Norwegian patients are the first in the world to test MDMA against depression
Most of the patients improved significantly. But why?
The capsules used in the treatment contain pharmaceutically manufactured MDMA.(Photo: Østfold Hospital)
IngridSpildejournalist
Published
MDMA is the active substance found in the illegal party drug ecstasy. It's known to induce an altered state of consciousness and to make you more empathetic, open, and talkative.
It is precisely these properties that have sparked the interest of researchers in psychology and psychiatry, and the role the substance can play in combination with psychotherapy.
"You feel safe and have self-compassion and trust in others. We believed this could help patients get more out of therapy and dare to explore topics that are usually too painful or shameful," says Tor-Morten Kvam, chief physician at Østfold Hospital.
He and his colleagues have previously been involved in a study on the effects of MDMA on post-traumatic stress disorder (PTSD).
The results show that most of the participants improved significantly.
9 out of 12 improved
The study is a pilot study. This is a small study with few participants – a kind of trial project to find out whether it's possible to conduct a larger study with a similar setup.
Kvam and his team recruited 12 patients suffering from moderate to severe depression. These participants received two MDMA treatments, spaced one month apart.
The effects of the substance lasted six to eight hours, during which patients alternated between inward reflection and talking with a psychologist or psychiatrist.
In addition to the MDMA sessions, participants also received several hours of psychotherapy before and after each treatment.
The results showed that 9 out of the 12 patients were significantly better two months after the final treatment.
Safe and feasible
Some patients experienced side effects, but none were unexpected or serious. The nine patients who responded well to the treatment had fewer and milder side effects than the three who did not improve.
This indicates that conducting larger studies using this type of treatment is both safe and feasible, Kvam and his colleagues conclude in a scientific article now published in The British Journal of Psychiatry.
Still, it's difficult to say whether MDMA was truly the cause of the improvement, and if so, how effective it really is.
This is what the treatment room looks like. While under the influence of MDMA, patients alternate between speaking with a therapist or immersing themselves in their inner experience.(Photo: Østfold Hospital)
No control group
"The biggest weakness of the study, as the authors themselves point out, is the lack of randomisation and a control group," Joar Øveraas Halvorsen, associate professor at NTNU, tells Science Norway.
Halvorsen has conducted his own research on the effects of psychotherapy, but was not involved in this study.
Annonse
Without comparing the results to those of other patients who did not receive MDMA, researchers cannot determine whether the effect is due to the placebo effect or if the patients simply improved on their own. Patients are often recruited into studies during particularly difficult periods, and it's not uncommon for them to get better even without treatment.
High expectations
It’s well known that pilot studies often overestimate how effective a treatment really is, Halvorsen adds.
This is an issue Kvam is also well aware of.
"It's common for the effect to be smaller in larger and more rigorous studies," he says.
Tor-Morten Kvam is a chief physician at Østfold Hospital.(Photo: Østfold Hospital)
Kvam also points out that almost all the patients who participated in the pilot study had contacted the hospital themselves because they were interested in this type of treatment.
"That means we’re working with a group of patients who come in with high expectations, and that can influence the outcome," he says.
This self-selected group also means the results may not reflect what would happen with the average patient dealing with depression.
MDMA + psychotherapy
A key question remains: What part of the treatment was actually effective?
MDMA was not administered on its own, but was part of a treatment programme that included many hours of psychotherapy.
And according to Kvam, the form of psychotherapy used in the study differs in important ways from standard approaches.
"First, we focus on not pathologising or labelling what comes up in therapy as a disorder. There needs to be room for unusual experiences, since these arise in a non-ordinary state of consciousness," he says.
"Second, our therapeutic model is built on the idea that people have an innate ability to heal themselves," he adds.
With the help of MDMA – enhancing trust and self-compassion – the patient is encouraged to discover for themselves what needs to be addressed, and in what order.
"Our role as therapists is to talk about the obstacles that prevent spontaneous healing. We're there to support and work alongside the patients and their inner resources, not to offer too many suggestions about what to do," he says.
"There's a more equal dynamic in the therapy room," he says.
The role of therapy
Could it be that this particular form of psychotherapy, rather than MDMA itself, accounts for much of the effect?
"That's absolutely possible," says Kvam. "In large studies on PTSD, half the patients received this type of psychotherapy with MDMA, while the control group received a placebo and the same psychotherapy."
"In these studies, around two-thirds of patients who received MDMA improved. But one-third – sometimes even half – of those in the control group also improved, despite often feeling disappointed when they realised they weren't in the MDMA group," he says.
On the other hand, patients who try using MDMA on their own often report little or no effect, Kvam explains.
This suggests that the psychotherapy component is essential.
Hope for a new treatment
"We can't draw firm conclusions about the effectiveness from this study," says Kvam. "We've taken a first step in exploring a treatment method with a new patient group, and the early signs suggest it may be effective. The next step is a larger, controlled study. I hope we or someone else will get funding to make that happen."
"Before MDMA-assisted psychotherapy can be introduced as a treatment for depression in regular clinical settings, we need more large-scale randomised controlled trials," says Halvorsen.
"We need studies that compare MDMA-assisted therapy with control conditions, such as a combination of antidepressants and psychotherapy," he adds.
