Post-traumatic stress disorder (PTSD) affects millions of people every year: mostly survivors and witnesses of terrifying or shocking events, such as warfare, assaults or disasters. Often misdiagnosed and misunderstood, PTSD is a condition for which existing treatment is often only marginally effective. As someone with a passion for psychology and mental health, I'd like to chat this week about the exciting developments that have come to the fore in using psychedelics to treat PTSD.
Before we explore the potential of psychedelics, it’s important to understand the exact nature of PTSD. First brought to the public’s attention by war veterans after the Korean and Vietnam war, PTSD can emerge after experiencing or witnessing a traumatic event, such as domestic violence, hijackings, aircraft or motor accidents, violent attacks or natural disasters. These stressful or traumatic events usually involve a situation where someone’s life has been threatened or severe injury has occurred.
The condition can be triggered not only by experiencing a traumatic event, but also from witnessing a traumatic incident. A diagnosis of PTSD is usually made when specific symptoms cause a certain level of distress and interference in a person’s everyday life.
Although symptoms of PTSD usually appear within three months of the traumatic event, PTSD starts at different times for different people. Sometimes, the signs of PTSD may start soon after a frightening event and then continue. Other people may develop new or more severe signs months or even years later. PTSD is often related to the seriousness of the trauma, whether the trauma was repeated or not, what the person’s proximity to the trauma was, and their relationship with the victim or perpetrator of the trauma.
Doctors typically categorize PTSD symptoms into the following three groups:
Intrusive symptoms: This occurs when sudden, vivid memories of the traumatic event are accompanied by painful emotions – a flashback – which completely take over the person’s attention or ability to function.
Avoidance symptoms: This takes place when the person feels an emotional numbness; where only routine, mechanical activities can be completed.
Hyper-arousal symptoms: This causes sufferers to act as if they are continually threatened by the trauma that caused their condition. They often become irritable, even when not provoked, and have trouble concentrating or remembering current information. PTSD sufferers may have exaggerated startle reactions and can suffer panic attacks, resulting from the extreme fear they felt during the traumatic event.
Can Psychedelics Help Treat PTSD?
There are two (traditional) types of treatment for PTSD: medication and psychotherapy. While helpful for many, these two options often fall short, which leaves a lot of room for alternative approaches like psychedelics.
How Psychedelics Work in PTSD Treatment
Enhanced Therapy Sessions: Psychedelics are administered in the presence of trained therapists, creating an environment of trust and safety. These substances can amplify the therapeutic process, allowing patients to delve deeper into their traumatic experiences and emotions.
Altered Perception and Connection: Psychedelics can alter perception and induce a sense of interconnectedness, potentially helping individuals view their trauma from a different perspective. This altered state of consciousness can facilitate healing and emotional release.
Neuroplasticity: Some studies suggest that psychedelics may promote neuroplasticity, the brain's ability to rewire itself. This could play a role in reshaping neural pathways associated with traumatic disorders.
How does MDMA help PTSD?
One of the most promising developments in PTSD treatment is MDMA-assisted therapy. Although there is still a lot to learn about the neurobiological mechanisms of action of this therapy, MDMA has been found to reduce levels of fear and distress and increase serotonin levels in the brain, leading to improved mood and behavior. Additionally, it has been observed to repair the brain’s neural pathways, which allows for better communication amongst neurons. This can help to reduce episodes of intense emotions and panic attacks, which can come with PTSD. MDMA also enables participants to engage in active, open discussions about their trauma without becoming emotionally overwhelmed—a major challenge to those suffering from PTSD.
It’s important to note that MDMA alone cannot treat a patient’s PTSD – and research doesn’t suggest it is a ‘cure’. What MDMA does is help the process of psychotherapy, by reducing defensiveness and anxiety, increasing relaxation and improving mood. Using the psychedelic allows the patient revisit traumatic memories and work through their emotions without being re-traumatized, or finding the associated anxiety or fear too overwhelming. Since MDMA appears to reduce anxiety associated with recalling traumatic experiences, it can also help increase insight and memory. Negative memories feel less confronting, allowing the therapist and patient to have sessions without the patient becoming overly anxious.
Another significant factor to keep in mind is that MDMA is an experiential medicine, which means that its therapeutic effects are heavily influenced by the setting in which it is administered, as well as the person’s frame of mind. This is a key distinction from other medications. For this reason, it is vital that patients are educated on the potential effects of the substance before they ingest it. The treatment setting needs to be thoughtfully constructed so that it provides the right amount of support and protection. Even more essential is that patients are guided through the experience by trained facilitators – such as doctors or psychologists with special training – who know how to gently shift and shape the experience to help with processing the many facets of trauma that will arise.
Is clinical MDMA different than recreational MDMA?
The MDMA used in a clinical setting is a drug produced to a pharmaceutical standard – like any other medication used to treat mental health. The purity and strength of the dose is known, and it is administered in a safe, controlled environment by a trained health professional during a therapy session.
Illicit MDMA, on the other hand, such as pills (also known as ecstasy), powders or crystals are not regulated, and the purity and strength are unknown. Moreover, even though these substances are sold as MDMA, they often only comprise trace amounts of MDMA, or none at all. Other drugs and ‘fillers’ are often used instead, making the effects more unpredictable and increasing the likelihood of a negative reaction.
The Legal Side
In June 2023, the U.S. Food and Drug Administration (FDA) published a new draft guidance that outlines important considerations to researchers who are investigating the use of psychedelics for the treatment of PTSD. The goal is to help researchers design studies that will yield interpretable results capable of supporting future drug applications. Describing basic considerations throughout the drug development process, the document covers topics such as trial conduct, data collection, and subject safety.
The Bottom Line
As someone who believes in the power of informed choices, I find these developments in PTSD treatment both promising and intriguing. The idea of healing through the exploration of one's mind with the assistance of carefully administered psychedelics brings about an interesting challenge to the more traditional approach to mental health treatment. While there are undeniably still challenges and questions that need to be addressed, the potential for a more effective treatment for PTSD is a source of hope for many. MDMA, in my opinion, should be viewed as a very powerful tool – it just needs to be in the right dose, in the right context, with the right support.