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MDMA‐Assisted Psychotherapy for Treatment of Posttraumatic Stress Disorder: A Systematic Review With Meta‐Analysis

K W Smith, Dakota Sicignano, Adrían V. Hernández, C Michael White

The Journal of Clinical Pharmacology October 28, 2021 DOI: 10.1002/jcph.1995 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Review Peer reviewed
Topics MDMA Psychedelic-assisted therapy PTSD
Keywords Psychotherapist Mood Clinical psychology
Citations 136
Key findings MDMA-assisted psychotherapy reduces PTSD symptoms more than control therapy, with greater likelihood of clinically significant improvement and loss of PTSD diagnosis.

Abstract

Abstract This article discusses current literature on the use of 3,4‐methylenedioxymethamphetamine (MDMA)‐assisted psychotherapy in the treatment of posttraumatic stress disorder (PTSD). MDMA, the intended active ingredient in illicit Ecstasy or Molly products, is a psychedelic that causes an elevated mood, feeling of bonding, and increased energy. In MDMA‐assisted psychotherapy, patients are subjected to 2 or 3 multihour sessions of therapy with a team of psychiatrists. The dosing of MDMA is used to allow the therapist to probe the underlying trauma without causing emotional distress. The use of MDMA‐assisted psychotherapy treatment reduced patient's Clinician‐Administered PTSD Scale (CAPS) scores from baseline more than control psychotherapy (–22.03; 95%CI, –38.53 to –5.52) but with high statistical heterogeneity. MDMA‐assisted psychotherapy enhanced the achievement of clinically significant reductions in CAPS scores (relative risk, 3.65; 95%CI, 2.39‐5.57) and CAPS score reductions sufficient to no longer meet the definition of PTSD (relative risk, 2.10; 95%CI, 1.37‐3.21) with no detected statistical heterogeneity. While therapy was generally safe and well tolerated, bruxism, anxiety, jitteriness, headache, and nausea are commonly reported. While MDMA‐assisted psychotherapy has been shown to be an effective therapy for patients with PTSD with a reasonable safety profile, use of unregulated MDMA or use in the absence of a strongly controlled psychotherapeutic environment has considerable risks.

In the evidence

This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.

  • State of the evidence: MDMA for PTSD Supports

    MDMA-assisted psychotherapy reduced CAPS scores more than control therapy (mean difference -22.03) with high heterogeneity, and increased rates of clinically significant improvement (RR 3.65) and loss of PTSD diagnosis (RR 2.10).

    Synthesized

Comparable studies

Other narrative reviews on MDMA and psychedelic-assisted therapy, most cited first.

Study Year Design Participants
Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. 2016 Review
MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? 2018 Review
Breakthrough for Trauma Treatment: Safety and Efficacy of MDMA-Assisted Psychotherapy Compared to Paroxetine and Sertraline 2019 Review
A Review of 3,4-methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy 2019 Review
Progress and promise for the MDMA drug development program. 2017 Review

Citations in the library

Cited by 101

and 96 more in the library

Cites 12

and 7 more in the library

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Explore topics

MDMA Psychedelic-assisted therapy PTSD Anxiety

By condition and practice

MDMA and psychedelic-assisted therapy MDMA for PTSD