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As we begin to place renewed focus on mental health advocacy and treatments, experts are urging for better solutions to long ingrained problems.
3,4 Methylenedioxymethamphetamine better known as MDMA has been making headlines for decades. First demonized in the rave scene if the 90s, this spectacular and incredibly useful substance was pulled from a number of novel treatments, effectively shutting down any medical application the chemical could possess. However, in more recent times, researchers are again turning towards this drug to help solve one of the most puzzling and destructive emotional issues that plague today’s society. Finding a new found beneficial relationship in MDMA and PTSD.
Having been around since 1912, few seem to realize the inherent innocuity of the drug, despite it only becoming a media sensation in the 1980s. Prior to its public stigmatization, the drug was considered to be a serious contender for best treatment in resistant behavioral psychotherapy. Pharmacologically, MDMA functions similarly to the SSRIs we know today. Where it differs is its ability to affect a number of symbiotic neurotransmitters all at once. Common antidepressants focus solely on our serotonin systems, where MDMA not only affects serotonin, but also norepinephrine and dopamine. Making it a triple threat when it comes to combating negative emotional responses to historic traumatic events. Something that currently known pharmaceuticals can’t do. So why are we hesitating to roll it out as a treatment?
Perhaps the biggest hurdle to getting MDMA into a clinical setting, is finding a way to shrug off the enduring social stigma that the drug itself has, as well as battling the stigma behind PTSD. Many patients that suffer with PTSD do not seek the help they need, often feeling like they are “beyond help” or have difficulty recalling the traumatic events during therapy sessions, ones that are pivotal to their treatment. This double-edged sword creates a space where hesitancy to seek treatment, coupled with the difficulty engaging in research make MDMA treatments a tough nut to crack.
MAPS, the multidisciplinary Association for Psychedelic Studies, described this issue in their mission statement, regarding the efficacy of MDMA used for treatment of PTSD as one of monetary concern. This is because MDMA is “off-patent”, which means that finding funding for both the drug itself and the necessary studies can be extremely difficult— as there would most likely be a low return on investment, making most investors shy away from funding these necessary studies. However, the association does press that despite it not being a money maker, using MDMA for PTSD treatment could prove to be a revolutionary paradigm within the psychotherapy space, one that is in dire need of disruption.
This disruption is so necessary, as most of the drugs that are considered gold standard for PTSD treatment don’t work well and can often come with uncomfortable and unproductive side effects. Things like lethargy, weight gain, somnolence, among others. Each contributing to difficulty in treatments. Not to mention they can be dangerous if stopped abruptly and require rigorous regimens and near constant concomitant therapy. Especially in places like the US, these treatment regimens can be cost prohibitive to many who suffer with PTSD and don’t have the resources or ability to collect the necessary resources, in order to afford appropriate treatments. Meaning that because of this inherent need for return on investment, many sufferers are left behind.
Understanding Treatment Resistant PTSD
On the other hand using MDMA therapy, PTSD patients in particular, could be a way to bring more effective treatment into the clinical setting. Particularly in the way that MDMA has been found to require fewer doses and is more effective, cutting lengthy regimens short. This also means that providers could more easily allocate their own dwindling resources as patients see better results, more quickly. The biggest issue with effective PTSD treatment is getting the patient into a state of mind where they can openly begin discussing their traumatic events openly and earnestly with professionals. Something that standard pharmaceuticals can’t seem to help.
When it comes to treating PTSD, statistics seem rather positive at first glance. According to current guidelines, 70% of the global population have been exposed to extreme and traumatic circumstances, however only about 6% of those resulted in clinical PTSD. Of that 6%, 44% of patients make a full recovery, whether or not treatment has been sought. But, of those left with the debilitating diagnosis, specifically those found in veteran populations, ⅔ of those that seek treatment and follow through with regimens (of which there is an extremely high dropout rate) still retain PTSD diagnoses and symptoms. Suggesting that non-traditional therapies are required specifically for these difficult to treat populations.
The only two medicinal treatments that currently hold FDA approval for PTSD are both SSRIs (selective serotonin reuptake inhibitors); paroxetine and sertraline. Despite the reported usefulness of these medications in other emotional disturbance arenas, such as depression, few positive outcomes are associated with their use in persistent PTSD.
How MDMA Can Help
However, practitioners are finding something different when using MDMA. Veterans have an incredibly high incidence of treatment resistant PTSD, one that modern medications don’t seem to ease. With MDMA, findings are positive, as it seems to promote a better neurological environment for therapy. Producing a “warm emotionally grounded feeling with a sense of self-acceptance.” Allowing patients to better access difficult memories without feeling alienated by the drug itself. MDMA for PTSD in Canada has also shown to be incredibly useful for veterans and trauma victims alike, largely because of the efficacy of the drug. Effects are short lasting, only evident for about 4 hours with a 2 hour gradual return to baseline. Despite the feelings of warmth and contentment, MDMA rarely produces any other cognitive effects of hallucinatory imagery. Studies are finding that low dose, infrequent MDMA therapy is showing much better results than that of traditional therapies in placebo-controlled trials. With many new trials urging the community to take a closer look at MDMA-assisted therapy. While MDMA trials for PTSD are currently few and far between, largely due to unfriendly legislation and difficulties in procuring funding for research, the studies in which MDMA is used for PTSD, results seem to be incredibly promising across the board. The benefits of these therapies seem to address more than just PTSD, calming comorbidities like alcoholism, suicidality, and depression as well. Which could mean that MDMA therapies will be beneficial to an exceptionally wide spectrum of patients in the future.