MDMA heads to Phase 3 trials for helping PTSD

A new study shows success in a series of Phase 2 trials.

MDMA heads to Phase 3 trials for helping PTSD
Photo credit: Jasper Graetsch on Unsplash
  • A new study in Psychopharmacology shows MDMA has a 50 percent efficacy rate for PTSD victims.
  • A series of six controlled, double-blind studies moves research to Phase 3 trials.
  • Combined with psychotherapy, MDMA could be a potent force in treating one of the our most challenging problems.

Over 8 percent of Americans will suffer from post traumatic stress disorder (PTSD) at some point in their lives, which is double the global average. Considering the current world population, that means roughly 308 million people will experience short-term or chronic PTSD from a variety of triggers: war, sexual assault, bullying — an entire list of invasive assaults. We're simply not equipped to handle such cognitive and emotional overload.

Which is why treatments are so badly needed. Last year, the Multidisciplinary Association for Psychedelic Studies (MAPS) published a study in The Lancet Psychiatry showing a 68 percent efficacy rate in PTSD symptom reduction; patients in that trial no longer needed ongoing treatment. It was another step on a decades-long battle to remove MDMA from Schedule 1 by proving its therapeutic value.

Now a new study, this one published in Psychopharmacology on May 7, combines the research of six Phase 2 studies on MDMA in order to move the research onto Phase 3. The tortoise-like approach that MAPS has taken since its 1986 founding has been critically important in opening a dialogue about the value of psychedelics. Of course, governmental oversight of these substances has not exactly been progressive.

But there is forward movement. As Michael Pollan notes in his opus on this topic, How to Change Your Mind, given the lack of continual efficacy and troublesome side effects of current pharmacological treatments, governmental agencies are now taking a hands-off approach to substances like psilocybin and MDMA. In fact, research is being requested.

How MDMA and psychedelic drugs can assist mental health

Fortunately, MAPS is happy to provide it. As study author Allison Feduccia, who began testing MDMA in rats in 2004, notes regarding her understanding of the substance,

"I… learned about the unique effects of MDMA and why it was used in couple's therapy prior to being placed on Schedule 1 list. Using a drug only a few times to enhance therapeutic processing to resolve underlying issues that cause PTSD symptoms seemed like an approach worth investigating."

MDMA increases the amount of serotonin, dopamine, and noradrenaline neurotransmitters in certain regions of the brain. Though ecstasy became victim to a bad public image in the '90s for being associated with kids at raves not drinking enough water while dancing all evening, little attention was paid to dosage and environment. As with many mind-altering substances, fear mongering usurped a levelheaded, rigorous clinical approach to better understanding how these drugs can benefit us.

The six trials included in this study were conducted between 2004–2017. A total of 103 volunteers took part. Participants underwent two or three 90-minute psychotherapy sessions prior to ingesting MDMA to establish a baseline for their conditions. This was followed by two to three supervised MDMA (or placebo) sessions. Volunteers remained overnight; a 90-minute "integration" session followed.

In total, half of the volunteers no longer met the clinical criteria for PTSD after their MDMA sessions. This is compared to 23 percent in the placebo group. This remained true after a year of follow-ups, which is especially important given that many pharmaceutical treatments require daily usage to remain effective.

Researchers are not certain why substances in the serotonin-producing family "reboot" people's psychological condition. One speculative idea is perspective. For example, LSD has shown efficacy in treating addiction issues. While on the psychedelic journey, a new worldview is introduced. When the subjects realize how their addictions destroy their bodies, they vow to change after the journey is over. Something about the realization coupled with neurochemistry makes the changes stick.

A dose of MDMA in the office of Dr. Michael Mithoefer, a psychiatrist, who has studied the use of MDMA as a treatment for PTSD in Mount Pleasant, SC, USA on August 24, 2017.

Photo by Travis Dove for The Washington Post via Getty Images

For some reason, psychedelics offer, at least in parts of the population, a "wake-up" powerful enough to reorient their relationship to reality. MDMA appears to have a similar function: experiencing the "bliss" associated with the substance, volunteers integrate the experience deeply enough to shift their outlook. The trauma of the past no longer holds as much power over them.

How this correlates on a neurochemical level remains to be seen. Yet as the study authors note, the efficacy of these Phase 2 trials is dependent upon MDMA and psychotherapy. Taking the substance but not being offered professional guidance might not prove as effective in long-term integration regardless of chemical interactions. As has long been espoused in the psychedelic community, set and setting are equally important factors in the experience; drugs alone will not do the trick.

Minor side effects were recorded during the sessions, including anxiety, dizziness, jaw clenching, nausea, and lack of appetite. Still, given the overwhelming and profound nature of the experience, the team notes that MDMA has "a low potential for abuse." None of the volunteers reported craving more; a number of respondents said they did not find pleasure, and that it was "rather difficult therapeutic work delving into their traumatic memories."

As Feduccia says of the research, the road ahead is long. But this is an important step in overturning decades of misinformation about substances like MDMA and their therapeutic potential. If Phase 3 trials hold up, an entirely new — and more importantly, sanctioned — line of treatment could open up.

"It has taken many decades to reach this point for MDMA drug development," she says. "We are seeing a shift in public opinion as scientific evidence builds support for use of MDMA and psychedelics for treating mental health conditions. These are exciting times we live in, and could very well likely be on the cusp of a new paradigm for psychiatric medicine."

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A landslide is imminent and so is its tsunami

An open letter predicts that a massive wall of rock is about to plunge into Barry Arm Fjord in Alaska.

Image source: Christian Zimmerman/USGS/Big Think
Surprising Science
  • A remote area visited by tourists and cruises, and home to fishing villages, is about to be visited by a devastating tsunami.
  • A wall of rock exposed by a receding glacier is about crash into the waters below.
  • Glaciers hold such areas together — and when they're gone, bad stuff can be left behind.

The Barry Glacier gives its name to Alaska's Barry Arm Fjord, and a new open letter forecasts trouble ahead.

Thanks to global warming, the glacier has been retreating, so far removing two-thirds of its support for a steep mile-long slope, or scarp, containing perhaps 500 million cubic meters of material. (Think the Hoover Dam times several hundred.) The slope has been moving slowly since 1957, but scientists say it's become an avalanche waiting to happen, maybe within the next year, and likely within 20. When it does come crashing down into the fjord, it could set in motion a frightening tsunami overwhelming the fjord's normally peaceful waters .

"It could happen anytime, but the risk just goes way up as this glacier recedes," says hydrologist Anna Liljedahl of Woods Hole, one of the signatories to the letter.

The Barry Arm Fjord

Camping on the fjord's Black Sand Beach

Image source: Matt Zimmerman

The Barry Arm Fjord is a stretch of water between the Harriman Fjord and the Port Wills Fjord, located at the northwest corner of the well-known Prince William Sound. It's a beautiful area, home to a few hundred people supporting the local fishing industry, and it's also a popular destination for tourists — its Black Sand Beach is one of Alaska's most scenic — and cruise ships.

Not Alaska’s first watery rodeo, but likely the biggest

Image source: whrc.org

There have been at least two similar events in the state's recent history, though not on such a massive scale. On July 9, 1958, an earthquake nearby caused 40 million cubic yards of rock to suddenly slide 2,000 feet down into Lituya Bay, producing a tsunami whose peak waves reportedly reached 1,720 feet in height. By the time the wall of water reached the mouth of the bay, it was still 75 feet high. At Taan Fjord in 2015, a landslide caused a tsunami that crested at 600 feet. Both of these events thankfully occurred in sparsely populated areas, so few fatalities occurred.

The Barry Arm event will be larger than either of these by far.

"This is an enormous slope — the mass that could fail weighs over a billion tonnes," said geologist Dave Petley, speaking to Earther. "The internal structure of that rock mass, which will determine whether it collapses, is very complex. At the moment we don't know enough about it to be able to forecast its future behavior."

Outside of Alaska, on the west coast of Greenland, a landslide-produced tsunami towered 300 feet high, obliterating a fishing village in its path.

What the letter predicts for Barry Arm Fjord

Moving slowly at first...

Image source: whrc.org

"The effects would be especially severe near where the landslide enters the water at the head of Barry Arm. Additionally, areas of shallow water, or low-lying land near the shore, would be in danger even further from the source. A minor failure may not produce significant impacts beyond the inner parts of the fiord, while a complete failure could be destructive throughout Barry Arm, Harriman Fiord, and parts of Port Wells. Our initial results show complex impacts further from the landslide than Barry Arm, with over 30 foot waves in some distant bays, including Whittier."

The discovery of the impeding landslide began with an observation by the sister of geologist Hig Higman of Ground Truth, an organization in Seldovia, Alaska. Artist Valisa Higman was vacationing in the area and sent her brother some photos of worrying fractures she noticed in the slope, taken while she was on a boat cruising the fjord.

Higman confirmed his sister's hunch via available satellite imagery and, digging deeper, found that between 2009 and 2015 the slope had moved 600 feet downhill, leaving a prominent scar.

Ohio State's Chunli Dai unearthed a connection between the movement and the receding of the Barry Glacier. Comparison of the Barry Arm slope with other similar areas, combined with computer modeling of the possible resulting tsunamis, led to the publication of the group's letter.

While the full group of signatories from 14 organizations and institutions has only been working on the situation for a month, the implications were immediately clear. The signers include experts from Ohio State University, the University of Southern California, and the Anchorage and Fairbanks campuses of the University of Alaska.

Once informed of the open letter's contents, the Alaska's Department of Natural Resources immediately released a warning that "an increasingly likely landslide could generate a wave with devastating effects on fishermen and recreationalists."

How do you prepare for something like this?

Image source: whrc.org

The obvious question is what can be done to prepare for the landslide and tsunami? For one thing, there's more to understand about the upcoming event, and the researchers lay out their plan in the letter:

"To inform and refine hazard mitigation efforts, we would like to pursue several lines of investigation: Detect changes in the slope that might forewarn of a landslide, better understand what could trigger a landslide, and refine tsunami model projections. By mapping the landslide and nearby terrain, both above and below sea level, we can more accurately determine the basic physical dimensions of the landslide. This can be paired with GPS and seismic measurements made over time to see how the slope responds to changes in the glacier and to events like rainstorms and earthquakes. Field and satellite data can support near-real time hazard monitoring, while computer models of landslide and tsunami scenarios can help identify specific places that are most at risk."

In the letter, the authors reached out to those living in and visiting the area, asking, "What specific questions are most important to you?" and "What could be done to reduce the danger to people who want to visit or work in Barry Arm?" They also invited locals to let them know about any changes, including even small rock-falls and landslides.

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