Does positive effects of therapy. More recently, MDMA

Does the use of MDMA assisted therapy for PTSD create long term remission in symptoms in people suffering from treatment resistant PTSD.
Melissa Sullivan-DiNardo
North Shore Community College

Ecstasy is considered an illegal drug that is typically found in clubs. However, prior to it being classified as a schedule I controlled substance in 1985 there was a sizeable group of psychologists, psychiatrists and therapists who were using 3,4 methylendiozmethamphetamine (MDMA) as a way to help increase the positive effects of therapy. More recently, MDMA has been used to assist in increasing the therapeutic outcomes of those who are struggling with treatment resistant PTSD. Due to MDMA being classified as a schedule I drug, there are only a few scientific controlled studies that have been completed, these have however shown positive improvements and education in symptoms.
In an article by Passie (2018) he reviewed that historical context of the use of MDMA. Passie provided an overview of the very beginnings of MDMA assisted therapy. Passie (2018), as early as 1960 Chilean psychiatrist Claudio Naranjo began to use Methylenediozy-amphetamine MDA, and early form of MDMA to facilitate psychotherapy (Passie 2018). Naranjo’s associate Alexander T. Shulgin synthesize MDA into MDMA (Passie 2018). This new synthesized version had lower hallucinogenic activity, and had some promising therapeutic properties (Passie 2018). Another important figure in the early days of MDMA psychotherapy was Leo Zeff (Passie 2018). Zeff was made aware of the toxicity of MDA in the early 1970s, and was introduced to MDMA by Shuglin. Zeff later became known as “the Secret Chief” due to his involvement in MDMA assisted therapy (Passie 2018). Zeff began this theraputic work in 1977, and over a 12 year period he provided MDMA assisted therapy to about 400 people, and trained over 150 therapists (Passie 2018). Ann Shulgin, a lay therapist and Shulgin’s wife began her work in MDMA assisted therapy in 1980, and instructed by Zeff to partner with a licensed therapist, and this therapist would refer clients who had been in therapy for the past 6 months (Passie, 2018). Having clients already involved in therapy continued to become a more common occurrence as the use Of MDMA therapy becomes more popular. Ann Shulgin structured her MDMA sessions by having clients agreeing to following 4 agreements, and additional prerequisite of treatment would be for clients to have a caring and trustful relationship with their therapist (Passie 2018). A strong therapeutic alliance is commonly known to improve the outcomes of therapy more than any other factor.
MDMA assisted therapy is a controversial topic due to the illicit nature of MDMA or ecstasy as it is more commonly known. Feduccia and Mithoefer (2018), “MDMA is a psychoactive substance that promotes release of serotonin, (nor)epinephrine, and dopamine…”(Feduccia and Mithoefer 2018). This has been shown to lead to “subjective effects that reportedly enhance aspects of therapy” (Feduccia and Mithoefer, 2018). Unfortunately, many people see ecstasy has a club drug, a drug that people take to get high and party and are unable to see the therapeutic effects that MDMA could have on those suffering from PTSD.
Oehen et. al report that PTSD is a major and costly public health problem all over the world, it has almost an 8 % prevalence rate in the US (Oehen et al., 2013). The most effective treatment for PTSD is psychotherapy, more specifically Cognitive behavioral therapy, Prolonged Exposure Therapy, Cognitive Processing therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR) (Oehen et al., 2013). These types of therapy can be effective, however according to Oehen et al., studies have shown that there is a high drop out rate and have a limited effect on decreasing a person’s symptoms. Due to the low efficacy of treatment, PTSD is considered a chronic illness, with high rates of psychiatric and medical comorbidity and suicidality (Oehen et al., 2013). Even with medication in combination with therapy has been shown to have modest effects. Feduccia and Mithoefer (2018), discussed the use of exposure therapy on individuals with PTSD and found that some patients experienced a reduction in their symptoms however 40-60 percent did not respond accurately (Feduccia and Mithoefer, 2018). Feduccia and Mithoefer (2018), also reported a high amount of dropout rates due the the various symptoms related to PTSD (Feduccia and Mithoefer, 2018).
Typical psychotherapy has been ineffective because many clients are unable to tolerate the feelings associated with their trauma or begin to emotionally numb during exposure treatments, which prevents the clients from fully processing the trauma and healing (Mithoefer et al., 2010). Mithoefer et al., postulate that by widening the window between the threshold between over and under arousal with the therapeutic effect of MDMA, that Clients will be able to stay engaged without becoming overwhelmed and be able to effectively utilize exposure therapy (Mithoefer et al., 2010). Mithoefer et al (2010), completed the first randomized controlled pilot study that measured the safety and efficacy of MDMA assisted psychotherapy for individuals with treatment-resistant PTSD, these individuals were either given MDMA with psychotherapy or placebo and psychotherapy in a double blind manner (Mithoefer et al., 2010). Participants were given various assessments in order to get a baseline for their symptoms prior to treatment, these were given at the end of the study as well to rate the effectiveness of MDMA assisted treatment (Mithoefer et al., 2010). Mithoefer et al., found that those individuals whom had the MDMA assisted treatment was clinically significant in symptom reduction; and high percentage of those individuals no longer meet the criteria for PTSD 2 months after MDMA assisted psychotherapy (Mithoefer et al., 2010).
In a follow up study, Mithoefer et al., completed a follow from the first trial to evaluate the durability of improvement in PTSD symptoms and absence of harmful effects or drug dependency after MDMA assisted psychotherapy (Mithoefer et al., 2013). Following the original study, of the therapy only individuals completed the MDMA assisted treatment, this lead to 19 out of 20 participants completing MDMA assisted treatment (Mithoefer et al., 2013). All participants were given three different outcome scales, these were completed in order to see if MDMA assisted treatment outcomes persisted overtime (Mithoefer et al., 2013). Mithoefer et al., found that 3 ½ years after the end of the original study exit there are clinically significant benefits, upwards of 89 % of participants had long-term improvements (Mithoefer et al., 2013).
Sessa and Nutt (2015) found that there are no lasting physiological or psychological effects, and no neurophysiological impairments or evidence of dependence (Sessa and Nutt, 2015). This is important as people with PTSD have a high rate of suicide and the financial, social and clinical impact that untreated PTSD has on society (Sessa and Nutt, 2015). With minimal side effects, and large positive treatment outcomes, MDMA assisted therapy for treatment resistant therapy is a step in the right direction.
MDMA assisted therapy allows those who suffer from treatment resistant PTSD to have relief from their symptoms, and do the work necessary to process their trauma, and be able to live their lives to the fullest. Advocating for alternative treatment options is an important part of being a part of the therapeutic community. More controlled randomized studies need to be completed prior to MDMA being considered a treatment of choice by a provider or by mainstream society and for it to have more evidenced based research behind it. Funding, the FDA and research needs to be increased in order to have MDMA to get research completed, and to expand treatment to others who suffer with mental health disorders. MDMA could be a safer alternative to other medications that often have strong side effects or could cause addiction to take place, as stated before MDMA has minimal to no long last impact on a person’s psychological or physiological wellbeing. MDMA is also a safer alternative to medications, and “traditional” treatment because it requires a person to participate in therapy prior and during the time a person is taking MDMA.
I look forward to seeing how MDMA treatment continues to expand. I think that it will be a useful tool in helping those people who have not seen results from traditional therapy. I think that we need to be mindful of alternative treatment as we move forward in treating those with PTSD and trauma, and other mental health issues. Being well rounded is the best course of treatment in my opinion, and I can see MDMA assisted treatment being a part of treating those with trauma in the future.

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Bibliography

Sessa, Ben, and David Nut. “Making a Medicine out of MDMA.” Cambridge University Press, The British Journal of Psychiatry, 2 Jan. 2018, Retrieved from www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/making-a-medicine-out-of-mdma/C731B7DC0DFDD1C4379C075B65E408E2.

Michael C Mithoefer, Mark T Wagner, Ann T Mithoefer, Lisa Jerome, Scott F Martin, Berra Yazar-Klosinski, Yvonne Michel, Timothy D Brewerton and Rick Doblin. (2012) Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamineassisted psychotherapy: a prospective long-term follow-up study Journal of Psychopharmacology, 27 (1) 28-29. Retrieved from http://journals.sagepub.com/doi/abs/10.1177/0269881112456611

Michael C Mithoefer,Mark T Wagner, Ann T Mithoefer, Lisa Jerome and Rick Doblin The safety and efficacy of 3,4-methylenedioxymethamphetamineassisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. Journal of Psychopharmacology 25(4) 439-452, 2010

Allison A. Feduccia, Michael C. Mithoefer (2018) MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? Progress in Neuropsychopharmacology & Biological Psychiatry, 84 (2018) 221-228. Retrieved from https://www.sciencedirect.com/science/article/pii/S0278584617308655

Torsten Passie. (2018) The early use of MDMA (‘Ecstasy’) in psychotherapy (1977-1985) Independent Scientific Committee on Drugs, (4) 1-19. Retrieved from http://journals.sagepub.com/doi/full/10.1177/2050324518767442

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