Treatment-resistant Posttraumatic Stress Disorder Research Articles

Virtual realities, real recoveries: exploring the efficacy of 3MDR therapy for treatment-resistant PTSD

Exposure-based therapies have shown promise in treating post-traumatic stress disorder (PTSD), but challenges exist in maintaining patient engagement and finding appropriate stimuli for graded exposure. Virtual reality (VR) technology has been used to enhance exposure therapy, but current software lacks customization and some patients remain treatment-resistant. A novel approach called multimodular motion-assisted memory desensitization and reconsolidation (3MDR) has the potential to solve some of the current limitations of VR-assisted exposure therapy. This study examines the efficacy of 3MDR treatment for individuals with treatment-resistant PTSD through a systematic review of relevant literature and clinical studies. Preliminary findings indicate promise for 3MDR in reducing PTSD symptoms, including emotional regulation and moral injury. However, further research with larger samples and controlled studies is needed to understand underlying mechanisms and validate these results. Moreover, this study highlights the importance of health-economic evaluations to assess costs and resource utilization associated with implementing 3MDR treatment in clinical services.

MDMA-assisted dialectical behavioral therapy for borderline personality disorder: A qualitative study of mental health clinicians

AbstractIn 2021, the final series of phase 3 clinical trials looking at MDMA-AT for treatment-resistant post-traumatic stress disorder (PTSD) found that 71.2% of 3,4-methylenedioxymethamphetamine (MDMA) full-dose participants no longer met criteria for PTSD. MDMA-assisted therapy is not US Food and Drug Administration (FDA) approved in treating borderline personality disorder (BPD), and while PTSD is quite different from BPD, it is possible that some of the beneficial effects of MDMA-assisted therapy may be applicable in treating BPD. Interviewing two clinicians utilizing dialectical behavioral therapy treatment and two MDMA-assisted therapy clinicians was one way to examine the phenomenology of MDMA-assisted therapy with BPD individuals in a thoughtful manner. An exploratory, qualitative, interview-based study assessed clinicians' perspectives of MDMA-assisted therapy and BPD and increased our understanding of underlying therapeutic mechanisms and processes and the role of pharmacological factors in these treatment modalities, optimizing treatment context, and leading to improved clinical responses and patient recovery. The codes generated unique perspectives of the participants revealing a chronological narrative which included three phases of treatment.

MDMA-assisted therapy for borderline personality disorder

AbstractAssociated with high-risk behavior, borderline personality disorder (BPD) remains one of the field's most misunderstood, misdiagnosed, and stigmatized conditions. Individuals with BPD are frequently labeled as treatment-resistant patients. Furthermore, 25–58% of BPD individuals have a comorbid diagnosis of post-traumatic stress disorder (PTSD), and BPD may be conceptualized as a trauma-spectrum disorder. In Phase 3 clinical trials for 3,4-methylenedioxymethamphetamine (MDMA) full-dose participants for treatment-resistant PTSD found that up to 71.2% no longer met the criteria for PTSD. While PTSD is quite different from BPD, a qualitative exploration on the overlap in etiology and conceptualization provided new perspectives by interviewing two clinicians who focus their treatment with BPD diagnosed individuals and two MDMA-assisted therapy clinicians. This research examines the etiological, conceptualization, and therapeutic mechanisms of MDMA-assisted therapists and dialectical behavioral therapists. Through eight qualitative interviews, perspectives of the four participants revealed the similarities and limitations of both treatments.

MDMA-Based Psychotherapy in Treatment-Resistant Post-Traumatic Stress Disorder (PTSD): A Brief Narrative Overview of Current Evidence.

Post-traumatic stress disorder (PTSD) is a debilitating mental health disorder that causes significant dysfunction in individuals. Currently, there are many approved pharmacotherapy and psychotherapy treatment options for PTSD, but unfortunately, half of the patients do not respond to traditional therapies. In this article, we review clinical trials and research on 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in PTSD patients, its pharmacokinetics, and current treatment guidelines for PTSD. Our findings are based on the results of the efficacy of MDMA-assisted psychotherapy from six phase II randomized controlled trials. MDMA-assisted psychotherapy for PTSD has received the "breakthrough therapy" designation from the FDA. MDMA can reduce PTSD symptoms even in treatment-resistant cases by increasing certain neurohormones, i.e., dopamine, serotonin, norepinephrine, and oxytocin. It also modulates activities in the brain regions involved in fear and anxiety. Future research is needed to show whether the advantages outweigh the disadvantages and whether its use can be integrated into available treatment options for PTSD.

The use of hyperbaric oxygen for veterans with PTSD: basic physiology and current available clinical data.

Post-traumatic stress disorder (PTSD) affects up to 30% of veterans returning from the combat zone. Unfortunately, a substantial proportion of them do not remit with the current available treatments and thus continue to experience long-term social, behavioral, and occupational dysfunction. Accumulating data implies that the long-standing unremitting symptoms are related to changes in brain activity and structure, mainly disruption in the frontolimbic circuit. Hence, repair of brain structure and restoration of function could be a potential aim of effective treatment. Hyperbaric oxygen therapy (HBOT) has been effective in treating disruptions of brain structure and functions such as stroke, traumatic brain injury, and fibromyalgia even years after the acute insult. These favorable HBOT brain effects may be related to recent protocols that emphasize frequent fluctuations in oxygen concentrations, which in turn contribute to gene expression alterations and metabolic changes that induce neuronal stem cell proliferation, mitochondrial multiplication, angiogenesis, and regulation of the inflammatory cascade. Recently, clinical findings have also demonstrated the beneficial effect of HBOT on veterans with treatment-resistant PTSD. Moderation of intrusive symptoms, avoidance, mood and cognitive symptoms, and hyperarousal were correlated with improved brain function and with diffusion tensor imaging-defined structural changes. This article reviews the current data on the regenerative biological effects of HBOT, and the ongoing research of its use for veterans with PTSD.

A multi-centre, double-blind, 12-week, randomized, placebo-controlled trial of adjunctive N-Acetylcysteine for treatment-resistant PTSD

BackgroundPTSD may involve oxidative stress, and N-acetylcysteine (NAC) may reduce the impact of oxidative stress in the brain. This study aims to investigate the efficacy of adjuvant NAC in people with treatment-resistant PTSD. MethodsA multicentre, randomised, double-blind, placebo-controlled trial for adults with PTSD unresponsive to first-line treatment. The intervention was either oral NAC 2.7 g/day or placebo for 12 weeks. The primary outcome was change in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks compared with baseline. Secondary outcomes included depression and substance craving. Follow-up measures were obtained at 16 and 64-weeks. Results133 patients were assessed, with 105 randomised; 81 participants completed the 12-week trial, 79 completed week-16 follow-up, and 21 completed week-64 follow-up. There were no significant differences between those taking NAC and those taking placebo in CAPS-5 scores at week 12, nor in secondary outcomes. Significant between-group differences were observed at week 64 in craving duration (Cohen's d = 1.61) and craving resistance (Cohen's d = 1.03), both in favour of NAC. ConclusionThis was the first multicentre, double-blind, randomised, placebo-controlled trial of adjunctive NAC for treatment-resistant PTSD. No benefit of NAC was observed in this group beyond that provided by placebo at end of the trial. Trial Registration: ACTRN12618001784202, retrospectively registered 31/10/2018, URL: http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376004

Is it safe enough? A pilot feasibility study of an 8-day intensive treatment for severe PTSD.

Intensive treatments for posttraumatic stress disorder (PTSD) are gaining increased research support. Treatment models targeting Complex PTSD and previously treatment-resistant PTSD have shown a good effect. A pilot study was performed to assess the feasibility of an 8-day intensive treatment program for severe PTSD in a Swedish public healthcare setting. Eleven participants completed treatment, and overall, the reduction in PTSD symptoms was considerable. Also, loss of diagnosis at 3-month follow-up was 100%. No adverse events occurred, and no elevation of suicidal intentions was reported. Symptom exacerbation could not be observed in the data and dropout due to the intensity of the treatment format did not occur. Based on these positive results, it is recommended that further research with larger samples is conducted. If found safe and effective, the 8-day treatment program could be an important addition to psychiatric healthcare.

A pilot study of closed-loop neuromodulation for treatment-resistant post-traumatic stress disorder

The neurophysiological mechanisms in the human amygdala that underlie post-traumatic stress disorder (PTSD) remain poorly understood. In a first-of-its-kind pilot study, we recorded intracranial electroencephalographic data longitudinally (over one year) in two male individuals with amygdala electrodes implanted for the management of treatment-resistant PTSD (TR-PTSD) under clinical trial NCT04152993. To determine electrophysiological signatures related to emotionally aversive and clinically relevant states (trial primary endpoint), we characterized neural activity during unpleasant portions of three separate paradigms (negative emotional image viewing, listening to recordings of participant-specific trauma-related memories, and at-home-periods of symptom exacerbation). We found selective increases in amygdala theta (5–9 Hz) bandpower across all three negative experiences. Subsequent use of elevations in low-frequency amygdala bandpower as a trigger for closed-loop neuromodulation led to significant reductions in TR-PTSD symptoms (trial secondary endpoint) following one year of treatment as well as reductions in aversive-related amygdala theta activity. Altogether, our findings provide early evidence that elevated amygdala theta activity across a range of negative-related behavioral states may be a promising target for future closed-loop neuromodulation therapies in PTSD.

Study protocol of an open-label proof-of-concept trial examining the safety and clinical efficacy of psilocybin-assisted therapy for veterans with PTSD

IntroductionPsilocybin-assisted therapy has shown significant promise in treating the cluster of mood and anxiety symptoms that comprise post-traumatic stress disorder (PTSD) but has yet to be tested specifically in this...

A Pilot Study Comparing a Community of Practice Group Therapy Program with and without Concurrent Ketamine-assisted Therapy

IntroductionHealthcare practitioners (HCPs) are facing a mental health crisis. Group therapies have long been used to treat symptoms associated with PTSD, anxiety and/or depression, however no studies have investigated the role of implementing group therapy with and without ketamine-assisted therapies (KaT).ObjectivesThe current study investigated the effects of the Roots to Thrive (RTT) group therapy intervention both with and without adjunctive KaT.MethodsIn the present study we conduct a secondary analysis of data derived from the 12-week group psychotherapy program to that of the same program with adjunct KaT. Participants were administered a series of validated psychiatric assessment tools before and after the 12-weeks. Inclusion criteria included a diagnosis of treatment resistant mental health condition (depression, PTSD and/or generalized anxiety disorder) and a score of 15 or greater on the PTSD Checklist for DSM-5 (PCL-5). To assess the effects of time x group interaction and calculate differences between the RTT only and RTT-KaT subgroups, a repeated measures ANOVA was conducted. Effect sizes were calculated through partial eta-squared.ResultsForty-nine HCPs with treatment-resistant PTSD, anxiety and/or depression were treated with the RTT group therapy model to target their symptoms. A total of 49 individuals (34 female, 10 male, 3 other) with a median age of 47 years old (SD 14.19) participated in the study. There were no statistically significant differences between RTT only (n=14) and RTT KaT (n=35) subgroups across gender [X2 (1, N=44) = 2.84, ns] or age [F (1, 36) = .257, p = .615]. From pre- to post-treatment, all patients showed significant reductions in scores of PTSD (from 39.3 to 20.99), depression (from 15.5 to 7.7) and anxiety (from 15.5 to 6.2). Two-way repeated measures ANOVA did not reveal any significant between-group differences between the RTT and RTT-KaT subgroups.ConclusionsThis observational study provides preliminary support for the potential of the RTT community of care model of group therapy and adds to a small but growing body of knowledge on the integration of group therapy and the broad category of psychedelic psychotherapies. Given the rapid proliferation and expansion of KaT clinics throughout North America, the finding that KaT did not appear to impact changes related to the RTT intervention suggests the need for further research to better explain the potential impacts of relational transference between the two groups, and the distinct contributions of ketamine administration in a group therapy context.Disclosure of InterestNone Declared

Medical cannabis for treatment-resistant combat PTSD.

Targeting the endocannabinoid system may have a role in the treatment of post-traumatic stress disorder (PTSD). However, few studies have examined the effectiveness of cannabis on symptoms of PTSD, and more research is needed to ascertain cannabis' effectiveness. In this retrospective naturalistic study, we followed 14 relatively mature (32-68 years of age), treatment-resistant, chronic combat post-traumatic patients who remained severely symptomatic despite treatment with many lines of conventional treatment prior to receiving medicinal cannabis. Our findings show that total sleep score, subjective sleep quality, and sleep duration significantly improved (p < 0.01). Total PTSD symptom score and its subdomains (intrusiveness, avoidance, and alertness) showed improvement (p < 0.05). However, there was no improvement in the frequency of nightmares (p = 0.27). The mean follow-up time was 1.1 ± 0.8 years (range of 0.5 to 3 years).

Application of Deep Brain Stimulation in Refractory Post-Traumatic Stress Disorder.

Post-traumatic stress disorder (PTSD) is a mental disorder that produces crippling anxiety and occurs in response to an extreme, traumatic stressor. Compared to the prevalence of PTSD in the general population, the prevalence of PTSD in at-risk populations (e.g., army veterans, those affected by environmental calamities, and others) can reach up to threefold. The conventional treatment of PTSD involves using SSRIs (serotonin reuptake inhibitors) and other anti-depressants along with psychotherapy such as debriefing and CBT (cognitive behavioral therapy). Due to increasing resistance to conventional treatment, more novel treatment options, such as stellate ganglion block shots and neuromodulation, are being explored. These neuromodulation techniques include transcranial magnetic stimulation (TMS), transcranial direct current stimulation (TDS), and deep brain stimulation (DBS). The rationale behind employing these techniques in refractory PTSD is the altered neurocircuitry seen in PTSD patients, which can be visualized on imaging. Studies involving the use of DBS for PTSD primarily target specific areas in the brain: the amygdala, the prefrontal cortex, the hippocampus, and the hypothalamus. This article aims to provide a brief overview of the various neuromodulation techniques currently employed in the management of treatment-resistant PTSD and an in-depth review of the available literature on animal models in which DBS for PTSD has been researched. We also shed light on the human clinical trials conducted for the same.

Hyperbaric Oxygen Therapy for Veterans With Treatment-resistant PTSD: A Longitudinal Follow-up Study.

PTSD is common among veteran combatants. PTSD is characterized by brain changes, for which available treatments have shown limited effect. In a short-term study, we showed that hyperbaric oxygen therapy (HBOT) induced neuroplasticity and improved clinical symptoms of veterans with treatment-resistant PTSD. Here, we evaluated the long-term clinical symptoms of the participants of that study. Veterans from our short-term study were recruited 1 or more years after completing HBOT. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and self-reported questionnaires were administered at a single site visit. Changes in clinical scores between long-term, short-term, and pretreatment evaluations were analyzed. Of the 28 participants who received HBOT during or following the short-term study, 22 agreed to participate in the current study. At a mean of 704 ± 230 days after completing the HBOT course, the mean CAPS-5 score (26.6 ± 14.4) was significantly better (lower) than at the pre-HBOT evaluation (47.5 ± 13.1, P < .001) and not statistically different from the short-term evaluation (28.6 ± 16.7, P = .745). However, for the CAPS-5 subcategory D (cognition and mood symptoms), the mean score was significantly better (lower) at long-term than at short-term evaluation (7.6 ± 5.1 vs. 10.0 ± 6.0, P < .001). At the long-term compared to the pretreatment evaluation, higher proportions of the participants were living with life partners (10 (46%) vs. 17 (77%), P = .011) and were working (9 (41%) vs. 16 (73%), P = .033). Decreases were observed between pretreatment and the long-term follow-up, in the number of benzodiazepine users (from 10 (46%) to 4 (18%), P = .07) and in the median (range) cannabis daily dose (from 40.0 g (0-50) to 22.5 g (0-30), P = .046). The beneficial clinical effects of HBOT are persistent and were not attenuated at long-term follow-up of about 2 years after completion of HBOT. Additional long-term effects of the treatment were observed in social function and in decreased medication use.

PO257 / #737 CLINICAL TRIAL OF RESPONSIVE NEUROSTIMULATION OF THE AMYGDALA FOR TREATMENT-RESISTANT COMBAT POST-TRAUMATIC STRESS DISORDER: E-POSTER VIEWING

Post-traumatic stress disorder (PTSD) is prevalent among veteran populations and is frequently unyielding to current evidence-based therapies, leading to a high incidence of severe treatment-resistant PTSD (TRPTSD)1,2. Deep brain stimulation offers precision, long-term application, and ongoing adjustability3. The aim of this current study (Clinicaltrials.gov NCT04152993) is to use responsive neurostimulation, targeting clinical symptoms based on simultaneously recorded alterations in fear circuitry in TRPTSD.

Czy psychoterapia wspomagana metylenodioksymetaamfetaminą (MDMA) okaże się przełomowa w terapii opornego na leczenie zespołu stresu pourazowego? Krytyczny przegląd narracyjny

Post-traumatic stress disorder (PTSD) is a common mental health condition that begins after exposure to a traumatic event. Despite recommended various therapeutic approaches, including both pharmacotherapy and psychotherapy, treatment is not as effective as expected. Over recent years the pharmaceutical industry has not been able to offer a new approach, founded on multiple mechanisms of action. That is why a part of researchers focused on psychoactive substances synthesized years ago and then banned. These days MDMA-assisted psychotherapy for the treatment of PTSD clinical trials are conducted, and due to previous results, the Food and Drug Administration (FDA) granted a breakthrough therapy designation. In this article, we present the mechanism of actions, the therapeutic rationale, applied psychotherapeutic methods, and potential dangers. If ongoing phase 3 studies are completed and clinical efficacy criteria are achieved, the FDA could approve the treatment as early as 2022.

Quantitative changes in mental health measures with 3MDR treatment for Canadian military members and veterans

ObjectiveMilitary members and veterans are at elevated risk of treatment‐resistant posttraumatic stress disorder (TR‐PTSD) due to higher rates of exposure to potentially traumatic events during the course of duty. Knowledge of TR‐PTSD is limited, and specific protocols or evidence‐based TR‐PTSD therapies are lacking. Multimodal motion‐assisted memory desensitization and reconsolidation (3MDR) therapy is an emerging intervention for combat‐related TR‐PTSD. The purpose of this study was to preliminarily assess the effectiveness of 3MDR in addressing TR‐PTSD in Canadian military members and veterans.MethodsThis study is a longitudinal mixed‐methods clinical trial. English‐speaking military members and veterans aged 18–60 with TR‐PTSD were recruited to participate. The intervention consisted of six sessions of 3MDR therapy. Quantitative data were collected pretreatment, posttreatment, and longitudinally at 1, 3, and 6 months after completion of 3MDR.ResultsResults from the first 11 participants to complete the 3MDR protocol exhibited statistically significant improvement (surviving multiple comparison correction) in clinically administered and self‐reported scores for PTSD (CAPS‐5 and PCL‐5), moral injury (MISS‐M‐SF), depression (PHQ‐9), anxiety (GAD‐7), emotional regulation (DERS‐18), and resilience (CD‐RS‐25).ConclusionThe preliminary and exploratory results from this clinical trial support the growing body of literature illustrating 3MDR as an effective treatment for military‐related TR‐PTSD. These results are notable given participants' previous lack of success with frontline psychotherapeutic and pharmacological interventions. Given that there are currently very limited treatment options for TR‐PTSD, 3MDR could prove to be a valuable treatment option for military members and veterans with TR‐PTSD.

The Redesign and Validation of Multimodal Motion-Assisted Memory Desensitization and Reconsolidation Hardware and Software: Mixed Methods, Modified Delphi-Based Validation Study.

BackgroundIn recent years, the delivery of evidence-based therapies targeting posttraumatic stress disorder (PTSD) has been the focus of the Departments of Defense in countries such as Canada, the Netherlands, and the United States. More than 66% of military members continue to experience symptoms of PTSD that significantly impact their daily functioning and quality of life after completing evidence-based treatments. Innovative, engaging, and effective treatments for PTSD are needed. Multimodal motion-assisted memory desensitization and reconsolidation (3MDR) is an exposure-based, virtual reality–supported therapy used to treat military members and veterans with treatment-resistant PTSD. Given the demonstrated efficacy of 3MDR in recently published randomized control trials, there is both an interest in and a need to adapt the intervention to other populations affected by trauma and to improve accessibility to the treatment.ObjectiveWe aimed to further innovate, develop, and validate new and existing hardware and software components of 3MDR to enhance its mobility, accessibility, feasibility, and applicability to other populations affected by trauma, including public safety personnel (PSP), via international collaboration.MethodsThis study used a modified Delphi expert consultation method and mixed methods quasi-experimental validation with the purpose of software validation among PSP (first responders, health care providers) participants (N=35). A team of international experts from the Netherlands, the United States, and Canada met on the web on a weekly basis since September 2020 to discuss the adoption of 3MDR in real-world contexts, hardware and software development, and software validation. The evolution of 3MDR hardware and software was undertaken followed by a mixed methods software validation study with triangulation of results to inform the further development of 3MDR.ResultsThis study resulted in the identification, description, and evolution of hardware and software components and the development of new 3MDR software. Within the software validation, PSP participants widely acknowledged that the newly developed 3MDR software would be applicable and feasible for PSP affected by trauma within their professions. The key themes that emerged from the thematic analysis among the PSP included the desire for occupationally tailored environments, individually tailored immersion, and the applicability of 3MDR beyond military populations.ConclusionsWithin the modified Delphi consultation and software validation study, support for 3MDR as an intervention was communicated. PSP participants perceived that 3MDR was relevant for populations affected by trauma beyond military members and veterans. The resulting hardware and software evolution addressed the recommendations and themes that arose from PSP participants. 3MDR is a novel, structured, exposure-based, virtual reality–supported therapy that is currently used to treat military members and veterans with PTSD. Going forward, it is necessary to innovate and adapt 3MDR, as well as other trauma interventions, to increase effectiveness, accessibility, cost-effectiveness, and efficacy among other populations affected by trauma.

Efficacy and Safety of Intranasal Esketamine in Patients With Treatment-Resistant Depression and Comorbid Chronic Post-traumatic Stress Disorder: Open-Label Single-Arm Pilot Study.

IntroductionMajor depressive disorder (MDD) is more likely to resist to usual treatment when it is associated with post-traumatic stress disorder (PTSD). Capitalizing on the effect of ketamine in both treatment-resistant depression (TRD) and PTSD, we conducted a study in order to assess the efficacy of intranasal (IN) Esketamine in patients having TRD with comorbid PTSD.Materials and MethodsIn this open-label, single arm, retrospective pilot study, 11 patients were treated with IN Esketamine (56 or 84 mg) with a longitudinal follow-up of 6 months. IN Esketamine was administered twice weekly during the first month, once weekly during the second month, and then once every 1 or 2 weeks. Patients were assessed with Montgomery-Åsberg Depression Rating Scale (MADRS), Patient Health Questionnaire 9 items, Global Assessment of Functioning (GAF), and Clinical Global Impression-Suicide Scale (CGI-SS).ResultsWe included 9 women and 2 men (mean age 47.3 ± 11.1 years). The mean (SD) MADRS scores decreased significantly from 38.6 (6.4) at baseline to 18.2 (10.03) after 6 months of IN Esketamine; 7 patients were responders and 3 patients were in remission. The percentage of patients who were moderately to severely suicidal declined from 63.6% at baseline to 27.3% after 1 month of IN Esketamine sessions. No serious adverse reactions were observed.ConclusionThis study reports the outcomes of 11 severely ill patients with comorbid TRD and PTSD after IN Esketamine treatment. Esketamine significantly improved depression symptoms, suggesting that it is likely to be a treatment of choice in this specific population.

Methylenedioxymethamphetamine (MDMA)-Assisted Therapy in Hawaii: A Brief Review

The Food and Drug Administration (FDA) granted breakthrough therapy status to 3,4-methyl​enedioxy​methamphetamine-assisted therapy (MDMA-AT) in 2017 due to preliminary evidence supporting its efficacy and safety in treating post-traumatic stress disorder (PTSD). A series of six phase-II clinical trials studying MDMA-AT for treatment-resistant PTSD found that 54% of MDMA-AT full-dose participants no longer met the diagnosis of PTSD after two MDMA sessions, compared to 23% in the control group. In the first phase-III clinical trial, 67% no longer met the criteria for PTSD after three sessions. The effects are durable, with 67% no longer diagnosable after one year and 74% at nearly four years. The MDMA-AT is being fast-tracked for potential FDA approval by 2023. In 2021, Hawaii’s Senate Bill 738 unsuccessfully proposed that psilocybin be removed from the Schedule I controlled substances list due to its clinical efficacy for major depressive disorder. Methyl​enedioxy​methamphetamine is also a Schedule I controlled substance and has proven to be a treatment option that could potentially benefit the people of Hawaii.

Methylenedioxymethamphetamine-assisted Psychotherapy For Posttraumatic Stress Disorder: A Review

IntroductionPosttraumatic stress disorder (PTSD) is a psychiatric condition which can be developed following traumatic experience. Treatment guidelines have long considered psychotherapy as a first line treatment. Despite that, PTSD remains an illness with high rates of comorbidity. Therefore, exploring novel therapies is of utmost importance.ObjectivesClarifying methylenedioxymethamphetamine (MDMA)-assisted psychotherapy efficacy in symptom relief in people with PTSD. Explaining clinical MDMA mechanism of action. Assessing safety of MDMA clinical use.MethodsPubMed database search, with “MDMA for PTSD” keyword expression. 12 Articles published in the last ten years were selected among the 112 best matches. Reference lists of articles were reviewed to identify additional articles.ResultsMithoefer et al. (2010) carried out the first controlled clinical study with MDMA-assisted psychotherapy in people with PTSD. Twenty patients with treatment-resistant PTSD were selected. They were given either placebo or two or three sessions of MDMA. 83% of the experimental group no longer met the criteria for PTSD (mean remission lasted 45 months without further MDMA doses) compared with 25% of the placebo group. Further studies were also suggestive of improvements in treatment-resistant PTSD patients undergoing MDMA-assisted psychotherapy. MDMA may increase exposure therapy effectiveness, allowing patients to stay emotionally involved while revisiting past traumas without being overwhelmed by anxiety and fear.ConclusionsTo date, MDMA-assisted psychotherapy studies demonstrated consistently positive results. However, they have been carried out with small groups of individuals. Therefore, larger trials should be conducted to assess MDMA’s efficacy and safety for it to become a licensed medicine.DisclosureNo significant relationships.