Should Ecstasy (MDMA) be a Psychiatric Medication?
You may not know this, but ecstasy (MDMA) has been studied as a psychiatric medication. Yes, that’s right, that stuff kids take at raves. The stuff that makes you thirsty and fall in love to the person next to you. That stuff. And MDMA was shown effective in several psychiatric uses.
But research on MDMA (ecstasy) was curtailed in 1985 when the US government named it a class 1 drug (like heroin) over the objections of doctors. Psychiatric research on MDMA is gearing up again though and it has shown promise in treating post-traumatic stress disorder (PTSD) and possibly depression and anxiety.
What is Ecstasy (MDMA)?
The active substance in ecstasy is MDMA (3,4-methylenedioxymethamphetamine). However, when ecstasy is purchased on the street, MDMA is common mixed with methamphetamines and other drugs.
So, to be clear, this means that while taking MDMA in a clinical setting may pose limited risk, taking it illicitly is a different risk profile altogether. I do not recommend you buy ecstasy off the street to treat mental illness. (Particularly if you suffer from bipolar 1 or any psychotic symptoms.)
The subjective effects of ecstasy (MDMA) are produced, in part, by a huge release of serotonin. This may be responsible for reducing the perception of threats and of negative emotions in others.
Ecstasy, MDMA, also increases levels of the neurohormones oxytocin, prolactin and cortisol. Oxytocin is thought to reduce feelings of fear and increase social affiliation and trust while cortisol is a stress hormone which may explain why some people experience anxiety while using MDMA.
How is Ecstasy (MDMA) Used in Psychiatry?
Interestingly, ecstasy is being used during psychotherapy and not as a psychopharmacological treatment, per se. MDMA is administered during elongated therapy sessions (8 hours) and patients work through emotions and memories that were impossible to handle beforehand. Two or three MDMA treatment sessions may be done with preparation therapy sessions beforehand and follow-up therapy sessions after.
“. . . enhanced self-understanding [and] insight into personal patterns or problems, greater self-confidence or self-acceptance, lowered defenses [while] undergoing a therapeutic emotional process,” and “less negative thoughts or feelings.”
Studies on MDMA
Right now all the studies are on MDMA-treatment of post-traumatic stress disorder (PTSD) but look for other studies in the future. These studies on PTSD and ecstasy (MDMA) look extremely promising. Right now, several countries have completed phase one research and are onto phase two.
Risks of MDMA in Psychiatry
Risks vary depending on who you ask but in controlled, clinical use the risks of ecstasy (MDMA) appear to be minimal. While some worry about the effects on memory and cognition, some studies have shown there is no effect to these areas. There haven’t been enough participants in studies to make conclusive statements about MDMA risks.
My Thoughts on MDMA in Psychiatry
I’m very interested in such medications. MDMA works on the brain in a powerful way that other drugs do not. In this way ecstasy is unique and is hopeful for people with treatment-resistant disorders. I have a feeling that flooding the brain in this unusual way may be helpful in improving intractable disorders. This is mostly a hunch on my part, but I look forward to seeing what the future holds.
Psychiatric Times, Does MDMA Have a Role in Clinical Psychiatry? By Michael C. Mithoefer, MD, 06 May 2011