MDMA: Everything You Need To Know

MDMA

What Is MDMA?

MDMA, often called ecstasy or Molly, is a psychoactive compound traditionally categorized as a psychedelic amphetamine that deemed a Schedule I controlled substance in the 1980s. Prior to its status as a controlled substance, it was used by psychotherapists for an array of psychiatric issues. In more recent times, MDMA has resurfaced as a potential therapy for PTSD and the data produced from randomised, controlled trials back the desire for MDMA to be utilised as an effective pharmacologic therapy in conjunction with psychotherapy (source)

While the subjective effects of (±)-MDMA are reminiscent of these psychoactive compounds, the nature of its phenomenology was deemed sufficiently unique to warrant a new classification as an entactogen: a term coined by David Nichols meaning, “to touch within” (source)

You may like to check the section of my website dedicated to psychedelics here.

How Long Does MDMA Last?

Subjective effects persist for, on average,  4–6 hours after oral administration

How To Take MDMA

It is generally administered to humans in doses ranging from 75–150 mg. It is unusual to be given a ‘booster’ which is often around 75mg.

How Is MDMA Taken?

It is available as a tablet, capsule, powder, or liquid and can be administered orally or intravenously, though the compound is typically administered orally in the hydrochloride salt form to humans.

What Does MDMA Do?

Some of the effects of ecstasy are: increased prosocial behaviour, decreased aggression, lowered social inhibition, enhanced response to the positive emotions of others, increased alertness, and positive mood.

My Interview With Jonathan Robinson on MDMA

How Does MDMA Work?

Based on clinical observations and qualitative review of video recorded sessions, it appears the therapeutic mechanisms are complex and may vary from individual to individual. Several theoretical explanations have been posed to explain the treatment effects. (source)

MDMA enhances release of monoamines (serotonin, norepinephrine, dopamine), hormones (oxytocin, cortisol), and other downstream signaling molecules (BDNF) to dynamically modulate emotional memory circuits. By reducing activation in brain regions implicated in the expression of fear- and anxiety-related behaviors, namely the amygdala and insula, and increasing connectivity between the amygdala and hippocampus, ecstasy may allow for reprocessing of traumatic memories and emotional engagement with therapeutic processes.

Based on the pharmacology of MDMA and the available translational literature of memory reconsolidation, fear learning, and PTSD, this review suggests a neurobiological rationale to explain, at least in part, the large effect sizes demonstrated for MDMA in treating PTSD. (source)

What Do The MDMA Trials Look Like?

The first MDMA session is proceed by three preparatory 90-min nondrug sessions to establish rapport and a trusting therapeutic relationship between the participant and therapists. During 8-hour MDMA-assisted sessions at monthly intervals, the approach is largely non-directive with a male/female co-therapist team creating a setting of safety and support. The participant alternates periods of internal reflection while wearing eyeshades and listening to music with periods of talking with the therapists about thoughts, emotions and memories that arise.

Therapists give support and encouragement for participants to reflect on and discuss whatever is unfolding, including traumatic memories as well as other psychologically relevant material, and will offer redirection as a choice if the participant appears unable to move forward in the process. (source)

After each MDMA session, participants have three 90-min integrative sessions, one the morning after MDMA and two during the month following, to further process and integrate the experiences catalyzed by MDMA. (source)

MDMA Toxicity

MDMA’s toxicity is still under question—as its use in non-medical settings has been linked to fatalities resulting from hepatic toxicity, cardiovascular toxicity, cerebral toxicity resulting from hyponatremia, hyperpyrexia, and serotonin syndrome. To clarify, most cases of serious toxicity have involved extreme dosing (i.e., blood levels of ecstasy much higher than the standard recreational or therapeutic dose), drug cutting (i.e. ecstasy is cut with another risky substance), or hazardous setting. (source)

That being said, there have been zero deaths or severely harmful events in any of the medical MDMA studies conducted since research originated in the 1980s.

MDMA Contraindications

Publications of studies describe interactions between ecstasy or psilocybin and medications from several psychiatric drug classes: adrenergic agents, antipsychotics, anxiolytics, mood stabilisers, NMDA antagonists, psychostimulants, and several classes of antidepressants. (source)

MDMA And PTSD

MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation. (source)

Post-traumatic stress disorder (PTSD) has become one of the most common psychiatric diagnosis in the United States specifically within the veteran population. The current treatment options for this debilitating diagnosis include trauma-focused psychotherapies along with selective serotonin re-uptake inhibitors (SSRI) and serotonin-norepinephrine re-uptake inhibitors (SNRI). Ecstasy has recently been shown as a novel therapeutic agent with promisingly results in the treatment of PTSD. (source)

MDMA And Depression

Ecstasy has shown preliminary positive effects in other indications as well, such as anxiety and alcohol addiction, however it has not been investigated in the treatment of depression until now (I think the study might be currently running). (source). Anecdotally, if you listen you my interview with Jonathan Robinson, read his book, or have experience with ecstasy it is safe to say that MDMA may be helpful for depression if taking with intent, in a safe set and setting, and taken alongside therapy.

MDMA And Anxiety

In a pilot trial demonstrated rapid and durable improvement in social anxiety symptoms in autistic adults following MDMA-assisted psychotherapy. Initial safety and efficacy outcomes support expansion (source).

MDMA And Alcohol Use Disorder

MDMA-assisted psychotherapy has never been formally explored as a treatment for any form of substance use disorder. But in recent years ecstasy has risen in prominence as an agent to treat posttraumatic stress disorder (PTSD). With its unique receptor profile and a relatively well-tolerated subjective experience of drug effects when used clinically, MDMA Therapy is ideally suited to allow a patient to explore and address painful memories without being overwhelmed by negative affect.

Given that alcohol use disorder is so often associated with early traumatic experiences, the author is proposing in a current on-going UK-based study that patients with alcohol use disorder who have undergone a medical detoxification from alcohol might benefit from a course of MDMA-assisted psychotherapy. (source)

 

 

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