Trial PaperPTSDAnxiety DisordersNeurocognitive DisordersSafety & Risk ManagementMDMA

The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study

In the first randomised controlled pilot trial, MDMA-assisted psychotherapy produced significantly greater reductions in Clinician-Administered PTSD Scale scores than placebo in 20 patients with chronic, treatment‑resistant post‑traumatic stress disorder (83% response vs 25%). There were no drug‑related serious adverse events, adverse neurocognitive effects or clinically significant blood pressure increases, suggesting MDMA may be a safe and effective adjunct to psychotherapy in refractory PTSD.

Authors

  • Rick Doblin
  • Michael Mithoefer
  • Lisa Jerome

Published

Journal of Psychopharmacology
individual Study

Abstract

Case reports indicate that psychiatrists administered ±3,4-methylenedioxymethamphetamine (MDMA) as a catalyst to psychotherapy before recreational use of MDMA as ‘Ecstasy’ resulted in its criminalization in 1985. Over two decades later, this study is the first completed clinical trial evaluating MDMA as a therapeutic adjunct. Twenty patients with chronic posttraumatic stress disorder, refractory to both psychotherapy and psychopharmacology, were randomly assigned to psychotherapy with concomitant active drug ( n = 12) or inactive placebo ( n = 8) administered during two 8-h experimental psychotherapy sessions. Both groups received preparatory and follow-up non-drug psychotherapy. The primary outcome measure was the Clinician-Administered PTSD Scale, administered at baseline, 4 days after each experimental session, and 2 months after the second session. Neurocognitive testing, blood pressure, and temperature monitoring were performed. After 2-month follow-up, placebo subjects were offered the option to re-enroll in the experimental procedure with open-label MDMA. Decrease in Clinician-Administered PTSD Scale scores from baseline was significantly greater for the group that received MDMA than for the placebo group at all three time points after baseline. The rate of clinical response was 10/12 (83%) in the active treatment group versus 2/8 (25%) in the placebo group. There were no drug-related serious adverse events, adverse neurocognitive effects or clinically significant blood pressure increases. MDMA-assisted psychotherapy can be administered to posttraumatic stress disorder patients without evidence of harm, and it may be useful in patients refractory to other treatments.

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Research Summary of 'The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study'

Introduction

Posttraumatic stress disorder (PTSD) is described as a chronic, debilitating anxiety disorder with high prevalence and limited treatment effectiveness. Mithoefer and colleagues note that existing pharmacotherapies (notably SSRIs) and psychotherapies produce meaningful benefit for many patients but leave 25%–50% of trial participants with inadequate response; combined pharmacotherapy and psychotherapy data are limited and mixed. Given the substantial unmet need, the authors introduce MDMA as a pharmacological adjunct that was historically used to facilitate psychotherapy and which, in modern Phase I work, has demonstrated an acute subjective profile of reduced fear, increased sociability and preserved clarity of consciousness. This pilot Phase II study set out to test two linked hypotheses: that MDMA could be administered without harm to carefully screened patients with chronic, treatment-resistant PTSD, and that when paired with manualised psychotherapy it would produce greater reductions in PTSD symptom severity than the same psychotherapy with inactive placebo. The trial therefore evaluates safety, tolerability and preliminary efficacy of MDMA-assisted psychotherapy in this population, and gathers feasibility data for future trials.

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Study Details

References (3)

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