Medical Editor: Dr. David Cox, PhD, ABPP
Also casually referred to as Molly or ecstasy, 4-Methylenedioxy-methamphetamine (MDMA) is a synthetic psychoactive substance that is commonly known for the state of euphoria it can induce.
The feelings of openness and peace have many people wondering: can MDMA be used to treat conditions like depression and anxiety?
Here, we will explore what research has discovered about MDMA as a therapeutic aid and what is still unknown.
What are the effects of MDMA in therapy?
The characteristic effect of MDMA is a state of euphoria and greater peace. It has both psychedelic and stimulant effects, often causing a person to feel more open to new ideas or experiences and connected to other people or the universe as a whole. Often, the senses are heightened or enhanced, and mild visual or auditory hallucinations can happen.
Factors such as trauma, insecurity, shame, or a general desire to avoid discussions about sources of sorrow in life can prevent a person from fully benefiting from therapy and can create hesitation to fully examine the underlying causes. Possibly the most relevant effect of MDMA as it relates to the treatment of depression and anxiety is a reduction in the fear response, which is what often hinders the psychotherapeutic process.
When MDMA is administered in a psychotherapeutic setting, a person may be freed from fears of reliving traumatic events, discussing sources of pain, identifying destructive tendencies, or other intimidating aspects of therapy that are necessary for positive growth.
One of the major appeals of MDMA as a therapeutic aid is the fact that most antidepressant drugs approved by the United States Food and Drug Administration (FDA) require daily dosage over long periods of time (often indefinitely), while at least one study has indicated MDMA requires 3 or fewer single treatments and has demonstrated impressive long-term efficacy after just one treatment.
How can MDMA help depression?
There is some evidence to suggest that it has antidepressant effects in people predisposed to depression. The potential benefit of MDMA as a treatment for depression is the rapid onset of its effects on serotonin, dopamine, and norepinephrine levels, while first-line antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) take about 6 weeks to demonstrate results. This could be particularly important if MDMA were to be used to treat cases of treatment-resistant depression (TRD).
Cognitive-behavioral therapy (CBT) is one of the most effective forms of therapy for depression, and the finding that MDMA appears to facilitate greater productivity in this aspect of treatment could indicate its possible relevance as a psychotherapeutic aid. CBT helps restructure negative patterns of thought that prevent emotional healing through awareness and actionable plans for changing behavior. With the assistance of MDMA, a person can be more open and receptive to CBT and might benefit long-term from the epiphanies that can occur during a session.
In addition to increased cognitive insights, people treated with MDMA-assisted psychotherapy reported improvements in sleep habits, healthier coping mechanisms, and regulation of their emotions, all of which contribute positively to improving the symptoms of depression.
How can MDMA help anxiety?
MDMA therapy for anxiety is currently in Phase 3 of clinical trials and was granted expanded access for the treatment of post-traumatic stress disorder (PTSD), which is a type of anxiety disorder. It has positive effects on the psychotherapeutic process by reducing the fear response, which is a major challenge for those suffering from PTSD who must interface with traumatic experiences of the past in order to heal from them.
Anxiety and depression are also unfortunately common conditions that occur in people living with life-threatening illnesses, such as cancer and serious autoimmune conditions. Understandably, such ailments cause immense existential distress that may not be sufficiently responsive to first-line treatment methods. MDMA-assisted therapy may offer a potential solution to this dilemma. Sarah Hogate Bacon, when writing about her guided experience with therapeutic MDMA to alleviate acute anxiety associated with life-threatening lung disease, said “I had a sense of safety, trust and gratitude for my body, which had betrayed me with illness and orthopedic calamities.”
Individuals with autism are at high risk for developing social anxiety, particularly those who are on the more high-functioning end of the spectrum and whose condition may not be recognizable to people who are unaware of it. The expectation to think and behave in ways that conform to a specific set of social norms can be overwhelmingly debilitating in this population. MDMA is being studied for its potential benefit in treating social anxiety in adults with autism, mainly due to anti-anxiety medications frequently showing up as ineffective when addressing this issue in this population.
Where can I get MDMA?
MDMA is not currently available as a prescription drug for depression or anxiety that you would pick up from a pharmacy. Though its status could change as research makes increasingly more compelling discoveries, it is classified as a Schedule I drug that is illegal for use outside of a federally approved setting. At this time, clinicians and practitioners who are able to use it legally in a therapeutic setting do so for the purposes of research.
The Multidisciplinary Association for Psychedelic Studies (MAPS) has been actively supporting such research. For example, MDMA was designated as a Breakthrough Therapy for the treatment of post-traumatic stress disorder (PTSD), and if it succeeds in fulfilling the requirements of its trial phases, it may be available as a prescription medicine during psychotherapy sessions as early as 2023.
Closing thoughts and resources
MDMA is not legal for personal use, and it can be dangerous to obtain illicitly due to a lack of regulation and possible adulteration with other potentially harmful substances. Without the guidance of a knowledgeable practitioner and research-recommended psychotherapy approaches, it is possible that MDMA could worsen depression or anxiety.
For more information about the clinical trials exploring the potential of MDMA as a medicine for certain conditions, check out the MAPS website for their descriptions of current studies.