Also referred to as ecstasy, MDMA is now commonly taken in the form of Molly, which is the same base drug but packaged differently and cut with different drugs. People associate these club drugs with similar social scenarios, including raves in the 1990s and house parties in the 2000s.

Most people are not aware that MDMA, which was originally developed as an appetite suppressant in the 1910s, first rose to popularity in the 1960s and 1970s as a drug prescribed by psychiatrists to promote better outcomes in psychotherapy. Recent research insights may soon restore this association between MDMA and therapy.

A study published in The Lancet showed that a group of veterans and first responders with post-traumatic-stress disorder (PTSD) who had not responded to other treatment methods experienced a dramatic reduction in symptoms after two sessions of MDMA-assisted therapy.

In these eight-hour MDMA PTSD sessions, two licensed therapists administered MDMA and sat at a client’s side, helping them explore traumatic memories and associated emotions. People who have studied the relationship between MDMA and PTSD say that the drug helps people with PTSD break through defenses and open up more readily to another person. As they express and process emotions more freely than they normally would, they make new connections and start to heal.

Using MDMA to Treat PTSD

Like many recreational and therapeutic drugs, MDMA boosts mood and energy by increasing levels of the brain chemicals serotonin, norepinephrine and dopamine. Researchers curious about its unique capacity to foster warm feelings and increased empathy have found that MDMA also increases levels of prolactin and oxytocin, hormones associated with friendly behavior and loving feelings.

Using MDMA to treat PTSD may work because of the way the drug counters the loss of trust and blunted emotions that people with PTSD often experience. For many people with PTSD, the desire to avoid trauma-related emotional reactions can be so strong that they withdraw from nearly all social activity. Due to unconscious psychological processes, they may experience dissociative reactions like episodes of amnesia, out-of-body experiences or mentally checking out during stressful encounters.

These experiences may reflect natural defenses against retraumatization. People with PTSD often have a hard time feeling safe and react with great sensitivity to even the mildest threats of boundary violation. This means that the potent emotional exploration therapy requires can trigger their defenses, causing them to “shut down” in therapy and stop making progress. The effects of MDMA can help lower these defenses and allow therapeutic work to take place.

While therapeutic methods vary, the cornerstone of any type of therapy is the therapeutic alliance, or the collaborative relationship between therapist and client. People with PTSD can have a hard time forming this bond. In MDMA-assisted therapy for PTSD, work to establish trust with a therapist that might otherwise take years—and might even fail after that much time—can take place in just a few sessions. When MDMA is used to treat PTSD, it can help people connect with both themselves and others in ways they haven’t in years.

MDMA Clinical Trials for PTSD

The success of an initial MDMA and PTSD study published in 2011, and the following phase II clinical trials, have been enough for the United States Food and Drug Administration (FDA) to approve MDMA as a breakthrough therapy for PTSD.

The FDA has now authorized phase III MDMA PTSD clinical trials to see if additional studies can replicate the results of previous studies. If the final phase of MDMA research for PTSD therapy confirms its safety and efficacy, MDMA could be fully approved for therapeutic use by 2021.

The MDMA clinical trials for PTSD treatment have shown that MDMA-assisted therapy not only alleviates symptoms but causes remission of PTSD in 68 percent of people who participate. This remarkable success rate may reflect the way PTSD affects emotion and memory and the unique way MDMA interacts with these psychological processes.

Research suggests that MDMA may increase connectivity between the amygdala, the part of the brain that signals emotional arousal, and the hippocampus, the brain region responsible for memory formation and retention, by reducing anxiety-driven activity in the amygdala. Additional research may lend further insight into the reason for the remarkable success of early trials of MDMA-assisted therapy for PTSD.

Risks and Cautions

From medical marijuana for pain management to ketamine for depression, researchers are finding that once-taboo drugs have the capacity to treat a wide range of medical and psychological problems successfully. This reflects a new era of open-mindedness and willingness to consider mental health and substance use without the restrictive moralism of the past.

However, it’s important not to forget that controlled substances like MDMA come with real and serious risks. In addition to the potential to develop into a dangerous addiction, MDMA use can trigger a range of physical and psychological problems. People who use MDMA before physical activity can become dehydrated and develop severe hyperthermia. Elevated heart rate from MDMA use causes people to faint, have panic attacks or even have seizures. Even for people who don’t have acute reactions, regular MDMA use can lead to chronic cognitive impairment.

Another serious risk of recreational MDMA use is being poisoned or otherwise negatively affected by additional substances that are cut in with it. When ecstasy or Molly are cut with significant amounts of synthetic drugs like “bath salts” or amphetamines, they can produce different effects, making people agitated and paranoid instead of friendly and open. In large amounts, these substances can trigger psychotic reactions like delusions and hallucinations.

One thing that makes MDMA-assisted therapy work is that the drug is sourced safely and is completely pure. It is also administered under close supervision in a low-risk setting. Most importantly, it is not taken passively but is used to facilitate therapy. Buying MDMA through the black market and taking it recreationally or even in a relatively therapeutic setting at home is unlikely to yield the same effect.

For people who have present or past substance use disorders, using MDMA even in a controlled therapeutic setting could come with more risks than benefits. It could trigger cravings in people who are in recovery or cause people who are using other substances to seek MDMA outside of therapy and develop a cross addiction. If it becomes widely available, the safety and risks of MDMA-assisted therapy should be evaluated by both client and therapist on a case-by-case basis.

Key Points: MDMA and PTSD

  • Unfortunately, MDMA-assisted therapy for PTSD is not yet fully approved by the FDA or widely available. However, based on the results of previous studies, the final and third phase of research is likely to be successful.
  • As this new approach to treating PTSD becomes better known and more widely implemented, it may lead to better treatment outcomes for people with the disorder.
  • Even MDMA-assisted therapy has its limits and is unlikely to become a universal cure.
  • One-third of people who participated in the clinical trials did not respond to the intervention and wider use is likely to reveal further limitations of this approach.
  • People who have struggled with addiction to MDMA or other substances should discuss concerns and risks before engaging in MDMA-assisted therapy.
  • Education will also be required to address potential confusion that the drug itself is a cure and to inform people about the risks of recreational MDMA use.

If you are concerned that you may have PTSD, you can read more about the disorder here. You can also take this quiz if you are concerned that you are developing an addiction to MDMA. While MDMA-assisted therapy is still pending approval, there are many other treatment options for people with PTSD, including people with co-occurring disorders. If you are ready to enter treatment for PTSD and addiction, contact The Recovery Village to learn about a wide range of therapeutic options that can meet your needs.