Psychedelics

How does MDMA work to treat PTSD?

MDMA, the active ingredient in “ecstasy” or “Molly,” has been isolated and controlled for safe, therapeutic use in research studies. MDMA-Assisted Psychotherapy for PTSD involves the use of prescribed doses of MDMA in conjunction with psychotherapy sessions. PTSD can make it difficult for you to respond appropriately to trauma-related triggers, and talking about a traumatic event in psychotherapy sessions can be difficult. Research suggests that MDMA may reduce activity in the amygdala, partly responsible for the exaggerated fear response in PTSD. The chemical changes that happen in the brain in response to MDMA use also evoke feelings of calm and trust and affiliation with other people, including a therapist. In addition to enhancing trust in the therapeutic relationship, MDMA can create a feeling of detachment from traumatic memories, allowing you to talk about and work through these memories without the sense of immediate threat. MDMA is not a therapy for PTSD in and of itself; rather, it is used in MDMA-assisted psychotherapy for PTSD as a “catalyst” or as a drug that supports the therapeutic processing of traumatic events in therapy sessions.

What is the treatment like?

In the current clinical trials of MDMA-assisted psychotherapy, treatment takes place in a quiet, comfortable, and private space with a psychotherapist. There are non-MDMA psychotherapy sessions before those with MDMA use begin. This provides an opportunity for you and your therapist to get to know each other and create an environment of comfort and trust. MDMA is only taken three times under supervision of the psychotherapist during the 12-week course of treatment. The in-between sessions don’t involve MDMA use. Eyeshades and headphones for calming music are provided, but their use is optional. The therapist will encourage the recognition of physical reactions and provide guidance on how to express and release uncomfortable feelings that may arise. Sometimes breathwork will be used with the aim of providing control, relaxation, or focus.

Since MDMA is a controlled substance, safety measures should be in place, as they are in supervised research trials. Although there have not been emergencies requiring medical intervention during any MDMA research sessions, MDMA-assisted psychotherapy should take place with quick access to medical care, just in case it’s needed.

Why does MDMA-assisted psychotherapy work?

As studies are still being conducted, the current research suggests that MDMA may reduce activity in the amygdala, partly responsible for the exaggerated fear response in PTSD. It may also increase the levels of beneficial hormones in the brain including serotonin and oxytocin, which evoke feelings of calm and trust and affiliation with other people, in this case the psychotherapist. With fears allayed and trust enhanced, you are able to connect with emotions surrounding the traumatic event and share those feelings openly with the therapist.

How can someone access MDMA-assisted psychotherapy for PTSD?

Currently, the way to access this treatment is through participation in an approved, supervised research study. It is important to note that this therapy is still being researched and that it is not recommended for all people with PTSD. This treatment also involves much more than simple use of MDMA. It focuses on the use of MDMA to support therapy for PTSD as provided by trained professionals. This research is being conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS).

Video and Audio

• The Promise of Psychedelics for PTSD
  From YouTube
• Psychiatrist Explores Possible Benefits Of Treating PTSD With Ecstasy Or Cannabis
  From NPR
• Using Psychedelic Drugs to Treat Mental Health Disorders
  From Diane Rehm

Available Programs (limited list)

MDMA-Assisted Psychotherapy - MAPS (scroll down to “MDMA-Assisted Therapy for PTSD: MAPS-Sponsored Clinical Trials”)

Participate in a MAPS Trial 

How To Join a Psychedelic Clinical Trial - Psychedelic.Support (scroll down)

Heroic Hearts Project - Helping veterans with PTSD access psychedelic programs.

Hope Project - Connecting military spouses, veteran women, and gold star wives to psychedelic treatments.

References

Doblin, R. (2019, July 9). The future of psychedelic-assisted psychotherapy. TED Talks.

Mithoefer, M.D., M. C. (2015). A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder (Version 7 ed.) [E-book]. Multidisciplinary Association for Psychedelic Studies.

Mithoefer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L., & Doblin, R. (2010). The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. Journal of Psychopharmacology, 25(4), 439–452.

Morgan L. (2020). MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD: what it is and what it isn’t. Annals of general psychiatry, 19, 33.

PRESS RELEASE: FDA Grants Breakthrough Therapy Designation for MDMA-Assisted Psychotherapy for PTSD, Agrees on Special Protocol Assessment for Phase 3 Trials - MAPS. (2017, August 26).

Thal, S. B., & Lommen, M. J. J. (2018). Current Perspective on MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder. Journal of Contemporary Psychotherapy, 48(2), 99–108.

The Veteran: Psychedelics for PTSD: What a Long Strange Trip It's Been - MAPS. (2021). MAPS.

Wagner, M. T., Mithoefer, M. C., Mithoefer, A. T., MacAulay, R. K., Jerome, L., Yazar-Klosinski, B., & Doblin, R. (2017). Therapeutic effect of increased openness: Investigating mechanism of action in MDMA-assisted psychotherapy. Journal of Psychopharmacology, 31(8), 967–974.