More commonly known as a party drug, MDMA (often going by the street name ‘Ecstasy’) likely has great therapeutic potential.

Many Marines return to the states with vivid memories of their combat experiences, and the array of emotions they face internally may be hard to deal with. Image credits: Marines from Arlington.

“Posttraumatic stress disorder (PTSD) is a serious and life-threatening psychiatric condition with unmet medical need despite available treatments” — the Multidisciplinary Association for Psychedelic Studies (MAPS) announced the FDA’s ruling, emphasizing the need for more innovative treatments for PTSD.

According to official figures, at least 7 or 8 in a hundred Americans will struggle with the disorder at some point in their lives. Some will never get rid of it. Some will be driven to suicide. It’s a complex and far reaching problem that disproportionately affects people in the military, for reasons that are easy to understand. Well, this new avenue for treatment gives unexpected hope to these millions of people.

Drugs versus disorders

It’s not the first time psychedelic drugs have been suggested as therapy for PTSD. It’s actually something that researchers have recommended for a long time. In 2012, MDMA has been shown to be effective in treating PTSD, though in a small trial. That same year, researchers also showed that the drug was safe for consumption in a regulated setting. Earlier this year, the findings were echoed over a larger spectrum of drugs, including LSD — though again, it was a small trial. This is one of the biggest hurdles when it comes to studying the potential of such substances: it’s virtually impossible to set up a large-scale trial. Well, that will change now, as a Phase 3 trial has been approved for the first time. Phase 3 trials are randomized controlled multicenter trials on large patient groups, with at least 300 participants.

“For the first time ever, psychedelic-assisted psychotherapy will be evaluated in Phase 3 trials for possible prescription use, with MDMA-assisted psychotherapy for PTSD leading the way,” said Rick Doblin, Founder and Executive Director of MAPS.

For anyone who ever took MDMA, it’s probably easy to understand why: for starters, it makes you feel very good. But there’s much more to it than that. The drug fills the user’s brain with the neurotransmitters that not only make them feel good, but also help them deal with painful memories. Basically, every time you recall a memory, you’re firing up some neurons. The neurons have a tendency to use the same connections time and time again — basically, walking on the beaten path — which means that a fearful memory will likely remain fearful. But new connections can also be made, and therefore the memory can be revised and dealt with. This is where MDMA helps. Simply put, it can use some of that feel-good to make fearful memories less fearful. Of course, taking the drug in a safe, controlled environment is a completely different experience than taking it at a party, and that’s what scientists are recommending here.

Not perfect, but promising

MAPS has been conducting MDMA trials since 1986, hoping to demonstrate its value to authorities. In one study, 67 percent of PTSD patients had no signs of the disorder after three MDMA therapy sessions. Just 23 percent of patients who didn’t take MDMA reported similar results. Another study tracked the long-term development of 16 patients who were unresponsive to any kind of treatment. Two of them had relapses — but the rest were cured following MDMA sessions.

In that sense, this isn’t a breakthrough in science, but rather in acceptance, both legal and social.

“This is not a big scientific step,” David Nutt, a neuropsychopharmacologist at Imperial College London, explained to Science. “It’s been obvious for 40 years that these drugs are medicines. But it’s a huge step in acceptance.”

Of course, this isn’t going to magically make PTSD disappear. It’s probably not going to work for everyone. Few treatments do. Some psychologists argue that giving people ecstasy isn’t going to help anyone, or that the treatment itself is unnecessary. But previous trials show that the treatment is effective, at least most of the time. It could drastically improve the lives of millions and it could save a lot of lives. If that’s not worth fighting against prejudice, then I don’t know what is.

The first Phase 3 trial (MAPP1), “A Randomized, Double-Blind, Placebo-Controlled, Multi-Site Phase 3 Study of the Efficacy and Safety of Manualized MDMA-Assisted Psychotherapy for the Treatment of Severe Posttraumatic Stress Disorder,” will begin enrolling subjects in Spring 2018,