September 2021

The Nation Reviewed

The agony and ecstasy

By James Bradley
Clinical trials in Perth will study the use of MDMA to treat PTSD and addiction

In June a team of researchers across 15 institutions in the United States, Canada and Israel published the results of a major study into the use of the drug 3,4-methylenedioxymethamphetamine – better known as MDMA or by its street name, ecstasy – in the treatment of post-traumatic stress disorder. The study, coordinated by the US-based Multidisciplinary Association for Psychedelic Studies (MAPS), showed that when administered in the context of a structured psychotherapy program, MDMA is not only safe but also highly effective, delivering markedly improved outcomes for patients.

These results are highly significant: PTSD is a profoundly debilitating condition that afflicts hundreds of millions of people worldwide. Those affected suffer a range of symptoms, ranging from flashbacks, crippling anxiety and depression to mood swings, persistent feelings of agitation and terror, and dissociative episodes. Although it is often linked to the experiences of military personnel, it can also be caused by a wide range of traumatic events, in particular rape and childhood abuse.

Dr Sabrina Adams is a clinical psychologist and an expert in the treatment of trauma. Originally from Melbourne, she moved to Canada after meeting her husband, psychiatrist Dr Simon Amar, at a conference in 2013. Together with Amar she has spent the past three years working with trauma patients in the Montreal component of the MAPS study. She believes there is a desperate need for new treatments for PTSD. “The treatments we have at the moment aren’t all that effective,” Adams says. “They can take a very long time, and they often involve taking medication every day for many years, if not forever, in order to manage symptoms.”

The reasons for this are complex. PTSD occurs when traumatic experiences overstimulate the parts of the brain that govern fear responses. Because the memories created by such events are laid down in the limbic system, which is responsible for our emotions, their activation tends to trigger the same overwhelming emotional responses as the initial event, leading to the brain and body becoming confused about what is present and what is past. This results in the flashbacks commonly associated with the condition, but also to patterns of hyperarousal and avoidance.

Conventional treatment for PTSD usually focuses on exposure therapy, in which patients are encouraged to approach and re-experience their trauma. This process allows the traumatic memories to be reprocessed, thereby breaking down the neurological patterns that cause the extreme reactions. Yet, for many patients, exposure therapy is not an option because they are too traumatised to discuss their experience. “Approaching traumatic memories can be incredibly difficult,” says Adams. “Often people get totally overwhelmed and lose their ability to talk and be present because they’re lost in their memories, or they just shut down and go numb, meaning they have no access to their emotions or memories.”

It is perhaps unsurprising that MDMA helps overcome this problem. Although it was first synthesised as a potential blood-clotting treatment in 1912, by the 1970s it was being used in couples counselling by psychotherapists, who found its ability to simultaneously disinhibit and to heighten feelings of empathy and connection beneficial. This practice largely ceased after MDMA was made illegal in the 1980s, but its continuing popularity as a party drug is a testament to these same abilities.

MDMA achieves these effects by triggering the release of serotonin and dopamine in the brain, creating feelings of wellbeing and happiness, and reducing anxiety. It also – importantly – increases levels of oxytocin, a hormone that plays an important part in social bonding and relationship building. “People with PTSD have an overactive fear response,” says Adams. “But MDMA helps suppress that, and makes them able to remember things they would usually be too afraid to remember. And that lets them feel their emotions – fear, anger, sadness, grief – without feeling overwhelmed. It also allows us to create an experience of safety and trust and connection, which can be especially helpful for people who suffer from developmental trauma as a result of growing up in situations where they were neglected or abused.”

The results of this process are remarkable. After just three MDMA sessions, according to the MAPS study, 88 per cent of patients experienced a meaningful reduction in symptoms, and two thirds no longer qualified for a diagnosis. Even more significantly, these outcomes seem to go beyond managing symptoms: by making the necessary reprocessing possible, they allow sufferers the possibility of recovery. Adams beams when she describes the outcomes. “We had one participant who’d experienced nightmares every night for many years arrive for their third reintegration session, and when we asked them how they felt, they just said, ‘I feel fine. There’s nothing wrong. The nightmares are gone.’ Seeing that, or somebody who has spent years avoiding a location associated with their trauma who no longer feels they need to avoid that place, or who has been very afraid and hypervigilant who can suddenly relax and feel at ease and joyful, and present and connected with their loved ones, is amazing.”

Despite mounting evidence of the effectiveness of MDMA therapy, Australian institutions have been extremely slow to begin exploring its possibilities. After a series of abortive attempts at various institutions, however, the first study of MDMA therapy for PTSD is scheduled to begin at Edith Cowan University in Perth later this year.

Dr Stephen Bright is one of the lead investigators on the Edith Cowan trial. A clinical psychologist specialising in substance use disorders, he became interested in MDMA because so many of the people he encountered with such disorders also seemed to have symptoms of PTSD. “Our service began to feel like a revolving door where we were patching people up, sending them back out into the world and then watching them relapse,” Bright says. “If you worked on the substance use the PTSD got worse, if you worked on the PTSD the substance use got worse.”

Bright believes the strong association between trauma and addiction means MDMA has the potential to transform treatment of many substance use disorders. “MDMA is useful in therapy because it dampens the fear response, and that creates a window in which people can talk about their trauma. Alcohol, and other disinhibiting drugs like benzodiazepines, do that as well, but because they scramble the brain they prevent the reprocessing of the trauma, meaning you just end up with people talking drunkenly about their trauma. But with MDMA they’re able to talk about it in a way that allows them to reprocess it.”

Bright sees Australia’s resistance to research into the possibilities of MDMA therapy as a result of outdated attitudes to drugs and drug use: “Australia is a particularly conservative country when it comes to drug-related issues.” But he also sees it as the legacy of policies that concentrate research funding on the relatively small cohort who experience harm as a result of drug use. “That focus on the pointy end means we’re not looking at the much larger group who don’t experience negative effects. That’s important because a better idea of what’s going on with that broader group could inform strategies to help with those who do suffer harm, by helping us understand how they use drugs without experiencing harm or falling into patterns of dependence.”

In Bright’s view, this involves radically shifting the dial of the national discourse. “We need to move forward from the idea of harm minimisation, and start talking about benefit maximisation, and how we can use these drugs for therapeutic purposes.”

Bright believes that the public is a long way ahead of politicians and regulators on this front. “When I do interviews on radio about this stuff, the callers understand the difference between using these drugs in a clinical setting and having fun with them. And that means they tend to be supportive, even if the shock jocks aren’t. So many people have experience of mental illness or are affected by it: they recognise we need new treatment options.”

There are also signs of change at an official level. The Association of Australian Medical Research Institutes’ Medical Research Future Fund recently allocated $15 million to research into innovative mental health therapies, making Australia only the second country in the world to fund research into MDMA and psychedelics. And while there is little prospect Australia will be quick to follow the lead of American and European regulators, who may well approve the use of MDMA for PTSD as soon as 2023, trials such as Bright’s may help persuade sceptics in the medical community and elsewhere that this therapy’s time has come.

James Bradley

James Bradley is an author and a critic. His books include WrackThe ResurrectionistClade and Ghost Species.

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