MDMA-assisted psychotherapy for the treatment of PTSD

Collin M. Reiff, William M. McDonald
2020 Revista Brasileira de Psiquiatria  
The current standards of care for posttraumatic stress disorder (PTSD) within the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) are two trauma-focused therapies (prolonged exposure therapy and cognitive processing therapy) and the selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine. 1,2 While trauma-focused therapy is effective, it is emotionally demanding, requires skilled psychotherapists, and has a high dropout rate. 1,3 It is estimated
more » ... 3 It is estimated that one-quarter of patients drop out of trauma-focused therapy, and up to one-half are left with significant residual symptoms. 3 SSRIs, which have side effects and require daily dosing, are effective in less than 60% of patients. 3 A recent randomized controlled trial found no difference in PTSD symptom severity at 24 weeks between treatment groups that received prolonged exposure therapy plus placebo, sertraline plus enhanced medication management, and prolonged exposure therapy plus sertraline. 2 At this time, there is a need for better treatments of PTSD in countries such as Brazil, where it is estimated that 5% of the civilian population met criteria for PTSD in the past year, and 10% of the population has met criteria for PTSD in their lifetime. 4 Recently, there has been a call for "disruptive pharmacology" to investigate new treatments with novel mechanisms that have previously been restricted. At the forefront of this movement are the classic psychedelics, psilocybin, LSD, and ayahuasca, as well as the entactogen 3,4-methylenedioxymethamphetamine (MDMA). 5 MDMA, also known as ecstasy, has demonstrated efficacy for the treatment of PTSD in military veterans and first responders. 5 It is currently in phase III clinical trials in the United States and has been designated as a "breakthrough therapy" for the treatment of PTSD by the U.S. Food and Drug Administration (FDA). 5 Brazil has a long history of psychedelic use in religious and healing ceremonies. More recently, Brazilian scientists have been involved in pioneering efforts in psychedelic research with ayahuasca. 5 The recent proof-ofconcept study by Jardim et al. investigates the efficacy of MDMA for the treatment of PTSD in survivors of civilian sexual trauma, and is the first published clinical study using MDMA in Brazil. This study also assesses the efficacy of MDMA-assisted psychotherapy (MDMA-AP) and demonstrates that 15 sessions of psychotherapy, Correspondence: Collin M. Reiff
doi:10.1590/1516-4446-2020-0020 pmid:33053043 fatcat:fwypi74isrhczcl42mz47nri5i