With an explosion in research looking at psychedelic therapy for a number of mental health conditions, FDA approval for MDMA-assisted psychotherapy for PTSD is anticipated for 2024.
How well this revolutionary research will be implemented into practice will depend on patients’ willingness to undergo psychedelic-based treatments and their ability to access those treatments, says Medical University of South Carolina psychiatrist Jennifer Jones.
Jones’ latest research, published in Frontiers in Psychiatry, examines these potential barriers in a population that stands to benefit greatly from psychedelic therapies for PTSD: individuals that use substances.
Changing treatments and outcomes
While some benefit from current treatments for PTSD – such as talk therapies – these treatments do not work for everyone. Jones highlights that for PTSD patients with alcohol or substance disorders, no-response rates are even higher.
“It is really interesting – in these early studies looking at psychedelic therapy for one indication, like PTSD, they noticed improvements in symptoms of another mental health disorder, like depression or SUD,” said Jones.
Since 2009, approximately 80 clinical trials involving MDMA have been completed or are ongoing, according to Clinicaltrials.gov.
These trials investigate the use of MDMA in a wide range of disorders, including anxiety, depression, obsessive compulsive disorder, SUD and PTSD, and highlight the potential effects of MDMA across multiple disorders, something that prior treatments have lacked.
“This is really important,” said Jones. “It is very common to have concurrent mental health disorders, so having a treatment like MDMA that could, for example, improve both PTSD and SUD symptoms is really exciting for the field.”
For MDMA-assisted therapy, the talk therapy component is a fundamental part of the treatment.
Jones continued: “In the context of MDMA-assisted therapy for PTSD, MDMA is thought to dampen the fear response around the traumatic memory, allowing the participant to engage with the therapy team to process this memory, sometimes for the first time in their lives.
“Instead of running from it, they can process the traumatic memory and move past it.
“Participants in psychedelic clinical trials have lasting benefits that come from changes in their behaviours, their thought processes and their interactions with others. Participants often point to these changes as what made the difference in their symptoms.”
Jones highlights, however, that the immediate effects of MDMA during therapy are not without concern, however.
“Ecstasy is a common descriptor for the effects caused by recreational MDMA, used so frequently that it became a nickname for the drug. However, because this therapy is a difficult process of self-healing, MDMA in this context does not usually produce ecstasy,” Jones said, highlighting the concern as a possible barrier to access.
For some, reluctance to receive MDMA-assisted therapy is tied to negative views of psychedelics and their recreational uses that have been perpetuated in the media.
Study results
In Jones’ study, approximately 70% of survey respondents indicated their support for MDMA-based research and belief that MDMA could be useful for treating mental health disorders. A smaller group, 59%, would be willing to receive an MDMA-based treatment if it were recommended by a mental health provider.
The survey results suggest that most people who use substances are open to MDMA research and would be willing to try an MDMA-based therapy.
Jones also examined the role of race and ethnicity on opinions about MDMA-assisted therapy.
Despite their underrepresentation in psychedelic clinical trials, racial and ethnic groups had similar levels of support for MDMA research. However, there were small, but potentially important, differences in willingness to try an MDMA-based therapy.
“While largely a hypothesis,” said Jones, “differences in willingness to participate in clinical trials are probably related to prior use or cultural beliefs.”
Jones believes these results can help researchers and mental health providers to understand how to develop and implement treatments more equitably for different patient and ethnic populations.
By discussing these issues prior to the FDA decision, Jones hopes steps can be taken to address patient concerns.
“It is my heartfelt goal that everyone who might benefit from MDMA-assisted therapy is able to receive treatment once it is available, and that they will not be held back by worries or stigma about the treatment,” said Jones.
“For that to be a reality, we have to seek input directly from those most likely to benefit from the treatments that we are developing.”
