Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: A systematic review and meta-analysis.
This systematic review and meta-analysis (2020) found 5 trials (n=106) that found large reductions in PTSD symptoms after MDMA-assisted psychotherapy. The studies showed large improvements, but were only moderate in quality.
Authors
- Anna Forsyth
Published
Abstract
Background
Posttraumatic stress disorder (PTSD) is a common psychiatric condition that can develop following a traumatic experience. PTSD is associated with significant disability, a large economic burden, and despite the range of therapies to treat PTSD, response to antidepressants is limited. A growing body of clinical research suggests the efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in individuals with treatment-refractory PTSD.
Aim
To assess the effectiveness and safety of MDMA-assisted psychotherapy for reducing symptoms of PTSD, a systematic review and meta-analysis was undertaken.
Methods
Six online databases were searched from inception to December 2018. Reference lists of relevant articles were manually searched as well as electronic sources of ongoing trials and conference proceedings. Researchers active in the subject were also contacted. Eligible studies included randomized and quasi-randomized clinical trials using MDMA-assisted psychotherapy for PTSD in comparison with other medications, placebo or no medication (supportive care). We used standard methodological procedures expected by the Cochrane Collaboration. Two authors assessed studies for inclusion and extracted data. Using random-effects meta-analysis with Cochrane’s Review Manager 5.3, we obtained standardized mean differences [SMD] and rate ratios [RR] for reduction in PTSD symptomatology.
Results
A total of 5 trials met inclusion criteria, totaling 106 participants (average age: 35-40 years, 70% female). Studies were rated as moderate in quality. MDMA-assisted psychotherapy demonstrated a high rate of clinical response (RR = 3.47, 95% CI: 1.70, 7.06), remission (RR = 2.63, 95% CI: 1.37, 5.02), with a large effect size at reducing the symptoms of PTSD (SMD = 1.30, 95% CI: 0.66, 1.94). Available evidence indicates that MDMA was well-tolerated, with few serious adverse events reported across studies.
Conclusions
MDMA-assisted psychotherapy appears to be a potentially safe, effective, and durable treatment for individuals with chronic, treatment-refractory PTSD. However, future studies involving larger samples and longer durations of treatment and follow-up are warranted-and underway.
Research Summary of 'Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: A systematic review and meta-analysis.'
Introduction
PTSD is a common, disabling condition with substantial public-health and economic costs and only modest response rates to existing pharmacotherapies. Earlier research shows trauma-focused psychotherapies (for example trauma-focused CBT, cognitive processing therapy, prolonged exposure, and EMDR) produce clinically meaningful gains, but nonresponse rates remain high, particularly in military and veteran populations. Pharmacological options authorised for PTSD (selective serotonin reuptake inhibitors) have limited efficacy relative to psychotherapy, and several experimental adjunctive pharmacotherapies have shown mixed results. In this context, a growing clinical literature has explored MDMA-assisted psychotherapy as a treatment for chronic, treatment-resistant PTSD; proponents argue MDMA’s psychopharmacology may facilitate therapeutic engagement, fear-extinction processes and social connectedness, but critics note that existing trials are small and potentially underpowered. Bahji and colleagues therefore undertook a systematic review and meta-analysis to synthesise randomized and quasi-randomized clinical trials of MDMA-assisted psychotherapy for PTSD. The stated aim was to assess effectiveness (clinical response, remission, symptom reduction and durability of effect) and safety compared with placebo, other medications, or supportive care, using standard Cochrane methods and random-effects meta-analysis to combine outcomes across eligible trials.
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Bahji, A., Forsyth, A., Groll, D., & Hawken, E. R. (2020). Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: A systematic review and meta-analysis.. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 96, 109735. https://doi.org/10.1016/j.pnpbp.2019.109735
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