Cutting Edge Psychology

Ecstasy as a treatment for PTSD?

Posted on April 27, 2013 at 4:30 AM

The party drug MDMA, colloquially known as the party drug Ecstasy, can be used to cure patients of severe post-traumatic stress disorder, according to a study of experimental testing of combining the drug with psychotherapy. The research, however, was not conducted on war veterans, a group most often associated with PTSD, but with rape victims, who, on average, had been living with their symptoms for 19 years.


Back in the early 2000s, Dr. Michael Mithoefer received the green-light from the DEA for clinical trials of MDMA. Along with his wife Ann, a nurse, he would administer two doses of MDMA over one intensive therapy session that lasted between eight and ten hours, following a week-long series of shorter, non-drug sessions. Then they would repeat the process three to five weeks later. During the drug-induced session Dr. Mithoefer would have the patient focus on their sexual assaults. The MDMA seemed to reduce their fear and calm them, enabling them to discuss and work through their problems in ways that they previously could not.


According to the  study, the patients symptoms of PTSD (anxiety, hyperarousal, depression, nightmares, etc.) dropped by 75%, which is "twice the relief" patients experienced with non-MDMA therapy. And the 15 out of 21 people who recovered, remained that way, nearly 10 years after treatment.


One woman who worked with the Mithoefers, Rachel Hope, shared her story with  CNN. She was raped repeatedly when she was four years old after her mother went out of town and left her in the care of a pedophile for six weeks. Decades later, in 1998, the news that the man who'd sexually abused her was being investigated for molesting another girl caused Hope to have a breakdown.


"I started having these outrageous flashbacks, and body memories. The first time, I thought someone slipped me a drug. Because it would be these unstoppable, full-body blackout memories, and people would tell me later, 'You were just screaming for an hour.'"


Her symptoms were debilitating, involving panic attacks, anxiety attacks, irritable bowel syndrome, insomnia, bleeding ulcers, and nausea. She'd been hospitalized multiple times. Hope tried nearly every form of therapy— eye movement desensitization and reprocessing , cognitive behavioral therapy, hypnosis, acupuncture, and  gestalt therapy —to no avail. She began to accept that she just might be disabled. And then she read about Mithoefers. Within weeks of working with them, she says that 90% of her symptoms were gone.


Naturally, the military is very interested in the Mithoefers' results. Loree Sutton, who served as an Army psychiatrist until she retired two years ago, finds the research "promising." Since publishing his work, Dr.Mithoefer began treating veterans, police officers, and firemen. But civilians actually make up the majority of the seven million people suffering with PTSD, many ofthem being survivors of sexual assault.


Comment:

i've come across this research before. It is actually not a test of Ecstasy on its own, as they provide plenty of emotional support during the trial- so it is a test of ecstasy and psychological support (but they usually fail to mention the latter element of the treatment, and only mention the drug element). Around 90% of people who undergo EMDR for trauma improve on their measures of PTSD- it is the most effective treatment for trauma devised yet, even though the woman quoted did not get better with it (that response is actually unusual), but like any effective treatment, may not suit any particular individual for a variety of reasons). But it demonstrates the point that not much can be concluded with small samples- for anyone to conclude any treatment approach is effective, the treatment condition (eg. ecstasy) needs to be isolated, and compared against placebo treatments (preferably double blind controlled experiments to eliminate experimenter bias); and then the finding needs to be independently replicated several times. If ecstasy then is proven to be effective by this kind of replicated research, then it may prove to be as effective as something like EMDR. At that point, if it is found to be as effective, then you would have to compare the potential risks/adverse side effects of either approach- is ecstasy safe for all people (or can some people flip out on it?).

 

No drug is safe for everyone, including cannabis, alcohol, prescription drugs, etc. This is because we are all born with a different loading of CYP450 liver enzymes which are required for the metabolism and elimination from the body of the drug in question. We all have different levels of the required CYP450 liver enzymes- some people have an abundance (the normal drug dose will barely touch the sides); some people have an adequate amount; some people have an inadequate amount (will suffer some adverse side effects); and some people have none of them (can suffer catastrophic side effects, including toxic psychosis). As such, any psychoactive drug will have a very different effect, depending on how well an individual's system is able to break down the drug and expel it (or fail to do so, resulting in a high concentration of the drug in the blood supply, which can ultimately poison the brain- what usually happens when people suffer a toxic psychosis from various drugs, including cannabis, alcohol, prescription drugs, etc).

 

Consequently, it is unwise to advocate the use of any drug (no matter how benign it might be for some people) as anyone can respond to it differently, according to their liver enzymes. There is no such thing as a universally safe drug- any drug which may be benign (or even 'great') for one person can drive another person to psychosis, despair and suicide. This is as true for ecstasy as it is for cannabis, alcohol, prescription drugs, etc. This fact would need to be accounted for in any advocacy of ecstasy over psychological approaches to PTSD which are known to be effective.

 

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1 Comment

Reply Gentian
11:18 PM on November 2, 2015 
Interesting article, thanks James. I agree, drugs (including psychiatric medication and other drugs, as they use the same metabolic pathways) can be very dangerous for certain people, and I'm one of them, due, as you say, to my CYP450 status. It's great to hear more and more people talking about this problem, which is actually more common than people realise. When , I used to take ecstacy, I would be unable to sleep or eat for up to days, and get very shaky, freezing cold, overheat, confused and at times, would pass out. I also have heard positive things about treatment for PTSD with MDMA, so perhaps in the future, (if MDMA therapy is ever made legal), people wanting to undergo that therapy could have a gene test first.