THE PTSD PROBLEM
Post-Traumatic Stress Disorder, or PTSD, is a mental disorder that can develop after someone undergoes a traumatic event. Individuals who experience PTSD often report recurring unwanted memories of the traumatic event, nightmares, and flashbacks. The intense distress also affects their choices, causing them to avoid certain areas, people, or activities that remind them of their trauma. They may develop depression, anxiety, irritability, and self-destructive behavior. Individuals who have PTSD are also at an increased risk for suicide and self-harm.
In the US alone, almost 8 million adults are expected to experience PTSD in a given year. Apart from those afflicted by it, PTSD also affects family, friends, loved ones, medical caretakers, and society as a whole. Veterans, victims of emotional abuse, physical abuse, natural disasters, or assault are all groups that are particularly vulnerable to developing the disorder.
Unfortunately, existing treatments for PTSD are often ineffective and even dangerous. Take, for example, benzodiazepines, widely-prescribed pharmaceutical drugs often given to treat PTSD. In a recent review of over 18 studies, including over 5,000 participants, researchers found no evidence to suggest that benzodiazepines improved symptoms of PTSD. If anything, the studies suggested that the drugs exacerbated symptoms. To make the crisis worse, many who have PTSD are reluctant to seek help, deterred by the stigma surrounding the disorder. It is clear that PTSD is a serious public health threat, and that new, effective treatments are needed.
Just as stigma can prevent individuals from seeking help, stigma can also prevent health care providers from implementing effective treatments. One such treatment is MDMA.
First synthesized in the early 20th century, MDMA became an important tool for psychotherapists by the 70’s and 80’s. The substance reduced anxiety and inhibitions in psychotherapy patients and quickly spread amongst psychotherapists due to its effectiveness in therapy. Inevitably, the drug leaked to the streets and caught the attention of drug enforcement. In the US, it was made illegal in 1985 and classified as a Schedule I substance. But in recent years, MDMA has been attracting attention as holding the potential to treat PTSD.
In a pilot study conducted by MAPS (the Multidisciplinary Association for Psychedelic Studies) and published by the Journal of Psychopharmacology, 20 patients with PTSD participated in psychotherapy sessions. These patients had all failed to respond to prior treatments and therapy and had been suffering from PTSD for many years. Before the therapy session, researchers gave 12 patients MDMA, and eight a placebo. Healthcare professionals carefully oversaw the study, and trained psychotherapists conducted the therapy sessions.
Afterward, the patients were measured according to the Clinician-Administered PTSD Scale for any change in symptoms of PTSD. The difference between the MDMA and the placebo group was staggering. While the placebo group showed only a 25% response rate to the therapy (2 of 8 patients), the MDMA group had an 83% response rate (10 of 12 patients). Following the treatment, nearly all of those who had received MDMA before psychotherapy no longer met PTSD criteria. The study also found no evidence of harm to patient health from the single session. Perhaps most remarkably, a long-term follow-up studyfound that 74% of the patients who had relieved their PTSD symptoms in the first study remained PTSD-free years later.
Here is a testimonial from one of the participants in the MAPS study:
“My symptoms of PTSD became “treatment-resistant” after the medication and psychotherapy that the Veterans Affairs provided was ineffective. I began to search for alternative treatment methods, and that’s when I heard about the trial of MDMA-assisted psychotherapy to treat PTSD. After being accepted as a participant and receiving the treatment, I am proud to say that I am no longer on medications, I am able to more fully live my life, and my relationship with PTSD has changed completely.”
NEW HORIZONS, NEW SOLUTIONS
The findings of MAPS’ studies paint a hopeful picture for the future of PTSD treatment. Many currently prescribed medicines are ineffective, dangerous, or both. Drugs like Paxil and Zoloft only show about a 20% success rate in patients, and while talk therapy treatment has worked better than existing medicines, it still requires consistent attendance, which is hard to guarantee in PTSD patients.
The early research suggests that MDMA may offer the most effective treatment for PTSD. But the research is still in its infancy. The MAPS studies used small samples, and more studies with larger samples are needed if MDMA is ever going to become an accepted treatment for PTSD. There is also the legal situation—MDMA is still classified as a Schedule I controlled substance. According to the DEA, a Schedule I listing means that a substance “has a high potential for abuse,” “has no currently accepted medical use in treatment,” and poses a significant health risk if used.
But public opinion is shifting, and the MAPS studies resulted in promising developments for the future of psychedelics. The FDA recently approved further clinical trials for MDMA in therapy, and given the drug a “Breakthrough Therapy” status that MAPS hopes will fast-track MDMA’s federal approval as a therapeutic drug. Legalizing MDMA would mark a significant victory not only for public health but the psychedelic cause as a whole.