You may be familiar with MDMA (3,4-methylenedioxymethamphetamine), also known as “ecstasy”, because of its reputation as a party drug. And you have likely seen some of the media reports on the new research and growing support for MDMA-Assisted psychotherapy for treating chronic PTSD (post-traumatic stress disorder). Due to adverse effects I’d like to share my concerns about this research and treatment and why I feel we can do better – by addressing nutrition and using amino acids like GABA and others.
In a recent press release, Colorado Study Shows Lasting Benefits of MDMA-Assisted Psychotherapy for Treating Chronic PTSD, the non-profit organization, Multidisciplinary Association for Psychedelic Studies (MAPS) reports these study results:
28 participants found that one month after their second day-long experimental session, 42.9% in the active-dose (100 mg and 125 mg) MDMA groups did not qualify for a diagnosis of PTSD, compared to 33.3% in the low-dose MDMA (40 mg active placebo) control group.
The results were even more notable 12 months after the third active-dose experimental session, which found that one year following treatment with MDMA-assisted psychotherapy, 76% of participants no longer had PTSD.
It is the largest U.S. FDA-regulated double-blind, placebo-controlled clinical trial of MDMA-assisted psychotherapy for the treatment of chronic PTSD and the results are impressive: 76% of the study participants no longer had PTSD after a year and 3 treatment sessions. I’m really happy for the participants BUT I believe we can do better because there are adverse reactions to this treatment and there are other safer approaches for recovery.
This comment about an acceptable risk profile and adverse reactions concerns me (and I suspect it concerns you too):
The study replicated previous research showing an acceptable risk profile for MDMA, with the most frequently reported adverse reactions during experimental sessions being anxiety, jaw clenching, headache, muscle tension, dizziness, fatigue, and low mood.
Adverse reactions one week following treatment included insomnia, low mood, irritability, and ruminations. Temporary elevations in pulse, blood pressure, and temperature were also recorded during MDMA sessions, and did not require medical intervention.
A common theme we see in the research on psychedelics is how effective it is for PTSD that doesn’t respond to therapy or medications. This paper states:
There is an immense need for innovative treatment options that improve outcomes, especially for PTSD refractory to psychotherapy and/or pharmacotherapies
I agree there is an immense need for successful treatment approaches, but jumping to MDMA from psychotherapy and/or psychiatric medications is skipping out the entire nutritional and biochemical step which is SO powerful and doesn’t have the above adverse effects. I’m concerned too many who have not seen benefits from therapy or medications are seeing MDMA as THE solution and are going to be harmed even further.
This paper, The Potential Dangers of Using MDMA for Psychotherapy, the author is concerned about the fact that “acute MDMA can stimulate the release of difficult feelings and memories, which may be distressing” and also the negative moods that occur after MDMA treatment:
This period of negative cognitions may be counter-productive, especially in psychiatrically vulnerable clients, for instance those with predispositions to anxiety, depression, or psychosis. For example, it could increase the likelihood of suicide in those individuals with strong post-recovery feelings of depression.
Because of this, I wholeheartedly agree with the author’s position:
it will always be far safer to undertake psychotherapy without using co-drugs. In selected cases MDMA might provide an initial boost, but it also has far too many potentially damaging effects for safe general usage.
In addition to psychotherapy, there are also so many nutritional and biochemical factors we can consider when it comes to PTSD. These don’t have any of the above damaging effects seen with MDMA. Here are a few to consider:
- In this blog post, PTSD from 3 tours in Afghanistan: Can GABA help with the anxiety? how low GABA can lead to physical anxiety, muscle tension and the need to self-medicate with alcohol or sugary foods in order to calm down and relax. We also have research supporting the use of GABA for helping with unwanted obtrusive thoughts which are common with PTSD. When low GABA is suspected we do an amino acid trial with GABA, one of the calming amino acids.
- A 2016 reports that blueberries boost serotonin and may help with PTSD and anxiety https://www.everywomanover29.com/blog/blueberries-serotonin-ptsd-anxiety/. This was an animal study where the traumatized rats were fed a blueberry-enriched diet. The study authors report an increase in serotonin levels, suggesting that “non-pharmacological approaches might modulate neurotransmitters in PTSD.”
- A recent meta-analysis, Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking, confirms the diet and lifestyle connection to being more impacted by trauma when health is not optimal.
I feel it is these above approaches and others like this that we need to be using to address PTSD, rather than subjecting individuals who are already suffering to treatments that have adverse reactions AND are not addressing underlying nutritional deficiencies of low GABA, low serotonin, out of balance endocannabinoid system and overall health, to name a few of many possible underlying biochemical factors.
If this treatment approach is approved, I would hope that all the adverse effects and dangers are clearly explained and I’d also like there to be informed consent before it is used – so individuals know exactly what they are getting into. Hopefully, by the time it is approved, nutritional psychiatry will be more accepted.
I’d love to hear your thoughts on this research and treatment approach. Is it something you have considered or would possibly consider in the future – you personally or with patients?
Or do you have similar concerns that I have?
Have you already tried MDMA recreationally (possibly for therapeutic reasons) and what were your experiences like?
Donna F says
November 2, 2018 at 8:04 pmHey Trudy, really enjoy all your wisdom. I loved mdma during my college days as it helped me connect deeply with other humans. I even counseled multiple individuals through their traumatic experiences while we were both in an mdma assisted state. Yes I agree that the initial trauma surfacing is itself traumatic and difficult, the beauty of mdma is that it helps the mind process the event and neutralize it in a way. Especially in a therapeutic setting, I can see this being most beneficial. And I’m really excited that fda is on board with this. I was 20 years ahead of my time, it seems lol. I do agree though that we should definitely take into account nutritional factors and supplementation of missing links such as GABA.
Trudy Scott says
November 4, 2018 at 8:02 pmDonna
Thanks for sharing your positive experiences. I’d love to hear more – did your use (and helping others) include therapy and was similar to this research in that it was just 3 full days over a year long period? Or how did it look? Did you or the individuals you counseled experience any of the negative moods that occur after MDMA treatment?
Unfortunately right now it’s unlikely that the functional medicine and nutritional approach will not be included when this MDMA-assisted psychotherapy is used. And clearly this will be needed especially for the negative moods that occur after MDMA treatment “especially in psychiatrically vulnerable clients, for instance those with predispositions to anxiety, depression, or psychosis. For example, it could increase the likelihood of suicide in those individuals with strong post-recovery feelings of depression.”
Chris G says
November 8, 2018 at 1:37 pmHello Trudy,
Thanks for the wonderful information here on your website.
I can share the impact that MDMA has had on myself and family members. Keep in mind, we are an exceptionally health-conscious family as far as diet / supplements. Have been for decades. In fact – I do believe we had taken this approach about as far as we could.
I have been a long-time Buddhist meditator and yoga practitioner, and have used MDMA a handful of times over the years, and feel the benefits of just a few sessions were lasting and profound. I had childhood traumas, and was not even consciously aware of the extent these were still affecting me, until I tried MDMA for the first time. Just to be clear, at this point, I feel I have gotten what is useful from it, and have no need to do it again.
A few years ago, two close family members were both in treatment for serious addiction issues, when a therapist suggested MDMA could be useful. I was very nervous about this, as I thought of MDMA as a street drug, and it didn’t make sense to me that a drug could help heal addiction. What I was unaware of at the time, was the ACES research that showed an undeniably strong association between unresolved childhood trauma and adult drug and alcohol addiction.
It took several sessions, over 6-9 months, for both to be healed of their addictions to a degree no one could have hoped for or anticipated. I am talking about serious, decades long substance, life threatening – trips to the hospital ER kind of abuse. MDMA not only resolved the compulsive drug and alcohol use – it resolved the underlying anxiety, depression, and insecurities that were the real drivers. An example, an in-law was diagnosed with PTSD after the murder of his firstborn child. He had been suffering in agony non-stop for two years. Just ONE session of MDMA with family members brought an end to the constant anxiety, grief and insomnia. It’s one year later and he is still doing great. No one I have seen has had issues with adverse affects after using MDMA. Rick Doblin, who is the director of MAPS, says that research with MDMA and placebo for controls, has shown that the MDMA ‘comedown’ is a myth.
I agree 100% that nutrition / healthy lifestyle are vitally important for mental health, but please keep an open mind that MDMA, in the proper setting, can be a profound tool for healing serious trauma.
Steven Fenwick says
November 16, 2018 at 11:09 pmMany therapists who use MDMA are familiar with the depressed mood from a serotonin crash after an MDMA session, and many already do recommend the use of 5-HTP or Tryptophan for this. The trauma healing benefits of these therapy sessions far outweighs the negative effects of a temporary low afterwards.
Steven Fenwick says
November 16, 2018 at 10:31 pmI’m a mental health counselor that recommends supplements like GABA and Tryptophan to many of my clients with anxiety and depression and find it very helpful. However this is very different from using MDMA assisted psychotherapy to resolve trauma. I have been following the research on this and it appears to be a very powerful treatment for severe trauma, and it normally only requires 1 to 3 sessions in which MDMA is used. Believe me if I could do that with GABA and Tryptophan then MDMA based therapy would not be necessary. It’s not like MDMA is taken on a regular basis like a psychiatric medication. What it does is that it calms the fight or flight reaction from the amygdala while trauma is processed in a calm way, without re-traumatization. And yes, sometimes serotonin levels are a bit depleted and people feel a bit down for a day or two afterwards. Many people in the MDMA therapy community use 5-HTP or Tryptophan to help with this.