MDMA is considered a psychedelic, but the drug effect does not significantly alter cognition, rather it enhances empathy and bonding and allows users to access and process feelings of emotional trauma.
This effect is primarily mediated through the release of serotonin and dopamine, and to a lesser extent, norepinephrine. The most promising clinical outcomes thus far have been found in using MDMA to assist with psychotherapy. These studies typically consist of a small number of MDMA-assisted psychotherapy sessions. Phase 1 and Phase 2 clinical trials have been completed examining the efficacy of MDMA-assisted psychotherapy in individuals with Post-Traumatic Stress Disorder (PTSD) and Phase 3 clinical trials are ongoing. Almost all MDMA research in Canada is sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). Their MDMA iscurrently under review in a Phase 3 clinical trial centred in Canada, the US, and Israel. There is a very high likelihood that these Phase 3 trials will show positive clinical efficacy of MDMA for treating PTSD, meaning MDMA would be considered a medicine, opening further research and treatment options.
Treatment of mental health disorders remains a difficult task. Lack of focus and funding has compounded this. Psychedelic drugs, especially when combined with psychotherapy provided by an accredited and trained therapist, offers one possible solution.
Spring-boarding off anecdotal and clinical reports from the golden era of psychedelic experimentation from the 1970’s and early 1980’s, in the past two years the US FDA has approved ketamine for treatment-resistant depression and has approved MDMA and psilocybin for the breakthrough therapy designation. Interestingly, though these three chemicals are often grouped together as ‘hallucinogens’ their pharmacological effects are quite different. Ketamine is a dissociative anaesthetic, which acts on the glutaminergic system, psilocybin could be considered a more classical ‘psychedelic’ as it works primarily through binding to the 5-HT receptor (3–5) whereas MDMA is an ‘entactogen’ working primarily through serotonin norepinephrine and dopamine transporters (6–10).