MDMA therapy is an emerging treatment approach for various mental disorders for post-traumatic stress disorder (PTSD) and anxiety disorders in particular. This approach uses the psychoactive substance 3,4-methylenedioxymethamphetamine (MDMA) or similar substances to promote therapeutic breakthroughs.
At MDMA therapy the substance is not used recreationally, but in a controlled therapeutic environment under the guidance of trained professionals. The goal is to promote a deeper connection with the patient's emotions and memories, allowing the underlying causes of mental illness to be better understood and processed.
How does MDMA work?
MDMA works by primarily increasing the activity of three neurotransmitters: dopamine, norepinephrine and serotonin. These neurotransmitters help regulate mood, energy, appetite, emotions, sexual activity and sleep patterns. The detailed explanation of how MDMA and legal anologues work can be found through the page below.
The latest known studies on MDMA therapy are below. Most studies are completed with a success rate of around 80% to reduce various anxiety symptoms with 2 or 3 sessions.
- Mithoefer MC et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021 May;27(5):801-809.
- Feduccia AA et al. Breakthrough for trauma treatment: safety and efficacy of MDMA-assisted psychotherapy compared to paroxetine and sertraline. Front Psychiatry. 2019 Aug 23;10:650.
- Mithoefer MC et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. J Psychopharmacol. 2013 Jan;27(1):28-39.
- Oehen P et al. A randomized, controlled pilot study of MDMA (±3,4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD). J Psychopharmacol. 2013 Jan;27(1):40-52.
- Mithoefer MC et al. A randomized trial of ±3,4-methylenedioxymethamphetamine-assisted therapy for the treatment of severe posttraumatic stress disorder in chronic combat veterans. J Clin Psychiatry. 2020 Dec 15;82(1):19m13277.
- Ot'alora G et al. 3,4-methylenedioxymethamphetamine-assisted psychotherapy for treatment of chronic posttraumatic stress disorder: A randomized phase 2 controlled trial. J Psychopharmacol. 2018 Dec;32(12):1295-1307.
- Wagner MT et al. Therapeutic effect of increased openness: Investigating mechanism of action in MDMA-assisted psychotherapy. J Psychopharmacol. 2017 Aug;31(8):967-974.
- Mithoefer MC et al. MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology (Berl). 2019 Aug;236(9):2735-2745.
- Carhart-Harris RL et al. MDMA-assisted psychotherapy for alcohol use disorder: a proof-of-concept study. J Psychopharmacol. 2020 Oct;34(10):1131-1141.
- Danforth AL et al. Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study. Psychopharmacology (Berl). 2018 Nov;235(11):3137-3148.
- Mithoefer MC et al. MDMA-assisted psychotherapy for anxiety associated with life-threatening illnesses: a randomized, double-blind, placebo-controlled phase 2 pilot study. Psychopharmacology (Berl). 2020 Jan;237(1):277-289.
- Sessa B et al. First study of safety and tolerability of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in patients with alcohol use disorder: preliminary data on the first four participants. BMJ Case Rep. 2019 Jul 29;12(7):e230109.
- Feduccia AA et al. MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? Prog Neuropsychopharmacol Biol Psychiatry. 2018 Jun 8;84(Pt A):221-228.
- Jerome L et al. Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials. Psychopharmacology (Berl). 2020 Jan;237(1):248-258.
- Sessa B et al. The use of MDMA in the treatment of Post-Traumatic Stress Disorder (PTSD) in the context of psychotherapy: The UK perspective. J Psychopharmacol. 2020 Oct;34(10):1095-1100.
- Kuypers KP et al. No evidence that MDMA-induced enhancement of emotional empathy is related to peripheral oxytocin levels or 5-HT1a receptor activation. PLoS One. 2014 Jun 17;9(6):e100719.
How does an MDMA session go?
MDMA sessions need proper screening, preparation, session and integration. First, it must be determined whether an MDMA session is health-wise possible. After going through the intake, it will become clear if there are any contraindications to be detected and if a session can take place safely. The time between the intake and the session is used to improve the neurochemistry and to prepare psychologically for the session. Some homework may need to be done in the form of small assignments.
During the day of the MDMA session, time is taken to discuss what the goals are and what the day will look like. Also, tips are given on how to handle certain situations. After MDMA, or the analog, begins to work, the session is characterized with spoken portions alternating with unspoken periods. During the phases without conversation, it is advised to listen to the music with an eye mask until the need to talk arises again.
After the session there is a brief discussion and one week after the session there is another follow-up discussion by phone. This last call acts as an integration call.