MDMA Therapy Approval?

I left the lasers, glow sticks & debauchery of the UK rave scene far behind me almost 2 decades ago. For those fleeting years weekends were 48 hours of hedonistic freedom, where freely available to those 'in the know' the club drug ecstasy; aka MDMA, Molly or Mandy. MDMA is a powerful mood enhancing compound that can increase energy, empathy and pleasure. The feeling on MDMA is often described as ‘loved up’ or ‘euphoric’.

With all the amazing medical advancements happening right now in the world of natural healing through plant medicines, Kambo treatments and psychedelics this got me thinking about MDMA. While not a natural substance it does have a profound effect on mood and I have started to see articles and videos popping up about the therapeutic use of this substance to heal PTSD and other trauma based disorders.

Thinking about it took me right back to my days of hedonism, I remembered some powerful psychedelic similarities between MDMA and DMT. I became fascinated by the potential and began investigating. Now with this being a chemical substance it can lead to a what's known as a “comedown” after use so I wanted to know how this could be used safely and effectively in a therapeutic setting. Would it be used as a one off treatment or would it be more like a microdosing regimen? I had no idea so I started digging.

Here’s some of the things I found:

• MDMA has been used very successfully to treat PTSD and trauma related conditions in as little as two sessions under the care of a therapist.

• MAPS (Multidisciplinary Association for Psychedelic Studies) has been working for 33 years to make MDMA safe and legal for therapeutic use. It is now in the third and final phase of that project and it is projected that by 2021 MDMA-assisted psychotherapy will be legal by prescription.

• In laboratory studies, pure MDMA has been proven sufficiently safe for human consumption when taken a limited number of times in moderate doses.

Let’s take a closer look at what MDMA really is and how it works.

What is MDMA and how does it affect brain chemistry?

3,4-Methylenedioxymethamphetamine or MDMA is a recreational drug commonly called “Molly”, “Mandy” or “Ecstasy”. MDMA is in a class of compounds called “phenylethylamines”. Phenylethylamine is the parent of the “amphetamines” which contain methamphetamine and other stimulant type compounds.

The exact mechanism of how MDMA works in the brain is quite complicated and beyond the scope of this article so I’ve summarised it -

MDMA acts primarily as a releasing agent of serotonin and to a lesser extent norepinephrine and dopamine. Essentially it floods the brain with these powerful, “feel good” neurotransmitters which creates a powerfully positive, altered state of consciousness. With that being said MDMA doesn’t create more serotonin within the brain, rather it causes the release of what the brain already has stored. For that reason there is a finite amount of serotonin that can be released before it essentially runs out. Similar to withdrawing £100 from a cash machine at night, you wake up with less to spend the next day.

This “running out” of the stores of serotonin are what cause the “comedown” feeling after use. This can be a period of feeling depressed, tired and irritable. With non-excessive use this feeling is only temporary and as the brain replenishes itself things do return to normal.

This all sounds great but how can MDMA be used to help people with PTSD?

Firstly, let’s just define PTSD - Post Traumatic Stress Disorder (PTSD) is a chronic condition that can severely affect a sufferers quality of life. When someone is traumatised and they are not able to deal with the energetic and emotional impact of this trauma at the time, it gets stored in the body. It literally gets locked inside. I also involves changes in the brain where there is decreased activity in the hippocampus and prefrontal cortex which are areas associated with learning and memory and increased activity in the amygdala, which is associated with fear. PTSD can be caused by any particularly stressful events. Examples of such events such are war, sexual assault, childhood abuse, accidents and torture.

A powerful treatment for PTSD involves getting the person to relive the trauma and then be able to properly manage the emotions that come up. As you can imagine for many severely traumatised people this could be extremely frightening and difficult. The memory of the trauma can invoke such a severe anxiety response that the person can’t cope. This can cause them to literally run out of the therapy room or go into a dissociated state where they feel safe. Essentially they are disengaging from the therapist rendering any further treatment useless.

As MDMA decreases fear and defensiveness, while increasing trust and empathy it can make it much easier for patients to bond with a therapist and be comfortable reliving certain memories. Brain-imaging has shown that MDMA dampens down the anxiety circuit of the brain and so can reduce the impact of reliving traumatic memories.

Talking from my own experience, I went through a very traumatic bereavement when I was in my late teens and I had a lot of trouble opening up and talking about it. It was just too painful. I remember the first time I used ecstasy, it was like having something unlocked inside me and suddenly I was able to talk about it. In fact, it felt really good to talk about it. It actually felt great. I was able to think about this person, revisit memories and talk about them without feeling the terrible pain of the loss. This was a revelation for me and has given me a real first-hand perspective on how MDMA could be used to help PTSD sufferers.

Are there any risks?

“Hang on a minute”, I can hear you saying; “this sounds promising but what about the risks, what about the ‘comedown’?”

A valid concern, let’s have a look at that.

Excessive use of MDMA over a period of time can cause more long term and potentially permanent changes in brain chemistry. The brain and body are always striving for a state of equilibrium. When the brain is being flooded with these neurotransmitters on a regular basis it will start to make changes in order to accommodate this. In other words, the brain thinks “Hmmmm, ok we now have regular large floods of serotonin, just to be safe I better make some changes so the receptors won’t absorb so much”.