The psychotherapeutic potential of MDMA (3,4-methylenedioxymethamphetamine): an evidence-based review.

Summary

MDMA has potential therapeutic properties but also significant risks. While it can produce positive mood effects and enduring positive cognitions in some therapeutic settings, it can also intensify negative thoughts and lead to low moods post-use, which may worsen psychiatric distress. Factors like setting and expectation are crucial for positive outcomes, but cannot be guaranteed. Further research is needed to clarify its psychopharmacological rationale and address concerns regarding its clinical utility in psychotherapy.

Study at a glance

Abstract

AIMS AND RATIONALE: The purpose of this study was to review whether methylenedioxymethamphetamine (MDMA) has the appropriate pharmacodynamic profile to be a therapeutic agent. Empirical descriptions of MDMA's subjective effects in humans will be reviewed to evaluate the proposal that MDMA has psychotherapeutic properties. The focus will be published evidence on its functional effects in therapeutic, medical, and other situations. MDMA is a powerful central nervous system (CNS) stimulant which affects several neurotransmitter systems and intensifies a range of psychobiological functions. Its acute mood effects can be very positive and life enhancing, and the affirmative cognitions engendered during MDMA therapy may well endure afterwards. However, MDMA also has a number of potential anti-therapeutic characteristics. Acutely, it can also intensify negative cognitions, and these may similarly endure over time. Psychotherapists have found that setting, intention, and expectancy are crucial for a positive outcome, but these factors cannot be guaranteed. Post-MDMA, there is a period of neurotransmitter recovery when low moods predominate, and these may exacerbate psychiatric distress. The explanations proposed for MDMA-assisted therapy are all psychodynamic, and a neurochemical model needs to be outlined. It has been suggested that enduring therapeutic gains can follow a single session, but again, this lacks a clear psychopharmacological rationale. Finally, diathesis-stress models suggest that psychiatric individuals are more prone to acute and chronic abreactions to CNS stimulants such as MDMA. There are a number of issues which need to be addressed before it can be argued that MDMA might be clinically useful for psychotherapy.