MDMA-assisted psychotherapy

Women at the Veterans Health Clinic in Virginia speak about PTSD. MDMA-assisted psychotherapy may be a breakthrough treatment for PTSD if it becomes legal. | Image source: Flickr CC user Mark Warner

MDMA’s been getting some bad press lately. In the last three years, MDMA-related deaths have increased in the US and around the world. The number of deaths in 2014 was six times higher than the year before, and the numbers have remained high. Authorities blame this rise on the increasingly stronger ecstasy pills that are now available at clubs, raves, and festivals.

But among the reports, there’s also a particular concern that MDMA may pose a bigger threat to women. An article published last year in Broadly reported that molly may be more dangerous for women, citing statistics that there’s a higher rate of MDMA-related hospitalization in young women and research showing that women experience the negative effects of MDMA — like anxiety — more acutely than men.

So what does all the bad press mean for MDMA as a therapy? While the dangers of club drugs are very real, we shouldn’t dismiss MDMA as a potential treatment for mental disorders just yet. This is particularly true for women, who are more likely to suffer from mental disorders like PTSD, depression, and anxiety. The majority of MDMA studies focus on the negative effects of the substance in a club setting, while most clinical studies are conducted in a “neutral” setting, meaning there’s no support or therapy given to participants. Considering that “a primary action of MDMA is to intensify ongoing psychological states,” studies that reported adverse effects in women — like these from PLOS One and Psychopharmacology — acknowledge that the neutral setting could be a limitation in the viability of the results.

Research suggests that women are more sensitive to the effects of MDMA, but this sensitivity is exactly why they may also respond better to MDMA-assisted psychotherapy. Other studies have shown that, in a therapeutic setting, women actually have a more positive response to MDMA therapy than men. In a supportive environment, a therapist can help a person to navigate and mitigate the possible negative effects so that the positive effects can be maximized.

The Importance of Dose and Setting

There have been very few studies that examine MDMA in a therapeutic setting, and even fewer that study the difference between MDMA’s more subjective effects in men and women (most focus on physiological and physical effects). But what has been published is promising.

In a 2001 study called “Gender Differences in the Subjective Effects of MDMA,” the results from 74 healthy volunteers showed that women – more than men – felt “carefree,” “free of worries and obligations,” and experienced “boundless joy” and “comprehensive love.” Women expressed that they felt though they were in “a wonderful other world,” and, at the same time, “at one with their surroundings.”

In the study, women scored much higher in two categories termed “oceanic boundlessness” and “visionary restructuralization,” which included characterizations of positive mood, recollection, and imagination — all of which are known to help with the treatment of mental disorders like PTSD.  While the study also backed up claims that women experience more anxiety from MDMA, it wasn’t until they reached stronger doses between 1.25 – 1.85 mg/kg, which suggests that staying within a reasonable dose can mitigate anxiety and maximize therapeutic effects.

In another case study published in the Journal of Psychoactive Drugs, six women who suffered from PTSD after a sexual assault underwent MDMA-assisted psychotherapy. Neither group — which were administered doses of 50 to 75 mg — experienced an increase in symptoms of PTSD, anxiety, depression, phobias, maladjustment, or self-esteem (contrary to other research), and all but one woman’s symptoms improved. Most importantly, none of the participants experienced retraumatization, meaning they were able to revisit their traumatic experience without causing further trauma.

Interestingly, of the study’s six participants, the woman who ranked highest on the PTSD scale prior to treatment also had the best response to the treatment. She also received the highest dose of MDMA of 75 mg — or 1.41 mg/kg, just above the lower threshold that the MAPs study found to induce anxiety. Not only did she improve most on the PTSD scale, she also experienced the greatest reduction in anxiety, depression, fear, and maladjustment, and the highest increase in self-esteem. Even more interesting is that the positive effects didn’t stop after the completion of the study — rather, her PTSD symptoms continued to decrease over the next six months.

More recently, a 2010 MAPS pilot study looked at the safety and efficacy of MDMA-assisted psychotherapy in 20 people who had been diagnosed with PTSD. While the study didn’t specifically examine gender differences in response to MDMA therapy, the study did use a majority of female participants (17 out of the 20 were women). The results were very hopeful: 83% of participants who were administered MDMA showed a significant decrease on the PTSD scale in comparison with the placebo group.

What’s the difference between these studies and the ones that say MDMA is more dangerous for women? A therapeutic setting. In all three studies, participants received non-drug psychotherapy before and after the MDMA experience with a therapist that helped them set a “realistic purpose” for the experience. For the case study with the six women who had been sexually assaulted, the therapists helped each woman explore the emotional and psychological extent of her trauma. These MDMA-assisted psychotherapy sessions helped to create an ideal setting in which she could process past traumas:

“The therapeutic potential of MDMA consists in temporarily reducing or eliminating anxiety and fear, thus helping subjects gain access to their emotions and internal conflicts without the overwhelming fear normally associated with these emotions and memories. This ameliorative effect simultaneously helps subjects access these traumatic emotions and communicate them to a therapist, thus enhancing both the therapeutic alliance and the psychotherapeutic process. Since it enhances both introspection and the strength of the therapeutic alliance—the most important variables predicting therapeutic outcome—MDMA seems an ideal tool for use in the psychotherapeutic process, especially for the treatment of PTSD.”

The Need for More Research, and Caution for MDMA Users  

In general, we need more research conducted in a therapeutic setting to truly understand MDMA’s ability to treat mental disorders. And within that realm, there’s a serious lack in research on how men and women respond differently to MDMA-assisted psychotherapy — women are often discluded from research because of complications with pregnancy and hormonal fluctuations due to menstrual cycles. But with the rates of mental disorders like PTSD, anxiety, and depression increasing in women, we need effective treatments now more than ever.   

Meanwhile, women who decide to take MDMA — either therapeutically or recreationally — should be careful. There’s always the risk that an ecstasy pill will be cut with other drugs like cocaine, heroin, or ketamine. Even if it’s pure MDMA, there’s still a risk. Whereas an average ecstasy pill in 2009 contained 20 – 30 mg, the average these days is closer to 100 mg (and pills confiscated at raves in the UK and Spain have tested upwards of 250 and even 400 mg). The risk of death is greater at higher temperatures, like those found at crowded clubs or summer festivals.

If you want to make the most of MDMA’s therapeutic benefits, it’s important to start with a small dose, set an intention for your experience, and integrate your experience afterward through talk therapy or home practices. By taking safety precautions and using mindful practices, you can mitigate the risks of MDMA and make the most of its life-changing potential.