Courtesy of the Multidisciplinary Association for Psychedelic Studies
The first time Lori Tipton tried MDMA, she was skeptical that it would make a difference.
"I was really nervous at first," Tipton recalls.
MDMA is the main ingredient in club drugs ecstasy or molly. But Tipton did not take pills sold on the street to get high at a party.
She tried to treat her post-traumatic stress disorder with the help of licensed therapists.
Tipton received a dose of pure MDMA. Then she lay in a quiet room with two specially trained psychotherapists, a woman and a man.
They sat next to Tipton as she recalls some of her deepest traumas, such as discovering her mother's body after a suicide.
"In the embrace of MDMA," as she describes it, Tipton was able to return to that moment without the usual fear and panic.
"I could find such empathy for myself. I realized how much I thought this was my fault," she says.
Synthetic psychoactive chemical MDMA appears as a promising – if unconventional – treatment for PTSD.
Researchers are testing how drug grade MDMA can be used in combination with psychotherapy to help patients with a severe form of PTSD who have not responded to other treatments. Unlike street drugs that can be counterfeit and unsafe, researchers use a clean, precisely dosed form of the drug.
It is not yet available as a treatment for PTSD outside clinical trials, but the success of early studies has advocates that the therapy could be available to more people for years to come; they aim for approval by the Food and Drug Administration, which granted breakthrough therapy status to MDMA-assisted psychotherapy in 2017.
Researchers are currently conducting Phase 3 clinical trials in more than a dozen locations in the United States, Canada and Israel. Clinicians treating PTSD hope that the next round of studies will show that MDMA treatment is an effective alternative to relieving their patients.
"The problem is that we haven't had a new drug to treat PTSD in over 17 years," said Sue Sisley, a physician and president of the Scottsdale Research Institute based in Arizona. "There are some diseases that are just unmatched and do not respond to traditional therapy, and we need to start thinking wider."
But MDMA is a Schedule 1 controlled substance, which means that it currently has no accepted medical use and has a "high potential for abuse" (something that MDMA's therapeutic advocates dispute). Because of this designation, the current research studies are privately funded by the Multidisciplinary Association for Psychedelic Studies, or MAPS.
"Anyway I would feel insecure"
Tipton struggled for years with PTSD before being treated with MDMA. She describes life with PTSD as "seeing the world through dirty glasses."
"Anywhere I would feel insecure," says the 40-year-old from New Orleans . "I would feel that I always have to be vigilant, because if I didn't, something bad would happen."
Tipton describes her 20s as a directory of tragedy and trauma. It began when her brother fatally killed in his home, on his birthday.
After his death, she began to care for her mother, who was struggling with mental illness. In 2005, Tipton's mother killed two people and then himself. Tipton was the one who discovered their bodies.
"I was completely separated. I couldn't believe what I saw," Tipton says.
The trauma continued to rise. The place she lived was destroyed when Hurricane Katrina hit New Orleans and the following year she was raped.
In the wake of the storm, she was formally diagnosed with PTSD, but first she did not take it seriously.
"Almost everyone who returned to New Orleans was diagnosed with PTSD," Tipton says.
As the years went by, Tipton suffered from panic attacks and terrible anxiety. She tried everything to treat her symptoms: talk therapy, antidepressants, hypnotherapy, meditation and yoga.
Nothing worked. She underwent exhausted and apathetic life, constantly triggered and struggled to be intimate with those close to her.
In 2017, Tipton came across an online ad to look for people with severe PTSD in New Orleans. Soon she participated in Phase 2 clinical trials for MDMA-assisted psychotherapy.
MDMA and therapy together?
MDMA was first synthesized in 1912, and its therapeutic benefits were studied in the 1970s. But these efforts stopped when the US federal government – in view of the growing popularity of ecstasy as a recreational drug – designated it a Schedule 1 drug 1985.
In recent years research has been resumed, funded by private sponsors such as MAPS
The treatment protocol in the current trial requires a 12-week course in psychotherapy with specially trained therapists. During that time, there are two or three day-long sessions that begin with the patient swallowing a calibrated dose of MDMA in p-form.
A team of two therapists, usually a man and a woman, then guides the patient through the eight-hour MDMA "session." Later, there is follow-up talk therapy, without the drug, to help the patient process any feelings, thoughts or impressions that arose when he was under the influence of the drug.
"MDMA lets you contact emotions and feelings in a much more direct way," explains Saj Razvi, a Colorado-based psychotherapist who was a clinical investigator in the phase 2 trials.
It is not quite clear how MDMA works on the brain. The psychoactive drug increases chemicals such as serotonin and oxytocin. It also loses activity in the amygdala, a part of the brain that processes fear. This can lead to a condition characterized by increased feelings of security and social connection.
It allows patients to return to traumatic memories and unpack those moments, without triggering the same panic.
Courtesy of the Multidisciplinary Association for Psychedelic Studies
"Trauma happens in isolation," says Razvi. "One of the things that MDMA does is really make you know that you are not alone."
Razvi has observed hundreds of hours of these sessions, saying they can sometimes look tough, almost like a "bad trip," but the process leads to emotional breakthroughs that otherwise "can take months or years to achieve."
PTSD in remission
After the phase 2 trials of MDMA-supported treatments completed in 2017, researchers found 54% of patients taking MDMA had improved so that they no longer fit the diagnosis of PTSD ( compared to 23% in the control group). In addition, the beneficial effects of treatment seemed to increase, rather than decrease, over time. One year later, the number that no longer had PTSD increased to 68% percent.
"It was amazing," says Sisley of the Scottsdale Research Institute. "Even with the best drug regimen, you rarely see patients go into remission."
Sisley is studying alternative treatments for PTSD and recently completed a clinical trial testing cannabis as a treatment for the condition among veterans. She says she hopes to be able to offer her patients MDMA-assisted psychotherapy as soon as possible, perhaps before the drug gets full FDA approval.
Brad Burge, a spokesman for the MDMA Trial Sponsor, Multidisciplinary Association for Psychedelic Studies, says the organization is working to get the FDA to include the drug in its expanded access program that may allow individual patients to be approved to use drugs that are still being studied. .
Burge calls MDMA "a chemical safety blanket."
"People with PTSD have a particularly difficult time with psychotherapy because they are asked to recall in detail, and process and think about literally the most frightening thing that has ever happened to them," he says.
Burge says the goal is to make MDMA-assisted psychotherapy available as a prescription treatment in a specialty clinic for anyone with PTSD.
MAPS is now working to convince public and private insurance plans to cover the treatment, Burge adds. He estimates that for patients who pay for it completely out of pocket, the cost of a 12-week treatment course would run between $ 5,000 and $ 10,000. Most of the cost is for guided therapy, not the actual drug.
Tipton describes his treatment with MDMA as transformative.
She could let go of the worrying feelings about her mother's death.
"This is a terrible thing that happened, but to bear the fear and shame of it, it is worthless," she says.
She also discovered other memories, feelings of joy that had been sealed away, like playing in the snow with her brother when they were children.
"I could remember exactly how I felt, that excitement from the first snow," she says.
At her last MDMA session, Tipton was even able to talk about her sexual abuse.
A year later, she was no longer re-examined and did not qualify as PTSD. Tipton says she believes the treatment saved her life.
"Everything is within my reach in a way it never was before," she says. "I want it for everyone."
This story is part of NPR's reporting partnership with KJZZ and Kaiser Health News.