Wayne State University’s Arash Javanbakht is an associate professor of psychiatry. This essay was first published in The Conversation.
MDMA paired with psychotherapy can better treat post-traumatic stress disorder or PTSD, including one that will be published in Nature Medicine soon. The news sparked widespread hope and enthusiasm in the newspapers, as well as among some scientists.
As a psychiatrist who specializes in neurobiology and the treatment of PTSD, I believe these advances are significant—but not as substantial as others have suggested. This strategy isn’t a brand-new panacea. A war veteran talks about his PTSD symptoms.
PTSD is an emotional memory condition.
Exposure to severe stressful experiences, such as natural disasters, motor car crashes, abuse, kidnapping, rape, war, and torture, causes post-traumatic stress disorder. People can experience PTSD, a state of heightened anxiety that involves hallucinations, delusions, and avoidance of any reminder of the trauma, depending on the form and nature of the trauma.
In the field of psychiatry, PTSD is described as an emotional memory disorder in which recalling a painful memory will cause intense anxiety as though the experience is occurring right now. PTSD patients also develop anxiety reactions to something that reminds them of the trauma. We may also think about PTSD as a background processing disorder: a person’s cognitive response to a noisy noise in a healthy civilian setting is the same as it is on the battlefield.
Treatments for PTSD that are currently available are reliable.
Antidepressant drugs and psychotherapy are the most common treatments for PTSD.
Since it discusses painful experiences and associated mental and cognitive responses, psychotherapy is one of the most common therapies for PTSD. That is, a person who has PTSD can conflate trauma with being the wrong person. Trauma-related cognitive patterns, or cognitions, are addressed in psychotherapies.
Exposure therapy is often used by trauma therapists to eventually help patients open themselves to experiences or memories that they fear before they learn that they are healthy. The aim is to assist the person with PTSD’s brain dissociating painful memories from the unpleasant feelings they elicit. Extinction of fear memories is the name given to this operation. And it’s here where scientists and others hope MDMA and other treatments can help by speeding up the disappearance of these terror memories.
MDMA: It won’t help with PTSD on its own.
For some people, exposure therapy to painful memories is a complex and stressful procedure. Researchers are looking for medications that can intensify the effectiveness of psychotherapy and speed up or improve the extinction of painful memories.
MDMA, or 3,4-methylenedioxymethamphetamine, is a stimulant that affects various neurotransmitters, such as serotonin, dopamine, and norepinephrine, which facilitate signaling between neurons. There are a few hypotheses on how MDMA affects the learning brain in treatment, but no one knows for sure.
MDMA can help patients feel better about themselves and others, increase bonding with the therapist, and improve extinction learning by decreasing anxiety during the retrieval of trauma memories.
Recent clinical trials show that combining MDMA with carefully delivered psychotherapy will help patients see better results. Furthermore, these symptoms seem to last for months after the procedure is completed. Following these encouraging findings, the researchers conducted a multisite phase 3 clinical trial involving 90 patients with severe PTSD, with 67 of them reporting substantial reductions in symptoms.
It’s crucial to mention that MDMA isn’t recommended as a stand-alone medication for any illness, and only “MDMA-assisted” psychotherapy is researched in this study.
Often breakthroughs shatter people’s hearts.
Even though these findings sound optimistic, I remain wary of medical breakthroughs. People have been too enthusiastic about promising remedies for PTSD and other mental conditions, such as psychoanalysis, ketamine, cannabinoids, augmented reality, propranolol, antidepressants, and memory-enhancing agents, in the evolution of psychology.
None, each of these therapies, was beneficial to certain people; neither of them was a cure-all. Many drugs, such as morphine, propranolol, and memory enhancers, never made it out of the lab and into the pharmacy.
We also don’t have an excellent mechanistic rationale for how MDMA can have accelerated effects while still maximizing long-term therapeutic effects.
The dynamics in actual clinical practice are vastly different from those of a tightly regulated laboratory trial with a small number of participants. Many mental or medical disorders that many people have, for example, are exempt from clinical trials. Psychotherapies are often administered possibly. When it comes to medications like ketamine and MDMA, blinding studies—that is, keeping both the patient and the doctor in the dark on whether they took the study medication or a placebo—is almost impossible. Most patients, and therefore most therapists, would consider when they were given the psychoactive drug or the placebo.
Trauma’s consequences have a wide range of effects, from mild to severe. We draw an arbitrary line on this spectrum—say, 70%—and mark whoever is over the line as having PTSD in order to use precise vocabulary in science. That isn’t to say that anyone at 65 or 60% doesn’t have symptoms or isn’t in pain. So far, none of the treatments that have been tested have entirely eliminated symptoms. They simply displayed a more significant reduction in symptoms as compared to a placebo.
MDMA’s potential threats and hazards
Though antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and psychotherapy are comparatively effective, substances such as cocaine, ketamine, and MDMA carry numerous risks. Addiction is the first. Even though patients in clinical trials are only given a small range of doses, it’s possible that anyone who gets a lot of help from a prescription issued in the clinic would look for it on the street.
The horrific heroin and benzodiazepine pandemic, about which people were so enthusiastic a few decades ago, is still with us. Longitudinal analyses of the dangers of future MDMA use are currently unavailable. Those with a history of prescription or illicit substance misuse and those with personality disorders can find this much more difficult.
While the marketing hype frequently implies that the medication is the solution, it’s important to note that what succeeded in these trials was a combination of drugs and psychotherapy.
It’s also essential to warn people that street drugs can not heal them. At all, the outcomes would be as successful as the treatment. As a result, an untrained individual delivering counseling, advice, or even fellowship using such agents can do much more harm than good. Negative memories can emerge, which the unskilled person is ill-equipped to cope with. It’s also worth noting that drugs purchased on the street can vary significantly from those used in testing. Impurities can be very harmful.
We’ve been here before in the realm of medical therapy. And, in some ways, the initial thrill is already costing us dearly.
