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Does MDMA Have Therapeutic Uses?
¨What is MDMA?
¨How does MDMA work?
¨How effective is MDMA in psychotherapy?
¨What are the possible side effects of MDMA?
¨Is this information on MDMA credible?
What is MDMA?
MDMA is an abbreviation for 3, 4-Methelenedioxymethamphetamine. It has been researched for almost a century under a variety of contexts. This drug was first synthesized and patented in the early 1910’s by Merck, a company in Germany, as a potential appetite suppressant. The U.S. Government studied it for a short period of time in the 1950’s in connection with the chemical warfare investigations of the Army and the CIA. Its therapeutic uses began in the 1970’s by a small group of psychiatrists and therapists who believed in the effectiveness of psychedelic psychotherapy. MDMA was designated a Schedule 1 drug in 1985, which means that it is considered one of the most dangerous drugs and has no known medical purposes. It “is illegal to manufacture, possess, or sell in the United States. Most other countries have similar laws” (http://members.dencity.com/warmth/x_01.htm). It has become a popular recreational drug, more commonly known as ecstasy, as of the late 1980’s and early 1990’s.
Many psychiatrists and therapists believe that clinical use of MDMA would be extremely beneficial in enhancing communication between people. They also believe that it would be useful in the treatment of Post-Traumatic Stress Disorder (PTSD) as well as anxiety, depression, and pain in cancer patients despite the possible side effects.
How does MDMA work?
The physical and psychological effects of MDMA have bewildered scientists for many years. The reasons behind this drug’s effect on people are still unclear, but extensive research leads to new discoveries every day. The use of MDMA has been linked to decreases in the serotonin (5-HT) and dopamine (DA) levels of the brain. Serotonin is a chemical in the brain that regulates “feelings, behaviors, and processes… [such as] appetite, sleep, aggression, mood, and sex” (http://www.aolsvc.worldbook.aol.com/wbol/wbPage/na/ar/co/502350?op1=&st1=Serotonin&op2=&st2=&op3=&st3=). Dopamine affects “paying attention, planning, and moving the body… [It] plays a key role in motivation, pleasure, and addiction” (http://www.aolsvc.worldbook.aol.com/wbol/wbPage/na/ar/co/164190?op1=&st1=Dopamine&op2=&st2=&op3=&st3=). They both act as neurotransmitters, chemicals that “carry information from one neuron (nerve cell) to another” (http://www.aolsvc.worldbook.aol.com/wbol/wbPage/na/ar/co/164190?op1=&st1=Dopamine&op2=&st2=&op3=&st3=). MDMA has been found to deplete uptake sites, called serotonin receptors. New studies have shown that MDMA may actually damage serotonergic activity.
These decreases in neurochemical and neurohormonal levels have been found to produce a variety of effects. One of these effects may be the “easily controlled state characterized by euphoria, increased well-being, increased sociability, and decreased anxiety” (http://www.maps.org/research/mdma/protocol/review1.pdf) that is experienced by MDMA users. This is why MDMA is believed to be beneficial in psychotherapy by many psychiatrists and psychologists. It induces a sense of trust between the patient and his therapist, which allows the patient to open up and explore any repressed feelings. In clinical practice, MDMA seems to have possessed, a unique action that enhanced communication, especially between people in a significant emotional relationship. Reductions in defenses and fear of emotional injury and a heightened capacity for introspection were reported. MDMA was reported to enhance retrieval of previously repressed memories, leading to reduction of symptoms (http://www.maps.org/research/mdma/protocol/review2.pdf).
How effective is MDMA in psychotherapy?
“Some have gone so far as to say that a single session with MDMA can achieve more than months of therapy for a few patients” (http://www.ephidrina.org/ecstasy/effects.html).
Many therapists believe that the properties of MDMA make it a better choice for use in psychotherapy than other psychoactive drugs such as LSD. Grinspoon and Bakalar describe it as being relatively mild with a “high” that does not last as long. It allows for introspection and reduced anxiety without extreme distortions of reality. “It evokes a gentler, subtler, highly controllable experience which invites rather than compels intensification of feelings and self-exploration” (1986, p. 399). They say the patients, who have undergone this type of therapy, report that MDMA improved their ability to communicate, improved their self-esteem, strengthened their trust, and created a more intense alliance between the patient and the therapist. These outcomes of their MDMA sessions reportedly lasted for days and even months after their last session.
Before 1985, when MDMA became classified as a Schedule 1 substance, many therapists used MDMA for its psychotherapeutic benefits. Rick Ingrasci, MD, MPH reported using it in 150 sessions with approximately 100 patients, including 11 cancer patients. Joseph Downing, M.D., used MDMA with 8 patients, and reported therapeutic benefits in 5 of them. Philip Wolfson, M.D., saw short-term progress with 3 psychotic patients. George Greer, M.D., reported using MDMA with 80 patients, and Manuel Madriz Marin, M.D., treated 20 patients with it for anxiety and depression. After MDMA became illegal, the Swiss Medical Society for Psycholytic Therapy received authorization to dispense it to 171 patients. Out of the 121 patients that responded to a follow-up survey, 85.1% indicated good or slight improvement. Therapists that support this type of psychotherapy agree that this form of treatment is not appropriate in all situations, but they believe that it can be invaluable in some cases.
Greer and Tolbert believe that the atmosphere in which MDMA is administered is essential to the success of the session therefore they developed a precise method of running the therapeutic sessions that involve the use of MDMA. The subject must identify their “expectations, motivations, and intentions” (1998, p. 371), become informed on the nature of MDMA, agree with the therapist on the goal of the session, prepare for the session, and be willing to accept any outcome, whether the experience is negative or positive. Each potential subject will undergo an initial interview consisting of brief medical and psychiatric history as well as how he heard about the sessions. He is then asked to complete a detailed background questionnaire pertaining to medical and psychiatric history, and use of drugs. Subjects with specified medical conditions such as hypertension, cardiovascular disease, epilepsy, diabetes, and pregnancy are excluded. Only “functional, relatively well-adjusted people” (p. 372) are allowed to participate. During the preparation session, the therapist describes his background to facilitate and enhance the patient-therapist relationship. All patients are required to read and sign an informed consent in order to continue. Greer & Tolbert include two case studies in their article. The first study involves a married man in his early seventies who has been diagnosed with multiple myeloma, a form a cancer in bone marrow. The purpose of the MDMA session was to relieve the intense pain that he was experiencing. His first session resulted in a pain-free state that he had not felt in four years. After the session, his pain did return, but the man believed that the therapeutic session with MDMA had taught him how to control the pain by himself. He participated in a total of four MDMA sessions before MDMA became a controlled substance, and the sessions had to stop. His pain eventually returned some time after the last session.
The second case study involved a Jewish woman in her mid-thirties. She wanted to take part in an MDMA session with her husband with the intention of achieving “increased awareness and personal expansion” (p. 377). Her first session led to the discovery of painful memories relating to the Holocaust that her parents had both survived. These feelings caused her to vomit, and she reported nausea and intense anger for the next few days. In spite of these negative reactions to the session, she participated in eight more sessions. She reported fewer arguments with her mother, less tension and irritability, and an increased understanding of her emotions.
The therapists observed that MDMA reduces the subject’s fear response. “With this barrier of fear removed, a loving and forgiving awareness seemed to occur quite naturally and spontaneously” (P. 377). Patients communicated their feelings more clearly and were able to explore feelings that had been repressed, such as the woman in the second case study. They were able to assess their lives, accept their own constructive criticism, and incorporate what they learned into their daily lives. Greer and Tolbert acknowledge that although MDMA appears to be beneficial in the appropriate therapeutic setting, harmful medical risks exist.
A collection of the subjective reports of twenty-nine people that were administered MDMA in therapeutic sessions indicates some common benefits and the unpleasant effects that may accompany the use of this drug. All sessions were conducted according to the method described above. Every subject indicated that he benefited to some extent from the experience. A variety of positive changes were experienced, including: enhanced communication and closeness with others, more loving feelings, improved self-confidence, lowered defenses, greater self-awareness, and expanded mental perspective. The majority of the group indicated that their goals were completely realized. Most reported positive mood and attitudinal changes, and all but one indicated that positive changes in their relationships occurred. Fifteen participants reported that they had positively changed their goals in life as a result of the MDMA session. On the other hand, many negative side effects were experienced. Jaw tension and teeth clenching were extremely common. All but one subject lost their appetite. Other side effects included nausea, fatigue, insomnia, difficulty walking, mild depression on subsequent days, and confusion. In spite of these reactions, six of the participants distinctively recommended the use of MDMA therapeutically. The results of this study suggest that MDMA may be extremely beneficial in assisting communication between two significantly involved people. In all cases, people were using MDMA to learn, not to cure a problem (Greer & Tolbert, 1986).
There is obviously insufficient evidence in support of MDMA’s therapeutic uses because of its classification as a controlled substance. Many people are currently seeking FDA-approval of research involving the therapeutic use of MDMA. If this is ever granted, much more information will be available.
What are the possible side effects of MDMA?
The possible side effects of MDMA are endless. This is the main reason why MDMA has never become a standard treatment for PTSD, anxiety, depression, or pain. The most recent research suggests that neurotoxicity, causing permanent brain damage, is a possibility because of MDMA’s effect on two important chemicals in the brain, serotonin and dopamine.
One study was conducted in order to determine MDMA’s effect on serotonin. Sixty-one subjects were involved, and they were divided into three different groups. Twenty-two were considered “long-term MDMA users” because they had used MDMA on at least twenty occasions. Nineteen were considered “long-term cannabis users” because they had used cannabis regularly for at least two years, but not MDMA. Twenty subjects were included who neither used MDMA nor used cannabis regularly. Tin electrodes, which are used to detect electrical brain activity and record electroencephalograms (EEGs), were placed on each subject. Each subject was also given a set of headphones through which stimuli were transmitted. Because neural potentials decrease proportionately when exposed to auditory stimuli, the serotonergic function in humans can be measured. The study concluded that serotonergic function impairment is evident in MDMA users in proportion to the total amount of MDMA consumed, not the frequency of MDMA use. The results also concur with studies showing that MDMA causes serotonergic function impairment in animals (http://ajp.psychiatryonline.org/cgi/content/full/158/10/1687).
These changes in serotonergic function may possibly be responsible for the effect that MDMA has been shown to have on mood and cognitive performance. In 1997, Curran and Travill conducted a study involving 24 subjects of ages twenty to twenty-seven. The volunteers were taken from a club, and divided into two groups. The first group of twelve included those who had taken MDMA on day 1, and the second group of twelve included those who had used alcohol on day 1, but not MDMA. The subjects were given a variety of tests and then asked to abstain from alcohol and MDMA for the next five days. The tests were given again on day 2 and day 5. The five tests included: prose recall task, serial sevens, Beck Depression Inventory, mood rating scale, and bodily symptoms scale. The prose recall task involved recalling details of a prose reading read by the experimenter immediately after it was read as well as after the completion of the other tests (15-20 minutes later). The serial sevens test involved serially subtracting seven from a specified three-digit number for 120 seconds. The Beck Depression Inventory is a standard depression inventory. The mood rating scale involved indicating one’s particular mood at that moment on a scale that ranged between two possible opposing mood types. The bodily symptoms scale involved indication one’s position on a scale that ranged between “no physical symptom” and “physical symptom severe.” For the prose recall task, MDMA users reported lower scores on immediate and delayed recall, although the scores improved over a few days. MDMA users completed fewer subtractions than the alcohol group, but the number of errors that each group made were not significantly different. The Beck Depression Inventory indicated that the subjects in the MDMA group had lower scores than subjects in the alcohol group on day 1. This means that they were less depressed. The scores were almost equal for the two groups on day 2, the MDMA group showing more signs of depression than the previous day. The MDMA users reported significantly higher scores on day 5. Some scores were in the normal range, and some scores indicated clinical depression that was mild to moderate. The mood rating scale found that MDMA users were “more contented, happy and interested than alcohol users” (p.825) on day 1, but they became “progressively more discontented, sad and bored over the subsequent test days” (p. 825). MDMA users also rated themselves as being stronger, more clear-headed, energetic, and tranquil on day 1, and drowsy, more feeble, muzzy, lethargic, and troubled on day 2. The results of MDMA users on the bodily symptoms scale indicated this groups of participants as sweaty and having dry-mouth on day 1. They were also more energetic. As the days progressed, the MDMA users became more tired, anxious, depressed, and agitated. This study concluded that the “high” mood experienced after taking MDMA may lead to a “low” mood on the following days. On the other hand, the experiment does not illustrate if these effects are a result of temporarily low levels of serotonin, an irreversible neurotoxicity, or a direct effect of the intense “high” mood that MDMA causes. Regardless, the “low” that would potentially be experienced by some patients after a therapy session could prove to be extremely harmful to those people. The study also shows that attentional function is impaired. Its findings are consistent with a similarly conducted longitudinal study conducted by Zakzanis and Young in 2001. They determined that MDMA use is associated with memory impairment. MDMA users had significant difficulty in recalling details of a prose passage, remembering first and second names, and remembering a particular route between two places, indicating a decline in retrospective memory.
Other complications include hyperthermia (rapid temperature increase), hyponatremia (low salt content in blood), hepatotoxicity (liver damage), increased heart rate and blood pressure, and seizures. These effects can be fatal. Other side effects include: dry mouth, dehydration, jaw clenching, blurred vision, rapid eye movement, chills, sweating, and loss of appetite. These immediate effects of MDMA usually last for approximately 6 hours, but feelings of anxiety and depression have reportedly lasted for days after taking a dose.
Is this information on MDMA credible?
The information regarding MDMA comes from three types of sources. Due to the popularity of MDMA as a recreational drug, one source includes drug awareness groups such as the U.S. Department of Justice Drug Enforcement Administration (DEA), and the National Institute on Drug Abuse, National Institutes of Health (NIDA, NIH). The second source is the Multidisciplinary Association for Psychedelic Studies (MAPS), which is a membership-based non-profit organization whose primary goal is to aid scientists in researching therapeutic uses of psychedelic drugs. They have opened an FDA drug master file and are currently seeking FDA-approval for a study on the benefits of MDMA in psychotherapy. The third source includes articles from scientific journals such as The Journal of Psychoactive Drugs, Addiction, American Journal of Psychiatry, and Neurology. All three sources are extremely credible.
The DEA describes MDMA as “a Schedule 1 synthetic, psychoactive drug possessing stimulant and hallucinogenic properties” (http://www.usdoj.gov/dea/concern/mdma/mdma.htm). In the past, it has been used therapeutically, and many psychiatrists and psychologists would like to see it used in psychotherapy again to enhance communication between people in significant relationships, and to help treat PTSD, anxiety, depression, and pain. MDMA has been shown to facilitate therapy sessions because of the effect that it produces on the patient. Scientists still do not understand the causes of these effects of MDMA. They do know that this drug causes the serotonin and dopamine levels in the brain to decrease. This may be the reason why some people begin to relax and open up. On the other hand, MDMA has dangerous side effects that can be deadly. Sources such as the DEA who believe MDMA to be extremely harmful with no medical purposes stands in opposition to organizations such as MAPS who would like to see MDMA legalized for medicinal purposes. There is some evidence that supports the use of MDMA as beneficial in psychotherapy. The results of studies done before MDMA became illegal show that some people may benefit. The subjects involved in these studies reported some positive results. However, there is more evidence that the effects of MDMA may be too dangerous as well as permanent. Possible side effects range from minor to fatal. Many studies done in the past five years have led experts to believe that MDMA may cause permanent serotonergic damage as well as cognitive impairment. The trend seems to be that as medical technology advances, scientists are capable of more fully understanding how MDMA works. These recent discoveries illustrate that MDMA may potentially cause neurotoxicity. In the 1970’s and 1980’s when the drug was used therapeutically, it may have seemed extremely valuable because little was known about its actual effect on the human body. As more research is done in this area, the negative effects seem to increasingly outweigh any positive outcomes that may be obtained through its use.
Curran, H.V., & Travill, R.A.(1997). Mood and cognitive effects of ±3,4-methylenedioxymethamphetamine (MDMA, ‘ecstasy’): weekend ‘high’ followed by mid-week low. Addiction, 92, 821-831.
Greer, G., & Tolbert, R.(1986). Subjective reports of the effects of MDMA in a clinical setting. Journal of Psychoactive Compounds, 18, 319-327.
Greer, G., & Tolbert, R.(1998). A method of conducting therapeutic sessions with MDMA. Journal of Psychoactive Compounds, 30, 371-379.
Grinspoon, L., & Bakalar, J.B.(1986). Can drugs be used to enhance the psychotherapeutic process?. American Journal of Psychotherapy, 40, 393-404.
Zakzanis, K.K., & Young, D.A.(2001). Memory impairment in abstinent MDMA (“Ecstasy”) users: A longitudinal investigation. Neurology,56, 966-969.
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