MDMA, the key ingredient in Ecstasy, eases symptoms of severe PTSD

The key ingredient in the illicit drug known as Ecstasy or Molly may offer profound relief from post-traumatic stress disorder. When paired with intense talk therapy, MDMA drastically eased symptoms in people who had struggled with severe PTSD for years, a new study reports.

“This is a big deal,” says Steven Gold, a clinical psychologist in Fort Lauderdale and professor emeritus at Nova Southeastern University in Plantation, Fla. “All other things being equal, the use of psychedelic medication can significantly improve the outcome.”

The results, published May 10 in Nature Medicine, are preliminary. But the findings offer hope to the millions of people worldwide who have PTSD, for whom new treatments are desperately needed. Antidepressants such as Zoloft and Paxil are often prescribed, but the drugs don’t work for an estimated 40 to 60 percent of people with PTSD.

Ninety people participated in the new study, which took place at 15 clinical sites in the United States, Canada and Israel. All the participants received 15 therapy sessions with therapists trained to guide people as they experienced the drug. Half of the participants received MDMA in three eight-hour therapy sessions; the other half received placebos during three eight-hour therapy sessions.

True to its nickname Ecstasy, MDMA evokes feelings of bliss and social connectedness. The participants took the drug (or the placebo) while wearing eye covers and listening to music, and occasionally talking with their therapist about their experience.

On average, the participants improved by the end of the 18-week trial, showing fewer PTSD symptoms such as unwanted, intrusive memories. But the benefits were far greater for people who took MDMA. By the end of the trial, 67 percent of the participants who took MDMA had improved so much that they no longer qualified as having a PTSD diagnosis. Among people who took placebos, 32 percent of the participants no longer met the criteria for PTSD at the end of the study. Those evaluations came from independent clinicians who assessed people without knowing who had taken the drug.

Many of the people in the trial had been living with severe PTSD for years. “Typically, we see PTSD as a disorder for life. Now, we may begin to let that go,” says Eric Vermetten, a psychiatrist at the Leiden University Medical Center in the Netherlands who works with veterans and members of the military with PTSD and was not involved in the new study.

It’s not clear exactly how the drug changes the brain. Some imaging studies suggest that MDMA dampens activity in the amygdala, a brain structure involved in fear. Other results from mice hint that the drug may open a window of heightened social learning, a scenario that may strengthen the relationship between a patient and a therapist.

The study included weeks of therapy before, during and after MDMA sessions. Those sessions required hard emotional work from the participants, says study coauthor Amy Emerson. “[MDMA] is not a magic pill.” The study was funded by the nonprofit group Multidisciplinary Association for Psychedelic Studies, or MAPS. Emerson is the chief executive officer of MAPS Public Benefit Corporation in San Jose, Calif., which organized the trial.

Over three-quarters of the participants in the trial were white. Without a more diverse group of people in the studies, it’s not clear whether therapy with MDMA would yield similar effects more generally, says Gold. Nor is it clear how long the benefits might last.

Another clinical trial comparing MDMA’s effects on PTSD symptoms to a placebo is in the works, Emerson says, as well as expanded use of MDMA in clinics. And researchers are following the health of the people in the current study to see whether the improvements last.

For now, the research is complicated by restrictions on MDMA, which remains an illicit drug in the United States. “There are a lot of barriers to break down related to this treatment,” Emerson says. “And there’s a lot of hope.”