“MDMA provides access” — therapists test ecstasy in trauma patients

When Nachum Patschenik’s father abused his son, something went wrong with the youngster. “There is a kind of death in your life, you breathe in and out, but you don’t live your life — for years,” Patschenik, now 47, tells us in a café in Jerusalem. He had lost the love of life, was ashamed, had avoided people.

Doctors diagnosed him with post-traumatic stress disorder (PTSD), which some people develop after extremely stressful events. Psychotherapy did not help the father of four until 2014 when he participated in a study with MDMA. The abbreviation stands for “methylenedioxymethamphetamine”.

The synthetic substance is contained in the party drug Ecstasy. Studies have shown “that MDMA can improve the therapeutic process for people suffering from PTSD,” stresses the US organization MAPS (Multidisciplinary Association for Psychedelic Studies). The researchers are studying the therapeutic potential of certain drugs. This may be because the substance can reduce anxiety, improve communication and introspection, and increase compassion.

Ingo Schäfer, head of the trauma outpatient clinic at the University Hospital Hamburg-Eppendorf, refers to figures according to which in Europe about two percent of the population suffers from PTSD once in their life. The disorder can be triggered, for example, by war experiences, kidnappings, assaults, or sexual abuse.

Symptoms include sleep disorders, lack of concentration, nightmares, or feelings of guilt and shame. Those affected are much more susceptible to addictions, depression, and other psychological problems. In about one in three people, the disease becomes chronic.

That psychotherapy with MDMA support can help such patients was shown, among other things, by a US study published in the journal “The Lancet Psychiatry” in 2018. In this study, a team led by Allison Feduccia from MAPS treated 26 patients, mostly war veterans and firefighters.

During therapy, they were administered the drug in two to three of the sessions. Twelve months after the end of therapy, 16 of the 26 participants no longer met the PTSD criteria. An analysis of five further such studies published in the journal “Psychopharmacology” in 2019 confirmed these results.

Therapy with Ecstasy — participants also report side effects

However, the studies should primarily examine the safety of the therapy. Some participants experienced anxiety, fatigue, headaches, and sleep problems. However, the authors stressed that the therapy was safe within the tested framework and could enhance the benefits of psychotherapy.

This was also confirmed by Andrea Cipriani and Philip Cowen of Oxford University in a “Lancet” commentary: “The unmet need for better PTSD therapies, especially for war veterans and rescue workers, is beyond question,” the psychiatrists wrote. “But whether the benefits of MDMA-assisted psychotherapy can be generalized to the psychiatric routine remains to be seen.”

This is now to be demonstrated in a donor-funded Phase 3 study involving up to 300 PTSD patients in the US, Canada, and Israel. The aim of the study, which has been running at a total of 15 centers since the end of 2018, is to obtain approval for the method in the USA in 2021.

The psychologist Keren Zarfati is leading the Israeli part of the study. Each of the 14 participants had a total of 15 therapy sessions, always with a male and a female therapist, she says. In three sessions, patients receive an MDMA tablet or a placebo. The substance is effective for about eight hours, while both therapists care for the patient. All in all, the participants are in hospital for 24 hours and under constant observation.

“Access” through MDMA?

“MDMA provides access”, says Zarfati. It allows a patient to come into contact with his trauma “in a controlled way”. Usually, PTSD patients cannot face their experiences, she explains, stressing that “MDMA does not do the work, the client does it with the therapists.

The Israeli Ministry of Health is also working on a pilot project with 50 participants. The psychotherapist in charge, Bella Ben Gershon, expects the project to start this year.

The purchase, trade, and production of MDMA are prohibited in Germany — as in other countries. The German Head Office for Addiction Issues writes: “The use of ecstasy damages the brain and nerves and can result in memory, speech disorders, and lack of concentration. Regular use of ecstasy can lead to psychological dependence”.

But even in this country, experts are interested in the combined form of therapy. “I believe that the approach is promising, but we do not yet know well enough for which patients in particular,” says UKE physician Schäfer. There is a need for research. “We are always happy about any potentially helpful approach, especially in the case of diseases that have a high tendency to become chronic.

Tomislav Majic from the Berlin Charité Hospital also finds the approach interesting but also sees a need for further research. Above all, the psychiatrist emphasizes: “However, this expressly does not mean that taking MDMA outside of a controlled therapeutic setting is safe or will even lead to beneficial effects on anxiety disorders such as PTSD”.

Patschenik says that he no longer has PTSD. His life has changed fundamentally after the therapy. “Afterwards I said to myself: ‘I know that my feelings are not as dangerous as I thought before. Now I can mourn what happened, that I lost my father at that point. It’s a way to let go of the past.’” Patschenik started to do sports, eat healthier food. In the meantime, the teacher is training to be a therapist himself.