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MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study

Jennifer M. Mitchell, Michael Bogenschutz, Alia Lilienstein

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Charlotte Harrison, Sarah Kleiman, Kelly Parker-Guilbert, Marcela Ot’alora G., Wael Garas, Casey Paleos, Ingmar Gorman, Christopher Nicholas, Michael Mithoefer, Shannon Carlin, Bruce Poulter, Ann Mithoefer, Sylvestre Quevedo, Gregory Wells, Sukhpreet S. Klaire, Bessel van der Kolk, Keren Tzarfaty, Revital Amiaz, Ray Worthy, Scott Shannon, Joshua D. Woolley, Cole Marta, Yevgeniy Gelfand, Emma Hapke, Simon Amar, Yair Wallach, Randall Brown, Scott Hamilton, Julie B. Wang, Allison Coker, Rebecca Matthews, Alberdina de Boer, Berra Yazar-Klosinski, Amy Emerson, Rick Doblin

2021 · Nature Medicine

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From the abstract

Abstract Post-traumatic stress disorder (PTSD) presents a major public health problem for which currently available treatments are modestly effective. We report the findings of a randomized, double-blind, placebo-controlled, multi-site phase 3 clinical trial (NCT03537014) to test the efficacy and safety of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of patients with severe PTSD, including those with common comorbidities such as dissociation, depression, a history of alcohol and substance use disorders, and childhood trauma. After psychiatric medication washout, participants ( n = 90) were randomized 1:1 to receive manualized therapy with MDMA or with placebo, combined with three preparatory and nine integrative therapy sessions. PTSD symptoms, measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5, the primary endpoint), and functional impairment, measured with the Sheehan Disability Scale (SDS, the secondary endpoint) were assessed at baseline and at 2 months after the last experimental session. Adverse events and suicidality were tracked throughout the study. MDMA was found to induce significant and robust attenuation in CAPS-5 score compared with placebo ( P < 0.0001, d = 0.91) and to significantly decrease the SDS total score ( P = 0.0116, d = 0.43). The mean change in CAPS-5 scores in participants completing treatment was −24.4 (s.d. 11.6) in the MDMA group and −13.9 (s.d. 11.5) in the placebo group. MDMA did not induce adverse events of abuse potential, suicidality or QT prolongation. These data indicate that, compared with manualized therapy with inactive placebo, 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.

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In the conversation

Original HN comments, with labels from simple text rules. A label describes the whole comment and may miss context or irony. Read the discussion to make up your own mind. About the labels

10 selected excerpts · 10 total mentions

xyzwave
Neutral mention · rule
You’re cherry-picking [0] (using Vice to boot). Not to mention people do that without drugs. How about the thousands who don’t commit violent crimes as a result of taking these drugs [1]? Sorta like the clothesline paradox [2]. 0. https://en.m.wikipedia.org/wiki/Cherry_picking#:~:text=Cherr.... 1. https://www.nature.com/articles/s41591-021-01336-3 2. https://www.oreilly.com/radar/the-clothesline-paradox-and-th...
36933
Neutral mention · rule
That’s the thing. We don’t know a cure, but we know of people who were cured. We just don’t really know how or why, scientifically speaking. And as far as I know there was never someone getting cured from t1 diabetes. That’s what I meant by apples and oranges. Ketamine or suffering & death? Ketamine no question. I agree, but it’s not so black and white how you may perceive it. It might be ketamine or death for you, I don’t know. For me it was certainly. So sorry, if it is for you now. I’m not telling you it’s bad or that you shouldn’t do it. Do whatever you think is the best for you. I went through all of that and found other methods of treatment actually effective of…
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solving the root causes of my suffering and not just the symptoms. Meditation, somatic experiencing and mdma therapy[1] are the main methods I found the most effective, in no particular order. I’m not looking to argue about your choice of treatment. If you want to share your experience or hear mine, give me a way to contact you. Have a good night/day. [1]https://www.nature.com/articles/s41591-021-01336-3
cpncrunch
Neutral mention · rule
>I did not notice that. So, then it really doesn't tell us anything new. It was in the linked article: https://www.nature.com/articles/s41591-021-01336-3 It's always good to go to the sources when looking at these potentially overhyped news articles. I would love this to be the answer to depression, but I'm somewhat skeptical. I'm also cognizant of the power of the placebo effect (and related psychological factors) in changing the brain, having fully recovered from ME/CFS and severe depression/anxiety myself.
bobosha
Neutral mention · rule
MDMA and Psilocybin have shown fantastic efficacy. Look up MAPS Trial for efficacy data, it's about as close to a magic pill for PTSD as one can imagine. "MDMA was found to induce significant and robust attenuation in CAPS-5 score compared with placebo (P < 0.0001, d = 0.91) and to significantly decrease the SDS total score (P = 0.0116, d = 0.43)." A p-value of 0.0001 is extremely good. [1] https://www.nature.com/articles/s41591-021-01336-3
aw1621107
Neutral mention · rule
> Research papers on it, like https://www.nature.com/articles/s41591-021-01336-3, are appearing in the top science journal in the world and are no less enthusiastic than a press release. The article actually discusses that very paper: > While we’re here, it’s worth talking about the MAPS MDMA-therapy trial itself. In May 2021, to much media fanfare, they published their Phase III clinical trial in Nature Medicine. The trial reported enormous, nearly unbelievable effect sizes: 0.91 of a standard deviation difference in score on a PTSD questionnaire between an MDMA and a placebo group (both groups got therapy). That’s the kind of effect medical researchers fantasise…
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about. > Are these effect sizes plausible? Nature Medicine also published two critical commentaries on the paper. The first one points out the issue we discussed above: that the blinding was almost certainly compromised in the study, since the control group got a completely inert placebo and the treatment group surely could tell whether they’d been given ecstasy. Expectations could have played a major role, and might explain at least some of the huge difference between groups (the commentary also makes the interesting point that researchers used to be required to collect data on which condition patients thought they were in, but since 2010 this is no longer the case. It might be time to bring back this rule). The second commentary asked for studies with more relevant control groups and longer follow-up periods to check the safety of the treatment. The MAPS researchers also responded, somewhat limply. > The journal also published an entirely uncritical commentary co-authored by Imperial College London’s David Nutt. Remember him? He was Fired4Truth as a drugs adviser by the UK Labour government in 2009 for criticising government policy on drug classification; he’s now a major psychedelics researcher who co-authored the psilocybin trial we encountered above. The commentary calls MDMA “remarkable” three separate times in about 1,000 words (it’s true the effect sizes in the study are remarkable, but what if they’re due to expectancy bias?). It also says it’s likely that MDMA “will be an approved medication within a few years”. > So there’s a final potential harm that stems from the breathless hyping and cheerleading of psychedelic treatments way beyond the evidence: it could mean that therapies—which come with their own rare but real dangers—are approved and rolled out to large numbers of patients when we need a lot more evidence that they really are beneficial in the long term.
btilly
Neutral mention · rule
I agree with the basic point of the article entirely. However he shows the same kind of bias that he is speaking out again by not discussing the best known branch of such research. And that is MDMA for PTSD. It is best known simply because it is, in fact, demonstrating that it works. The FDA has been repeatedly calling it a "breakthrough therapy" since 2017. It is in multiple phase 3 trials around the world that are going well, and full approval is expected this year. Research papers on it, like https://www.nature.com/articles/s41591-021-01336-3, are appearing in the top science journal in the world and are no less enthusiastic than a press release. Let me quote, "These…
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data indicate that, compared with manualized therapy with inactive placebo, 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." So no matter how much questionable research there may be - and I'm sure it is a lot - let's not throw out the baby with the bathwater. There is also good research, and these drugs have the potential to make a huge difference.
jaminal
Neutral mention · rule
> there are absolutely zero studies that show that these compounds are either safe or dangerous. there are many studies about these medicines - curious where this statement that there are none is coming from? here's a tip of the iceberg, a good place to start -- https://www.nature.com/articles/s41591-021-01336-3 https://www.tandfonline.com/doi/abs/10.3109/00952990.2016.11... https://www.hopkinsmedicine.org/news/newsroom/news-releases/... https://www.hopkinsmedicine.org/news/media/releases/hallucin... https://www.hopkinsmedicine.org/news/media/releases/magic_mu...
neuro_image2
Neutral mention · rule
I strongly encourage anyone reading this to watch Dr Ben Sessa's lecture on using MDMA to treat addiction and trauma. https://youtu.be/11u7iX4j1tA The reality is, SSRIs and other pharmaceuticals that have been used to treat common psychiatric illnesses (anxiety/depression) have dismal outcomes and fail the vast majority of patients that they have been given to. Fortunately, there is a growing body of evidence that MDMA and psychedelic assisted therapy could revolutionize the treatment of mental health disorders. Unfortunately, for the last 50 years, governments, industry and the military industrial complex (together with the MSM) have spread lies and scaremongering to…
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block the therapeutic use of these life-changing therapies. Here is another video for anyone wanting to know more about the topic: (Lecture by Prof. David Nutt: The New Psychedelic Revolution) https://youtu.be/1JjzVcfei60 I'm optimistic that the next few decades will bring about better approaches to these massively underserved (and largely exploited and discarded) people. References: https://www.nature.com/articles/s41591-021-01336-3 https://www.tandfonline.com/doi/full/10.1080/09540261.2021.1...
neuro_image2
Neutral mention · rule
That's a surprisingly disparaging and unsupported reply (but I welcome the discussion). You may want to review your comments and question whether they're a fair response to what I've written. I also wonder why you find it necessary to be so adamant and pejorative. You clearly have a strong negative bias on this issue (without any demonstrable knowledge on the topic). I'm a physician with subspecialty qualifications and publications across multiple fields in neuroscience, so I would strongly argue against your points on the nervous system (you seam to be talking from the position of someone without biological or neuroscience training). There is substantial 'non-biased'…
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evidence for the utility of psychedelics. Here are just a a few publications, which may interest you: https://www.nature.com/articles/s41591-021-01336-3 https://www.nejm.org/doi/full/10.1056/NEJMoa2032994 https://journals.sagepub.com/doi/full/10.1177/02698811166755... https://link.springer.com/article/10.1007/s00213-017-4771-x https://www.cambridge.org/core/journals/psychological-medici...

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