Abstract
Background: 3,4-methylenedioxymethamphetamine (MDMA), known recreationally as “Molly” or “Ecstasy”, is a triple monoamine reuptake inhibitor. MDMA specifically acts as a weak 5-HT1 and 5-HT2 receptor agonist, targeting 5-HT2A, 5-HT2B, and 5-HT2C receptors. Its potential use for therapeutic purposes with these pharmacological profiles remains a controversial subject. Studies have shown the potential benefits in clinical trials for post-traumatic stress disorder (PTSD). A larger amount of data has been provided for the push in support of MDMA-assisted psychotherapy in these patients. Objective: The aim of this article is to compute a meta-analysis and conduct a systematic review of the effects of MDMA on PTSD, discussing the potential benefits and adverse events relative to dosing and stability of treatment.Methods: Articles were collected and analyzed for systematic review: 16 articles were included in the systematic review that met the criteria for the use of MDMA in the treatment of PTSD as well as assessing the safety and efficacy of the drug in human participants. Ten studies were used for the meta-analysis, with a cumulative sample size of 168 patients. The significance of the findings on dosing and efficacy of MDMA in healthy human participants was quantified based on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD symptom scores.Results: The disorders for which MDMA demonstrated a net positive or net negative effect on symptoms are presented separately. Adverse events in patients across all disease classes are presented. The therapeutic index for patients who demonstrated a benefit is also presented. An odds ratio for beneficial and adverse events is used to determine treatment-resistant patients who may benefit from clinical trials of MDMA.Discussion: Findings show promising evidence for the potential therapeutic use of MDMA alongside psychotherapy in the treatment of PTSD. The pharmacological profile of MDMA may provide direction for future drug developments to treat patients with treatment-resistant psychiatric disorders.
Highlights
Background3,4-methylenedioxymethamphetamine (MDMA), known recreationally as “Molly” or “Ecstasy”, is a triple monoamine reuptake inhibitor that acts as a stimulant and hallucinogen [1]
We developed a search strategy to retrieve references relating to the treatment of post-traumatic stress disorder (PTSD) using MDMA using the following keywords: “MDMA”, “MDMA assisted psychotherapy”, “ecstasy”, “3,4-methylenedioxymethamphetamine”, “posttraumatic stress disorder”, and “PTSD”
The overall risk ratio (RR) for a clinical response was significantly higher in the experimental group (RR = 3.10, 95% CI: 1.29, 7.45), showing that after treatment the participants had a significantly increased likelihood of clinical response for PTSD symptoms
Summary
Background3,4-methylenedioxymethamphetamine (MDMA), known recreationally as “Molly” or “Ecstasy”, is a triple monoamine reuptake inhibitor that acts as a stimulant and hallucinogen [1]. It is a recreational drug that produces an energizing effect, distortions in time and perception, and enhanced enjoyment from sensory experiences [1]. Years of reported experiences by recreational users combined with research data collected over the last 50 years have allowed the once “dangerous and messy drug” to be approved by the United States Food and Drug Administration (FDA) for its use in psychiatric treatment [2]. Studies on psychiatric treatments for mental illness have shown that there is a general dose-dependent benefit of MDMA in assisted psychotherapy, where the Clinician-Administered PTSD Scale (CAPS) total scores at the primary endpoint showed changes proportional to the dosage amount [3]. There is still much to be learned about MDMA’s therapeutic dosing effect and its support with psychotherapy treatment of PTSD
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