Post-traumatic stress disorder (PTSD) will affect roughly 26 million Americans at some point in their lives, according to the Department of Veterans Affairs. The condition characterized by depression, hopelessness, memory problems, difficulty maintaining relationships, and recurring visions of the trauma-related event is known to be difficult to treat. Up to a third of people are still symptomatic 10 years after diagnosis, and the main therapeutic drugs of choice – the selective serotonin reuptake inhibitors sertraline and paroxetine – fail in up to 60% of patients. However, a study published yesterday suggests that there may be an effective new drug for the disease: MDMA, the primary chemical in drugs known colloquially as Ecstasy and Molly.
In a phase 3 study led by neurologist Jennifer Mitchell of the University of California at San Francisco, treatment with three doses of MDMA – accompanied by a single therapy – over a period of 18 weeks was significantly more effective in treating PTSD symptoms than the same talk therapy accompanied by a placebo. In some cases, people who received the MDMA did not even meet a diagnosis of PTSD at the end of the study period.
The sample group of subjects who took part in the study was relatively small – just 90 people – but they had suffered for a long time, an average of 14.8 years since symptoms began. The group included veterans who had experienced combat trauma, victims of sexual assault and / or domestic violence, people who had been through mass shootings, and some who had suffered childhood trauma.
Before starting the study, all were rated on three scales. The first physician-administered PTSD scale for DSM-5 (CAPS-5) is a 30-point survey that asked subjects to rate symptoms such as unwanted memories of the traumatic event on a scale of zero to four rate, with four being the most serious. The second, the Sheehan Disability Scale (SDS), is a similar self-assessment survey in which subjects are rated on a scale from 0 to 10 for the extent to which their PTSD affects their professional, domestic, and social life. The third, the Beck Depression Inventory, is a 21-question survey that asks subjects to rate feelings such as sadness, hopelessness, self-criticism, and self-loathing on a scale of zero to three. In all of the surveys, MDMA appeared to improve results dramatically better – when combined with talk therapy – compared to placebo.
At the end of 18 weeks, the researchers found the mean CAPS-5 score in the MDMA group fell 24.4 points, compared with a 13.9 point decrease in those who received the placebo. The SDS values fell by 3.1 points in the MDMA group compared to 2.0 points for the placebo. For the Beck inventory there was a difference of 19.7 points compared to 10.8. Even more dramatic, at the end of the study period, 67% of people who had taken MDMA no longer met the criteria for a PTSD diagnosis, compared with 32% of the placebo group. All of this, according to Mitchell, means that MDMA could be the treatment of choice for PTSD in the future.
“I speculate the demand will be unprecedented,” she said in an email to TIME. “There are so many people with PTSD and current treatment options leave much to be desired.”
It’s unclear how MDMA works, but the paper suggests the chemical could increase the availability of the neurotransmitter serotonin in the brain; The researchers also cite animal studies that show that MDMA can reduce the reactivity of the amygdala, the brain center in which primal feelings such as fear, anger and fear are processed.
The researchers admit that the course of the study was brief and further follow-up examinations are needed to determine how long the positive effects of MDMA treatment lasted. Furthermore, the results of the study by no means suggest that a traditional intervention may not be effective. On average, all subjects benefited from their 18 weeks of care. But the MDMA group clearly did better. The researchers write that this could be due to the drug’s ability to make people more prosocial (or better connected with others), which in turn could improve the relationship with a clinician and make talk therapy more effective.
The results were strong enough that Mitchell believes they could mean not only that MDMA becomes a frontline treatment for PTSD, but that similar drugs with their own therapeutic value could emerge. “I hope this opens the door to testing other psychedelic compounds for other conditions – like LSD for alcohol use disorders and psilocybin for obsessive-compulsive disorder [obsessive-compulsive disorder] and distress at the end of life, ”she says.