PTSD is a mental disorder that occurs in about 5-10% of people who experience a traumatic event. 1 With PTSD, you struggle to process a traumatic experience; as a result, it causes you continuous psychological distress. One of the most promising new treatments is taking MDMA for PTSD.
MDMA (sometimes called “Molly” or “ecstasy”) is a recreational drug that causes euphoria and feelings of love and connectedness. New research suggests that pairing MDMA with talk therapy may help people face their traumatic experiences and process them, relieving PTSD symptoms.
Here’s a look at MDMA for PTSD, how the therapy works, its legal status, and where you can try MDMA-assisted psychotherapy.
What is PTSD?
Posttraumatic stress disorder (PTSD) is a disorder triggered by witnessing or experiencing a traumatic event.
In some cases, people recover from trauma without issue. With PTSD, however, a traumatic experience continues to affect you for months or years. You may experience 2,3
- Persistent, distressing memories of the traumatic event
- Nightmares about the traumatic event
- Intense stress or physical reactions (shaking, loss of muscle control, etc.) in response to cues that resemble the event (for example, fireworks that sound like gunfire to a combat veteran)
- Social isolation
- Suicidal thoughts
- Self-destructive behavior
- Hypervigilance (feeling unable to relax, being on constant alert)
- Loss of interest or pleasure in activities that you used to enjoy
Around 60-80% of people experience a traumatic event at some point in their lives. 4 Of those who do, 5-10% will develop PTSD as a result. 1
PTSD causes significant changes to your brain. 2 People with PTSD typically have a smaller hippocampus, which governs learning and memory, and a smaller medial prefrontal cortex, which controls emotional reactivity. As a result, their amygdala—the part of the brain that processes fear and threat—is overreactive, and they have exaggerated emotional responses to things a cognitively healthy person wouldn’t consider threatening.
PTSD also increases glutamate activity in the brain. Glutamate is your brain’s main excitatory neurotransmitter—it increases brain activity and produces a feeling of stimulation. High levels of glutamate may explain why people with PTSD are hypervigilant. It may also explain why they feel constant stress and fear.
Here’s a look at glutamate activity in a brain with PTSD versus a healthy brain 5:
With current treatment options, about 30% of people recover from PTSD. 2 Another 40% see partial recovery, although some symptoms remain.
There’s also a high chance that people with PTSD will develop other mental disorders. Women with PTSD are disproportionately likely to develop anxiety disorders, while 52% of men with PTSD develop alcoholism. 2
Researchers are continuously looking for better ways to treat PTSD. One of the most promising new treatment options is MDMA-assisted psychotherapy.
How Does MDMA Work?
3,4-Methylenedioxymethamphetamine (MDMA; sometimes called “Molly” or “ecstasy”) is a stimulant and popular recreational drug.
In its pure form, MDMA is a white or beige crystal. People typically take MDMA orally, either by swallowing the crystal directly or putting it into pills.
MDMA causes massive, sustained dopamine and serotonin release across your brain, particularly in your brain’s reward centers. The name “ecstasy” is appropriate; MDMA causes intense euphoria that lasts for several hours.
MDMA’s effects include 6:
- Increased empathy for others and yourself
- Feelings of happiness and connection with those around you
- Increased energy
- Increased sociability
- Intensified emotions
What is MDMA-Assisted Therapy for PTSD?
A growing body of research suggests that pairing MDMA with psychotherapy is an effective treatment for PTSD. Studies have been ongoing for several years, and in 2017, the U.S. Food and Drug Association (FDA) granted MDMA “Breakthrough Therapy” status for treating PTSD.
In a typical MDMA therapy session, PTSD patients take a moderate dose of MDMA under the guidance of the therapist or a medical professional. Once the MDMA kicks in, the patient undergoes two or three hours of therapy—sometimes with a single therapist, sometimes with a team of therapists.
Benefits of MDMA therapy
Studies suggest that MDMA-assisted therapy causes robust improvement in PTSD symptoms.
When patients take a controlled dose of MDMA prior to a therapy session, they seem to be more able to explore and resolve traumatic experiences during the session. The theory is that MDMA makes you feel so positive that a therapist can probe at underlying trauma without causing you emotional distress. 7
MDMA also increases empathy and feelings of love—both self-love and love for others. As a result, MDMA can help you forgive and accept a traumatic experience, as well as reduce your shame and guilt surrounding the event. 8
Finally, MDMA increases prediction errors—mismatches between what you expect to happen in response to a stimulus and what actually happens.
For example, you may be scared that exploring a traumatic experience will cause you panic, stress, fear, and so on.
While on MDMA, however, you may be brave enough to explore the traumatic event anyway. Because you feel so positive, you may find that exploring the traumatic event doesn’t, in fact, cause a negative reaction in you. As a result, you become less scared of the traumatic event, you realize that you can face it more effectively than you thought, and your PTSD symptoms decrease. 9
In a 2021 study, 90 patients received therapy for severe PTSD. Half of the patients received MDMA before their therapy sessions, while the other half received a placebo. Both groups improved, but patients in the MDMA group saw almost double the improvement in their PTSD symptoms, compared to the placebo group. 10 Several other trials have found similar results. 7,9
Potential risks and side effects of MDMA
Taking MDMA recreationally comes with a fair degree of risk. Illegal drugs are often adulterated or contain inconsistent doses, which could be fatal.
With MDMA-assisted therapy, however, you’re taking a controlled dose of pure MDMA in a medically supervised setting. As a result, the risks and potential side effects of MDMA therapy are fairly minimal.
The most common side effects patients report are 7:
- Bruxism (grinding your teeth)
At the time of this article’s publication, MDMA is federally illegal in the United States. Using or possessing MDMA is punishable by fines and time in prison.
By corollary, MDMA-assisted therapy is also illegal. As a therapist, giving MDMA to your patients can cause you to lose your license and may come with additional legal charges, such as distribution of an illegal drug.
However, MDMA is currently undergoing phase 3 clinical trials with excellent results, which means it may become legal for therapeutic use soon. You can visit clinicaltrials.gov to see if you qualify to participate in any upcoming or ongoing research on MDMA therapy.
MDMA Therapy for PTSD Frequently Asked Questions
Here are some frequently asked questions about MDMA-assisted therapy for PTSD.
Has the FDA approved MDMA for PTSD?
Currently, the FDA has not approved MDMA for PTSD. MDMA is federally illegal. However, in 2017 the FDA did give MDMA “Breakthrough Therapy” status for treating PTSD. As a Breakthrough Therapy, MDMA is easier to access for scientific purposes, allowing MDMA research to progress more quickly.
Where can you get MDMA therapy for PTSD?
At the time of this article’s publication, MDMA treatment for PTSD is illegal in the United States except for government-approved research. If you want to try MDMA therapy legally, your only current option is to sign up for an approved clinical trial.
MDMA-assisted therapy shows promise as a treatment for PTSD. Clinical trials suggest that it’s close to twice as effective as standard therapy at reducing PTSD symptoms. The FDA has given MDMA “Breakthrough Therapy” status and it may soon be legal for therapeutic use.
However, MDMA is currently illegal to possess or use. The best way to try MDMA therapy is through a government-approved clinical trial.
1. Yehuda R, Hoge CW, McFarlane AC, et al. Post-traumatic stress disorder. Nat Rev Dis Primers. 2015;1:15057. doi:10.1038/nrdp.2015.57
2. Mann SK, Marwaha R. Posttraumatic Stress Disorder. In: StatPearls. StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK559129/2022.
3. Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD – Trauma-Informed Care in Behavioral Health Services – NCBI Bookshelf. Accessed May 24, 2022.
4. Wang Z, Zhu H, Yuan M, et al. The resting-state functional connectivity of amygdala subregions associated with post-traumatic stress symptom and sleep quality in trauma survivors. Eur Arch Psychiatry Clin Neurosci. 2021;271(6):1053-1064. doi:10.1007/s00406-020-01104-3
5. Holmes SE, Girgenti MJ, Davis MT, et al. Altered metabotropic glutamate receptor 5 markers in PTSD: In vivo and postmortem evidence. Proc Natl Acad Sci USA. 2017;114(31):8390-8395. doi:10.1073/pnas.1701749114
6. Meyer JS. 3,4-methylenedioxymethamphetamine (MDMA): current perspectives. Subst Abuse Rehabil. 2013;4:83-99. doi:10.2147/SAR.S37258
7. Smith KW, Sicignano DJ, Hernandez AV, White CM. MDMA-Assisted Psychotherapy for Treatment of Posttraumatic Stress Disorder: A Systematic Review With Meta-Analysis. J Clin Pharmacol. 2022;62(4):463-471. doi:10.1002/jcph.1995
8. Krystal JH, Kelmendi B, Petrakis IL. Psychotherapy-supported MDMA treatment for PTSD. Cell Rep Med. 2021;2(8):100378. doi:10.1016/j.xcrm.2021.100378
9. Tedesco S, Gajaram G, Chida S, et al. The Efficacy of MDMA (3,4-Methylenedioxymethamphetamine) for Post-traumatic Stress Disorder in Humans: A Systematic Review and Meta-Analysis. Cureus. 2021;13(5):e15070. doi:10.7759/cureus.15070
10. Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025-1033. doi:10.1038/s41591-021-01336-3