Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-29T13:00:11.469Z Has data issue: false hasContentIssue false

MDMA-Assisted Therapy for Treatment-Resistant Posttraumatic Stress Disorder (PTSD) – One step further toward a patient-centered treatment pathway

Published online by Cambridge University Press:  01 September 2022

S. Pratas Penedos*
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
M.J. Freire
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
I. Fonseca
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
A. Franco
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
N. Ribeiro
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
L. Moreno
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
M.M. Magalhães
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
P.A. Afonso
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
I.M. Alves
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
L. Paulino
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
C. Ramos
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
M.M. Figueiredo
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
L. Madruga
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
A. Gamito
Affiliation:
Setúbal Hospital Center, Psychiatry And Mental Health, Setúbal, Portugal
*
*Corresponding author.

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction

PTSD is a chronic, debilitating condition with limited treatment efficacy. Accessing traumatic memories often leads to overwhelming distress, impacting treatment process. Current approved pharmacological treatments have exhibited small to moderate effects when compared with placebo. Evidence suggests 3,4,-methylene-dioxymethamphetamine(MDMA)-assisted psychotherapy as a viable option for refractory PTSD.

Objectives

Comprehensive review of early clinical research, proposed mechanisms, safety and emerging therapeutic models.

Methods

Eligible studies will be identified through strategic search of MEDLINE.

Results

Pre-clinical and imaging studies suggest memory reconsolidation and fear extinction as candidate psychological and neurological mechanisms, involving MDMA’s combined effects of increasing serotonergic activity, as well the release of oxytocin and brain-derived neurotrophic factor in key memory and emotional circuits. Resulting reduction in amygdala and insula activation and increasing connectivity between the amygdala and hippocampus may create a “tolerance window” of neuroplasticity for emotional engagement and reprocessing of traumatic memories during psychotherapy. Early clinical trials report impressive and durable reduction in PTSD symptoms, with a safety profile comparable to that of SSRIs. A recently completed randomized, double-blind, placebo-controlled phase 3 trial reported full remission of PTSD symptoms in 67% of patients at 2 months, with no increase in suicidality, cardiovascular events or abuse behavior. Emerging treatment models underline the importance of unmedicated therapeutic sessions for preparation for the experience and subsequent integration as essential for full benefit and safety of the clinical context.

Conclusions

The psychological impact associated with the COVID-19 pandemic is an reminder of the emotional and economic burden associated with PTSD. MDMA-assisted therapy may be a breakthrough approach meriting further multidisciplinary investment and clinical research.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
Submit a response

Comments

No Comments have been published for this article.