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MDMA, Used In Therapy, May Help People Heal From PTSD: Shots



Therapists Marcela Ot'alora and Bruce Poulter are trained to conduct MDMA-assisted psychotherapy. In this reenactment, they demonstrate how they help guide and watch over a patient who is revising traumatic memories while under the influence of MDMA.
                
                
                    
                    Courtesy of the Multidisciplinary Association for Psychedelic Studies
                    
                

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Courtesy of the Multidisciplinary Association for Psychedelic Studies
        
    

Therapists Marcel Ot'alor and Bruce Poulter are trained to conduct MDMA-assisted psychotherapy. In this reenactment, they demonstrate how they help guide and watch over a patient who is revising traumatic memories while under the influence of MDMA.

Courtesy of the Multidisciplinary Association for Psychedelic Studies
            
        

The first time Lori Tipton tried MDMA, she was skeptical it would make a difference.

"I really was, at the beginning, very nervous," Tipton remembers.

MDMA is the main ingredient in club drugs ecstasy or molly. But Tipton wasn't taking pills sold on the street to get high at a party.

She was trying to treat her post-traumatic stress disorder, with the help of licensed therapists.

Tipton was given a dose of pure MDMA. Then she lay down in a quiet room with two specially-trained psychotherapists, one woman and one man.

They sat next to Tipton as she recalled some of her deepest traumas, like discovering her mother's body after a murder-suicide.

"In the embrace of MDMA," as she describes it, Tipton could revisit this moment without the usual terror and panic.

"I was able to find such empathy for myself. I realized how much I was thinking this was my fault," she says.

The synthetic psychoactive chemical MDMA is emerging as a promising – if unconventional – treatment for PTSD.

Scientists are testing how the pharmaceutical grade MDMA can be used in combination with psychotherapy to help patients who have a severe form of PTSD that has not responded to other treatments. Unlike street drugs that may be adulterated and unsafe, researchers use

It's Not Yet Available as a treatment for PTSD beyond clinical trials, but the success of early trials has proponents hopeful that the therapy could be available to more people in the coming years; they're aiming for approval by the Food and Drug Administration, which granted breakthrough therapy status to MDMA-assisted psychotherapy in 2017.

Researchers are now conducting phase 3 clinical trials at more than a dozen sites across the US, Canada and Israel . Clinicians who treat PTSD are hopeful the next round of trials will show MDMA treatment is an effective option to relieve their patients' suffering.

"The problem is we haven't had a new drug to treat PTSD in over 17 years," says Sue Sisley, a physician and president of the Scottsdale Research Institute based in Arizona. "There are certain diseases that are just intractable and not responsive to traditional therapy, and we need to start thinking more broadly."

But MDMA is a Schedule 1 controlled substance, which means that it currently has no accepted medical uses and has a "high potential for abuse" (something that MDMA's therapeutic proponents dispute). Because of that design, the current research trials are privately funded by the Multidisciplinary Association for Psychedelic Studies, or MAPS.

'Anywhere I would feel unsafe'

Tipton scrapped for years with PTSD before she got treated with MDMA. She describes life with PTSD as "seeing the world through dirty goggles."

"Anywhere I would feel unsafe," the 40-year-old from New Orleans says. "I would feel like I was always vigilant because if I didn't, something bad was going to happen."

"When you have PTSD, you are living in this constantly triggered environment," says patient Lori Tipton. More than a year after trying MDMA-assisted psychotherapy, Tipton no longer qualifies as having PTSD. She believes it "saved her life."
                
                
                    
                    Will Stone
                    
                

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Will Stone
        
    

"When you have PTSD, you are living in this constantly triggered environment," says patient Lori Tipton. More than a year after trying MDMA-assisted psychotherapy, Tipton no longer qualifies as having PTSD. She believes it "saved her life."

Will Stone
            
        

Tipton describes her 20s as a catalog of tragedy and trauma. It began when her brother fatally overdosed in her home, on his birthday.

After his death, she began caring for her mother, who scraped with mental illness. In 2005, Tipton's mother killed two people and then herself. Tipton was the one who discovered their bodies.

"I was completely just disassociated. I couldn't believe what I was seeing," Tipton says.

The traumas continued to pile up. The place she lived in was destroyed when Hurricane Katrina hit New Orleans, and the following year she was raped.

In the aftermath storm, she was formally diagnosed with PTSD, but at first she didn't take it seriously.

"Nearly everyone returning to New Orleans was diagnosed with PTSD," Tipton says.

As the years went by, Tipton suffered from panic attacks and terrible anxiety. She tried everything to treat her symptoms: talk therapy, antidepressants, hypnotherapy, meditation and yoga.

Nothing worked. She went through life exhausted and apathetic, constantly triggered, and struggling to be intimate with those close to her.

In 2017, Tipton came across an online ad in search of people with severe PTSD in New Orleans. Soon, she was enrolled in phase 2 clinical trials for MDMA-assisted psychotherapy.

MDMA and therapy together?

MDMA was first synthesized in 1912, and its therapeutic benefits were studied in the 1970s But those efforts stalled when the US federal government – in light of the growing popularity of ecstasy as a recreational drug – designated it a Schedule 1 drug in 1985.

In recent years, research has been resumed, funded by private sponsors such as MAPS.

in the current trial calls for a 12-week course in psychotherapy with specially trained therapists. During that time, there are two or three daylong sessions that begin with the patient swallowing a calibrated dose of MDMA in pill form.

A team of two therapists, generally one man and one woman, then guides the patient through the eight- hour MDMA "session." Later, there's follow-up talk therapy, without the drug, to help the patient process any feelings, thoughts, or impressions that came up while under the influence of the drug.

"MDMA allows you to contact feelings and sensations in a lot more direct way, "explains Sai Razvi, a Colorado-based psychotherapist who was a clinical investigator in phase 2 trials.

It's not completely understood how MDMA works on the brain. The psychoactive drug boosters chemicals like serotonin and oxytocin. It also tamps down activity in the amygdala, and part of the brain that processes fear. This may lead to a state characterized by heightened feelings of safety and social connection.

That allows patients to revisit traumatic memories and unpack those moments without triggering the same panic.

A dose of MDMA used in the MAPS experimental protocol for PTSD treatment.
                
                
                    
                    Courtesy of the Multidisciplinary Association for Psychedelic Studies
                    
                

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Courtesy of the Multidisciplinary Association for Psychedelic Studies
        
    

The MDMA scope used in the MAPS experimental protocol for PTSD treatment.

Courtesy of the Multidisciplinary Association for Psychedelic Studies
            
        

"Trauma happens in isolation," Razvi says. "One of the things that MDMA does is, really, let you know that you are not alone."

Razvi has observed hundreds of hours of these sessions and says they can sometimes look tough, almost like a "bad trip," but the process leads to emotional breakthroughs that otherwise "may take months or years to accomplish."

PTSD in remission

After the phase 2 trials of MDMA-assisted treatments concluded in 2017, researchers found 54% of patients who took MDMA had improved to the point that they no longer fit the diagnosis for PTSD (compared to 23% in the control group). In addition, the beneficial effects of the treatment appear to increase, rather than wane, over time. A year later, the number who had no longer had PTSD had risen to 68% percent.

"That was astonishing," says Sisley of the Scottsdale Research Institute. "Even with the best pharmaceutical regimen, you rarely ever see patients go into remission."

Sisley studies alternative treatments for PTSD and recently completed clinical trial testing for cannabis as a treatment for the condition among veterans. She says she hopes to offer her patients MDMA-assisted psychotherapy as soon as possible, maybe before the drug receives full FDA approval.

Brad Burge, a spokesman for the MDMA Trial Sponsor, the Multidisciplinary Association for Psychedelic Studies, says the organization is working to get the FDA to include a drug in its expanded access program that can allow individual patients to be approved for drug use that are still being studied.

Dr. Sue Sisley, president of the Scottsdale Research Institute, has spent much of her career working with people who have severe PTSD. She hopes to offer MDMA-assisted psychotherapy at her Arizona clinic through the FDA's expanded access program.
                
                
                    
                    Will Stone
                    
                

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Will Stone
        
    

Dr. Sue Sisley, president of the Scottsdale Research Institute, has spent much of her career working with people who have severe PTSD. She hopes to offer MDMA-assisted psychotherapy at her Arizona clinic through the FDA's expanded access program.

Will Stone
            
        

Burge calls MDMA "a chemical security blanket."

"People with PTSD have a particularly hard time with psychotherapy because they've been asked to recall in detail, and process and think about literally the scariest thing that's ever happened to them, "he says.

Burge says the goal is to make MDMA-assisted psychotherapy available as a prescription treatment in a specialty clinic to anyone with PTSD.

MAPS is working now to convince public and private insurance plans to cover the treatment, Burge adds. He estimates that for patients paying for it entirely out-of-pocket, the cost of a 12-week treatment course would run between $ 5,000 and $ 10,000.

Healing

Tipton describes her treatment with MDMA as transformative.

She was able to let go of the troubling feelings surrounding her mother's death.

"This is a terrible thing that happened, but carrying the fear and shame over this, it's worthless," she says.

She unearthed other memories, too, feelings of joy that had been sealed away, like playing in the snow with her brother when they were children.

"I could remember exactly how I felt, that excitement of the first snow," she says.

By her last MDMA session, Tipton was even able to talk about her sexual assault.

A year later, she was reassessed and no longer qualified as having PTSD. Tipton says she believes the treatment saved her life.

"Everything is at my fingertips for me in a way that it has never been before," she says. "I want that for everybody."

This story is part of NPR's reporting partnership with KJZZ and Kaiser Health News.


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