively to situations that others find non-triggering and may avoid situations or people that remind them fully of their previous trauma.
Subjective diagnoses make it difficult to summarize statistics. However, according to psychiatry.org, approximately 3.5% of adults in the US suffer from PTSD each year, and it is estimated that about one in 11 people will have PTSD in their lifetime. Women are the predominant afflicted, 2: 1 more than men, and the three ethnic groups that most commonly experience PTSD symptoms in the United States are Latinos, African Americans, and Native Americans – all minorities who have experienced high levels of violence and intolerance overall and general contempt that has been directed against them throughout history.
What is MDMA?
3,4-methylenedioxymethamphetamine, colloquially known as ecstasy or molly (slang for “molecular”), is a man-made psychoactive drug made from safrole oil, which is mainly found in sassafras plants. MDMA has properties of both hallucinogens and stimulants, which work primarily through its interaction with serotonin receptors. It forces the brain to release large amounts of the neurotransmitter while blocking its reuptake to aid in the extra absorption. MDMA is available either as a pressed pill or as a powder, which can range from brown to white.
MDMA is known to promote a sense of connectedness between people, reduce anxiety and fear, and increase feelings of empathy. It was developed by Merck Pharmaceutical in 1912, but its effects were not understood until the 1970s when chemist Alexander Shulgin developed a new method of synthesizing the drug and tried it with some of his friends as a psychotherapist. This is the time at which it was used in psychotherapeutic practices as a treatment method in connection with therapy sessions, the so-called psychedelically supported therapy.
Although MDMA was useful in dealing with mental disorders, it was made illegal in 1985. In 1984, President Ronald Reagan’s administration enacted the Comprehensive Crime Act, which allowed the government to ban drugs in an emergency. When the subject of MDMA came up in 1985, after other psychedelics had already been illegalized, that law was used to immediately illegalize the association by adding it to Appendix I of the Treaty on Psychotropic Substances and ending its therapeutic use.
The illegalization of psychedelics began with smear campaigns during the Vietnam War, which culminated in 1968 with the passage of the Staggers-Dodd Act, which specifically illegalized LSD and psilocybin. This was followed by the creation of the Psychotropic Substances Convention in 1971, which banned most of the rest, with the exception of MDMA, which was later banned.
While the subject is obviously controversial, statements by John Ehrlichman, former Assistant to the President for Internal Affairs under President Nixon in 1994, have made it clear that the war on drugs was not necessarily about drugs. Raise further concerns about why drugs like MDMA have become illegal. In his statement he claimed:
“The Nixon campaign of 1968 and the Nixon White House afterwards had two enemies: the anti-war left and the blacks … We knew that we couldn’t make it illegal to either be against the war or against blacks, but by us Bringing the Public into It If we associate the hippies with marijuana and the blacks with heroin and then grossly criminalize both of them, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and slander them on the evening news night after night. Did we know we were lying about the drugs? Of course we did. “
MDMA used to treat PTSD
What do we really know about MDMA’s ability to treat PTSD symptoms? A systematic review was published in 2020 examining articles published by the end of March 2019 using key terms such as “treatments for PTSD” and “MDMA pathway”. All articles came through PubMed and ScienceDirect.
In identifying and reviewing these articles (and their sources), it was found that there have been many small researches that show that MDMA helps reduce psychological trauma. However, the authors of the review made a very important point. They stressed that none of the research showed MDMA as a cure for PTSD because it had not been specifically researched. What the review identified, and what had been investigated, was the usefulness of MDMA-assisted psychotherapy and its ability to help people who were unable to resolve their trauma problems through other avenues.
The big story with MDMA today revolves around ongoing studies. By last summer, the Multidisciplinary Association for Psychedelic Studies (MAPS) had started phase 3 clinical trials on MDMA. MAPS conducts double-blind, placebo-controlled, randomized studies at multiple locations to test the safety and effectiveness of MDMA-assisted therapy for PTSD. The participants are 200-300 PTSD patients, all over the age of 18 but with a different history to produce their traumatic experiences.
These studies follow the Phase II studies with promising results and are the final hurdle required by the US Food & Drug Administration (FDA) to assess legalization in the treatment of PTSD. Should it get the passport, MDMA could be prescribed along with therapy in residential outpatient facilities so users can gain their experience in a safe and controlled environment.
How likely is the FDA to approve MDMA for the treatment of PTSD? It’s an Appendix I psychedelic, after all, which defines it as highly dangerous with no therapeutic value. Apparently, the FDA identified MDMA as a “breakthrough therapy” for PTSD as early as 2017.
The FDA defines “breakthrough therapy” as a “drug that treats a serious or life-threatening condition, and preliminary clinical evidence suggests that the drug may have a substantial improvement in a clinically significant endpoint over available therapies.” This definition is intended to help to accelerate research progress to bring products to market. In 2019, the same name was given to psilocybin in magic mushrooms by the FDA.
More information on MAPS phase 3 studies
Phase 3 studies were designed according to an evaluation of the special protocol agreed between MAPS and the FDA to ensure that the studies and results are compliant. The trials are taking place at 15 different locations in three countries: the USA, Canada and Israel. The participants receive three therapy sessions with MDMA or placebo over a 12-week therapy period as well as three preparation sessions and three integration sessions without medication. The MDMA / placebo sessions take place every 3-5 weeks.
The (CAPS-5) – physician-administered PTSD scale – is the primary measurement tool for the success of the study. This is a loosely structured interview used in most PTSD studies and requires evaluation by evaluators who are “blind” or do not know where the study participant is falling on the actual drug or placebo. Study investigators will also use other measurement tools including, but not limited to: Beck Depression Inventory and Inventory of Psychosocial Functioning.
“Phase 3” naturally implies that this is not the start of the study. The results of the Phase 2 study show the following about MDMA and its ability to treat PTSD: It may reduce anxiety and defenses. Increasing introspection and communication as well as empathy and compassion; and generally improves the therapeutic experience of people suffering from PTSD. Phase 2 consisted of 107 patients.
Two months after MDMA-assisted treatment in phase 2, 61% of patients were no longer diagnosed with PTSD. One year after treatment, 68% no longer qualified as PTSD. All participants had chronic PTSD that was resistant to treatment and that they had suffered from for an average of almost 18 years.
It is getting hot in the race to see which psychedelic will receive first medical legalization in the US (as the US so often sets the standard for other parts of the world). Magic mushroom psilocybin is sure to make waves, but it looks like MDMA is going to take the win. With the FDA drooling ahead of approval and the pharmaceutical world getting its ducks in a row, it looks like MDMA will be officially approved for the treatment of PTSD soon, with a change in global legalization policies likely to follow.