People getting psychotherapy for severe post-traumatic stress disorder (PTSD) do better if they're on ecstasy at the time, new research has found.
Ninety long-term sufferers were given either a placebo or a recreational-size hit of MDMA before going into a therapy session, three times over a couple of months.
Eight weeks later they were assessed, and the results were inarguable - those whose therapy sessions were enhanced with ecstasy were more than twice as likely to no longer meet the diagnostic criteria for PTSD (67 percent) than those who had therapy alone (32 percent).
The success rate was higher than for traditional selective serotonin-reuptake inhibitor (SSRI) medications, which can take months to have an effect.
Only two patients in the study reported serious suicidal behaviour or ideation - both in the placebo group. Only one reported cardiovascular problems - someone in the placebo group.
Researchers from the University of California and the Multidisciplinary Association for Psychedelic Studies (MAPS) said it appears to work by producing a "'window of tolerance', in which participants are able to revisit and process traumatic content without becoming overwhelmed or encumbered by hyperarousal and dissociative symptoms".
It does this by temporarily rolling the brain back to a state "that typically closes after adolescence", where people have more "self-compassion" and are no longer suffering "PTSD-related shame and anger".
Also, the "acute prosocial and interpersonal effects of MDMA may support the quality of the therapeutic alliance".
Paul Glue, a University of Otago professor who researches pharmacology and psychiatry, said the new study backs up earlier findings of the effectiveness of MDMA in therapy.
"The results are very encouraging as they indicate that there may be a new effective treatment for a severe disorder with high levels of treatment resistance and few alternative treatments."
University of Auckland associate professor and brain researcher Suresh Muthukumaraswamy said the success rate was "really high... in patients who are very unwell".
"MAPS hopes that the MDMA-assisted therapy approach will be approved in 2023 by the [US Food and Drug Administration]. If that timeline goes as planned, we may see an application for the introduction of MDMA-assisted therapy for PTSD in New Zealand in the years after that."
But it's not as simple as dropping an E and sitting on the couch for an hour.
"It is critically important to recognize that MDMA is given under clinical supervision as an aid to a psychotherapy - each patient gets around 12 hours of therapy and the drug, which is of pharmaceutical grade quality and is never given without therapy and preparation sessions," said Dr Muthukumaraswamy.
And this could make it difficult to roll out here.
"Because this treatment requires considerable psychotherapy input along with medication... if this treatment were to become available in New Zealand, we lack large numbers of clinical psychologists and/or psychotherapists to allow wide access to treatment," said Dr Glue, who will soon, with MAPS, be conducting a trial involving using MDMA to treat depression and anxiety in patients with terminal cancer.
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