3,4-Methylenedioxymethamphetamine facilitates fear extinction learning

R. and colleagues report that systemic administration of MDMA before extinction training produced persistent and robust enhancement of long-term extinction of conditioned fear. A systemic dose cited in the extracted text (7.8 mg kg-1) given prior to extinction training reduced conditioned freezing at subsequent extinction tests, and these reductions persisted for several days and generalized to a novel context in which the conditioned stimulus (CS) was presented. Molecular measures showed increased expression of the immediate early gene Fos in both the amygdala and the medial prefrontal cortex (mPFC) following MDMA treatment and extinction. Increases in Bdnf mRNA were observed specifically in the amygdala, but only when MDMA administration was combined with extinction training; MDMA alone did not produce the same amygdala Bdnf increase. The extracted text notes that earlier work observed mPFC Bdnf increases at 24 h after a different MDMA dose, but such changes were not seen here at the time points sampled. Direct infusion of MDMA into the basolateral amygdala (1 μg) reproduced the extinction-enhancing effects seen with systemic MDMA. Infusions into the infralimbic cortex (IL) also enhanced extinction, whereas infusions into adjacent regions did not. Critically, blocking BDNF signalling in the BLA abolished the extinction enhancement produced by systemic MDMA, indicating that BDNF signalling in the BLA is necessary for MDMA's effect on extinction in these experiments. The authors also report that some reductions in freezing observed during extinction training—particularly early reductions in freezing after MDMA—are likely attributable to MDMA's psychostimulant effects rather than to enhanced extinction acquisition per se. For example, a systemic dose of 5.6 mg kg-1 and central infusions of MDMA both altered freezing during testing and increased locomotor behaviour during the same period. Nonetheless, long-term extinction enhancements (including reduced freezing in a novel context) were observed even when immediate reductions in freezing during training were not required, supporting a lasting effect on extinction memory rather than a transient performance effect. The extracted text does not present numerical sample sizes, effect sizes, confidence intervals or p-values for these findings, nor does it give detailed time-course data beyond qualitative descriptions.

The authors interpret their findings as evidence that acute MDMA administered prior to extinction training enhances fear extinction learning via a mechanism that requires activity-dependent BDNF signalling in the amygdala. They emphasise that MDMA must be present during extinction training to produce the observed long-term enhancements, because MDMA combined with extinction—but not MDMA administered after training—led to increased Bdnf expression in the amygdala and to persistent reductions in conditioned fear. R. and colleagues position these results as a possible mechanistic basis for clinical observations that MDMA-assisted psychotherapy can produce long-lasting alleviation of post-traumatic stress disorder (PTSD) symptoms. They note that MDMA's acute pharmacology—robust, rapid increases in extracellular serotonin and norepinephrine via reverse transport, and interactions with 5-HT2A receptors—could plausibly engage activity-dependent processes that upregulate BDNF and consolidate extinction memory. They contrast the rapid monoamine release produced by MDMA with the slower effects of chronic selective serotonin reuptake inhibitor regimens, which can increase BDNF only after prolonged treatment. The authors acknowledge uncertainties and limitations. They state that, given MDMA's broad neuropharmacology, it is difficult to specify precisely how it increases extinction learning and Bdnf expression. They note differences from prior reports (for example, a previous observation of increased mPFC Bdnf 24 h after MDMA) and suggest that some BDNF-related changes may occur at time points not sampled in their assays. They also discuss the potential confound of MDMA's stimulant effects on immediate freezing measures, arguing that short-term reductions in freezing do not fully account for the long-term extinction enhancement. Finally, they highlight safety concerns—MDMA's abuse liability and potential neurotoxicity—and recommend isolating the specific pharmacological mechanisms responsible for extinction enhancement to develop safer therapeutic agents. The authors conclude that their preclinical data support further clinical investigation of MDMA as an adjunct to exposure-based therapies, given the role of impaired activity-dependent BDNF release in extinction-learning deficits observed in PTSD.

R. and colleagues conclude that MDMA facilitates fear extinction learning in mice in a manner that depends on BDNF signalling in the basolateral amygdala. MDMA must be on-board during extinction training to induce enhancements, which are long-lasting and generalise to novel contexts. These preclinical findings provide a mechanistic rationale for further clinical study of MDMA as an adjunct to exposure-based therapies for PTSD, while underscoring the need to clarify the underlying pharmacology and to address safety concerns.