MDMA: A Brief Overview

Brief History

In 1912, the German pharmaceutical company Merck first synthesized MDMA aiming to develop a drug that would eventually help with stopping blood loss, happy accident indeed.

Fast forward to 1977, the chemist and advocate of psychedelics, Alexander “Sasha” Shulgin, introduced MDMA to Leo Zeff, a psychotherapist and early supporter of psychedelics in therapy. Over the subsequent twelve years, Zeff treated over 4,000 patients with MDMA and provided training to 150 therapists on its therapeutic application. Ann Shulgin, the wife of Alexander Shulgin, also played a significant role in treating numerous patients.

By the 1980s, MDMA gained popularity as a recreational drug in nightclubs and raves. However, in 1985, the Drug Enforcement Administration categorized MDMA as a Schedule I controlled substance, impeding further research into its therapeutic potential.

In recent years, there has been a resurgence in research and MDMA is anticipated to be approved as a prescription by FDA in 2024. Yep, you read that right.

Science of MDMA

3,4-Methylenedioxymethamphetamine (MDMA) is a synthetic drug.Meaning it does not commonly occur in nature. MDMA works by preventing the reuptake of dopamine, resulting in elevated dopamine levels in the brain. The methamphetamine component within MDMA hinders the repackaging of dopamine into vesicles, causing substantial increase in dopamine release. Dopamine is a “feel-good” hormone. It’s associated with pleasure, reward, motivation etc.

Additionally, MDMA raises serotonin levels by impeding serotonin reuptake and interfering with its repackaging. The surge in serotonin release due to MDMA is significantly greater (three to eight times) than the release of dopamine.

The simultaneous increase in dopamine and serotonin creates distinctive effects, such as mood elevation, stimulation, alertness, and positive motivation from the dopaminergic side. The heightened serotonin levels activate neural networks associated with social connection and empathy. Therefore, MDMA induces a pro-social effect, fostering enhanced empathy for oneself and others.

Psychological Impact of MDMA

While it does alter mood and has some psychedelic qualities; its effect profile differs significantly from that of the classic psychedelics. Rather than hallucinatory experiences, MDMA produces a milder experience during which people feel more empathic, more open to bonding with others, and better able to process emotional or traumatic memories.

Scientists believed that MDMA, when combined with therapy, may produce a ‘window of tolerance,’ in which participants are able to revisit and process traumatic content without becoming overwhelmed or encumbered by hyperarousal and dissociative symptoms.

The effects of MDMA on the brain are both short-term and long-term, consistently pointing towards decreased threat detection, increased positivity, heightened prosocial tendencies, and reduced activity in threat detection centers of the brain. After the session, individuals exhibit a diminished threat response to previously troubling memories.

Safety

It is important to remember that it is still a federally illegal substance in the United Stated and most other countries. Pill or other forms sold illegally as MDMA are commonly laced with other harmful substances. Besides contamination risks, actual MDMA can cause other side effects. Even though fatal overdoses with MDMA are rare, acute adverse health effects such as high blood pressure, faintness, and panic attacks can be caused by it. Never use any therapeutic substance without discussing it with a licensed medical professional. As always, MDMA is not a magic bullet that will cure everything. It has the potential to treat certain populations with certain diseases when combined with other tools used by trained medical professionals.

Conclusion

I will conclude by quoting the scientists from this study,

“In summary, MDMA-assisted therapy induces rapid onset of treatment efficacy, even in those with severe PTSD, and in those with associated comorbidities including dissociative PTSD, depression, history of alcohol and substance use disorders, and childhood trauma. Not only is MDMA-assisted therapy efficacious in individuals with severe PTSD, but it may also provide improved patient safety. Compared with current first-line pharmacological and behavioral therapies, MDMA-assisted therapy has the potential to dramatically transform treatment for PTSD and should be expeditiously evaluated for clinical use.”