Houston, Texas, USA : New research from King’s College London has found that MDMA, the main ingredient in ecstasy, causes people to cooperate better—but only with trustworthy people. In the first study to look in detail at how MDMA impacts cooperative behaviour the researchers also identified changes to activity in brain regions linked to social processing.
Problems with social processing are recognised as a fundamental difficulty in a range of psychiatric conditions and are not treated effectively by current medications. The results of the study, published in The Journal of Neuroscience, may be relevant for psychiatric conditions such as post-traumatic stress disorder (PTSD).
MDMA is used by recreational users due to its profound social and emotional effects and is known to release neurotransmitters—chemical messengers in the brain—linked to behaviour and mood. However, scientists know little about how different neurotransmitter systems in the brain contribute to complex social behaviour.
Twenty healthy adult men were either given a typical recreational dose of MDMA or a placebo pill and completed several tasks while in an MRI scanner, including the Prisoner’s Dilemma. In the Prisoner’s Dilemma players choose to either compete or cooperate with another player. Both players get points if they cooperate, but if one player chooses to compete they receive all the points while the other player gets nothing.
The researchers found participants under the influence of MDMA became more cooperative, but only when interacting with trustworthy players.
Senior author, Professor Mitul Mehta from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), said: “We asked people what they thought of their opponent and, surprisingly, MDMA did not alter how trustworthy they thought the other players were. Untrustworthy players were rated as low on the scale, whether on MDMA or placebo, and trustworthy players were given equally high ratings.”
“Importantly, MDMA did not cause participants to cooperate with untrustworthy players any more than normal. In other words, MDMA did not make participants naively trusting of others.”
When playing the Prisoner’s Dilemma, participants believed that they were playing real people through a computer. In fact, the ‘people’ were pre-programmed computer responses which behaved in either a trustworthy or untrustworthy manner, differing by how much they cooperated over the course of the game.
First author, Dr. Anthony Gabay who carried out the work at King’s College London and is now at Oxford University, said: “When trustworthy players betrayed the participants the breach in trust had an equally negative impact whether participants were under the influence of MDMA or not. However, MDMA led to a quicker recovery of cooperative behaviour and this tendency to rebuild a relationship led to higher overall levels of cooperation with trustworthy partners.”
“Using MRI scans, we were also able to see that MDMA had an impact on brain activity when processing the behaviour of others, rather than altering the decision-making process itself.”
MDMA increased activity in the superior temporal cortex and mid-cingulate cortex, areas known to be important in understanding the thoughts, beliefs and intentions of other people. When processing the behaviour of trustworthy players, MDMA increased activity in the right anterior insula but decreased it when processing behaviour of untrustworthy players, reflecting the different behaviour shown to different opponents. The right anterior insula is important for the integration of appraisals, risk and uncertainty.
Professor Mehta said: “Understanding the brain activity underlying social behaviour could help identify what goes wrong in psychiatric conditions. Given the social nature of psychotherapy, understanding how MDMA affects social interaction sheds light on why the drug could become a valuable tool in treating patients.”
MDMA is currently undergoing phase 3 clinical trials for treating PTSD when used alongside with psychotherapy and has been given Breakthrough Therapy designation by the FDA.
Citation : Journal of Neuroscience. DOI: 10.1523/JNEUROSCI.1276-18.
Image : Image showing brains regions which showed increased activity on MDMA compared to placebo. Image credit: King’s College London
A second study found that MDMA (Ecstasy) may relieve the agony of PTSD
MDMA (Ecstasy) may relieve the agony of PTSD
Better known to nightclubbers as ecstasy, the euphoria-inducing drug MDMA appears to alleviate Post-Traumatic Stress Disorder (PTSD) in war veterans, firefighters, and police officers, researchers said.
In a trial in the United States, three different doses of the drug were tested on 26 service personnel diagnosed with the debilitating affliction after experiencing trauma in the line of duty.
Those on the two higher doses—75 or 125 milligrammes—enjoyed greater relief of PTSD symptoms than those given the smallest dose of 30 mg, a team reported in the journal The Lancet Psychiatry.
All 26 received psychotherapy throughout the drug trial, and did not know what dose they were receiving.
A month after their second dose, 86 percent of the 75 mg group no longer met the diagnostic criteria for PTSD, said the study authors.
The figure was 58 percent for the 125 mg group and 29 percent for the 30 mg group.
In a second leg of the study, participants previously on 30 mg who had their dose upped to 100-125 mg of MDMA saw symptoms “significantly” decrease.
After one year, the severity of symptoms among the 26 remained “significantly reduced”, the researchers reported. Sixteen participants who suffered from PTSD when they joined the trial no longer met the criteria for diagnosis.
The findings suggest this “novel approach to pharmacotherapy” may help accelerate patient treatment by combining psychotherapy with a fast-acting drug “administered only a few times at monthly intervals,” said the team.
But this did not mean that people suffering from a psychiatric disorder should rush out in search of ecstasy—an illegal drug—in the hopes it will make them feel better, said the team.
MDMA treatment should only be done hand-in-hand with psychotherapy under the supervision of a qualified medical professional, they added.
Too soon to tell
During the trial, 85 “adverse events”—including anxiety, headaches, fatigue, and insomnia—were reported by 20 trial participants. It is not clear whether the MDMA or something else was responsible.
One trial participant was admitted to hospital with suicidal thoughts.
PTSD is triggered by living through a traumatic event. Sufferers continue to experience stress or fear long after the danger has passed—sometimes for years.
Symptoms include flashbacks and bad dreams, and PTSD sufferers can be easily startled, or quick to anger. The disorder is linked to a high suicide risk.
Previous research has shown that MDMA helps relieve PTSD symptoms in victims of sexual crimes.
The latest study focused on 22 military veterans, three firefighters, and a police officer.
The trial did not include a control group of participants given an MDMA “dummy” dose, or placebo. Nor did it compare the effectiveness of MDMA to existing medicines.
University of Oxford experts Andrea Cipriani and Philip Cowen observed that some recreational MDMA users experience a sharp drop in mood a few days after the chemical-induced high.
Such a side-effect would be of “particular concern in individuals vulnerable to depression and suicidal feelings,” the duo wrote in a comment also published by The Lancet.
“The unmet need for better PTSD treatment, particularly in veterans and first responders, is undoubted,” they added.
But further research must determine whether MDMA therapy offers any real benefit to mainstream psychotherapy.
Citation for second study : Michael C Mithoefer et al. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial, The Lancet Psychiatry. DOI: 10.1016/S2215-0366(18)30135-4
A follow-up study found lasting benefit from MDMA for people with PTSD.
Follow-up study finds lasting benefit from MDMA for people with PTSD
A research team made up of a group of private practitioners and medical experts has conducted a follow-up study of a trial of 3,4-methylenedioxymethamphetamine (MDMA) use in therapy sessions to treat Post Traumatic Stress Disorder (PTSD). In describing their results in their paper published in the Journal of Psychopharmacology, the team says that 17 of 20 patients who participated in the original study reported positive results long term.
The follow-up study was based on an original trial where 20 patients suffering from long term PTSD were given MDMA (the main ingredient in the party drug ecstasy) as part of their psychotherapy sessions. The researchers reported at the time that 83% of the participants showed improvements in their condition two months later.
In this new work, the researchers revisited the original patients three and a half years later (one refused to participate leaving just 19) to see how well they were doing. They found that just two of the patients had suffered a relapse – the rest they say maintained the relief they had found in the original trial.
The research was sponsored by the group Multidisciplinary Association for Psychedelic Studies (MAPS), whose mission is to seek out treatments for a variety of mental ailments using non-traditional drug therapies. In addition to providing funds for the trials they also worked out agreements with the government to allow for legal testing of the drug (it currently has as a Schedule I status.)
Study leads (and husband and wife) Michael and Ann Mithoefer conducted the original trial out of their private practice office. Each trial was conducted with a single patient at a time and involved a non-pharmaceutical therapy session followed by one where the patient was given a dose of MDMA. Another traditional session was held later – the sessions that included use of the drug lasted up to eight hours because the effects of the drugs last that long.
The researchers believe that MDMA helps PTSD sufferers by allowing them to relive the emotionally traumatic experience that led to their condition in a more relaxed and receptive way. Because of the promising results, MAPS is calling on the government to relax its rules on the testing and use of MDMA for medical applications.
Citation for third stuydy: Durability of improvement in posttraumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study, Journal of Psychopharmacology. doi: 10.1177/0269881112456611