Over the past few years, MDMA, the psychoactive substance also commonly known as “ecstasy” or “molly,” has gained attention as a potential therapeutic tool for treating mental health conditions such as PTSD, anxiety, and depression. Despite its reputation as a “club drug”, emerging data from clinical trials have shown MDMA-assisted psychotherapy is a promising treatment for individuals struggling with mental illness.
MDMA: A Brief History
3,4-methylenedioxy-methylamphetamine, or MDMA, is a synthetic pharmaceutical synthesized by German pharmaceutical giant Merck in the early 20th century. Its intended use when patented was to serve as a clotting agent to control bleeding, It was not until decades later that this medication began getting attention from psychiatrists after initial studies began reporting on its physiological effects.
Thus began a small wave of unofficial research being conducted by psychiatrists and psychotherapists whose clients were communicating more effectively and making deeper insights about their issues.
Around this time illicit MDMA was becoming more accessible on the street and quickly seeped into underground rave subculture in the 80’s and soon thereafter became classified as a Schedule I Drug by the DEA.
It wasn’t until early the 2000’s that research MDMA’s therapeutic benefit for mental health resumed and has since shown tremendous promise as an adjunct treatment to psychotherapy, especially for PTSD, anxiety, and mood disorders.
How Does MDMA Affect the Brain
MDMA is a empathogen-entactogen that alters brain chemistry by affecting the levels of several neurotransmitters, including serotonin, dopamine, and norepinephrine. Chemically, MDMA is a phenethylamine derivative with a substituted amphetamine group. It shares some chemical structures with mescaline, a serotonergic psychedelic, from which it may draw its psychoactive properties from.
When ingested, MDMA is rapidly absorbed into the bloodstream, crosses the blood-brain barrier, and enters the brain, where it acts as a serotonin agonist, increasing its release and blocking its reuptake. This results in a surge of positive emotions, feelings of empathy and social connectedness, and an altered sense of time perception.
Additionally, MDMA affects the release of dopamine and norepinephrine, which can contribute to its stimulant-like effects. However, prolonged or repeated use of MDMA can lead to long-term changes in the brain’s serotonin system, which may contribute to the development of tolerance, dependence, and other adverse effects.
Legality of MDMA in Therapeutic Settings
In recent years, the legal landscape around therapeutic MDMA and MDMA-assisted psychotherapy has been changing. The US Food and Drug Administration (FDA) granted MDMA-assisted psychotherapy a “Breakthrough Therapy” designation in 2017, indicating that it may offer significant benefits over existing treatments for certain conditions. This designation allows for expedited development and review of the treatment.
In 2021, the FDA granted “Expanded Access” status to a limited number of patients with PTSD, allowing them to receive MDMA-assisted psychotherapy while the medication is still undergoing clinical trials. This decision reflects a growing recognition of the potential therapeutic benefits of MDMA for mental health conditions.
Additionally, in some places, such as Canada, the use of MDMA in clinical trials for certain conditions is legal, and some countries have decriminalized personal use of MDMA. However, the use of MDMA for any purpose outside of approved clinical trials remains illegal in most countries.