The Potential Dangers of Using MDMA for Psychotherapy

MDMA has properties that could aid psychotherapy, but its effects are complex and not always beneficial. The drug acts as an entactogen, promoting feelings of love and warmth, yet it can also trigger negative experiences because it non-selectively releases thoughts and emotions—similar to LSD. Acutely, MDMA alters hormone levels, raising cortisol, oxytocin, and testosterone; oxytocin may help therapy, while cortisol can increase stress. After use, a neurochemical recovery period often brings lethargy and depression due to low serotonin. Regular use risks serotonergic neurotoxicity, memory problems, and other psychobiological issues. Proponents argue MDMA-assisted therapy should be limited to reactive disorders like PTSD, as it may worsen distress in those with prior psychiatric conditions.

Study at a glance

Abstract

MDMA has properties that may make it attractive for psychotherapy, although many of its effects are potentially problematic. These contrasting effects will be critically reviewed in order to assess whether MDMA could be safe for clinical usage. Early studies from the 1980s noted that MDMA was an entactogen, engendering feelings of love and warmth. However, negative experiences can also occur with MDMA since it is not selective in the thoughts or emotions it releases. This unpredictability in the psychological material released is similar to another serotonergic drug, LSD. Acute MDMA has powerful neurohormonal effects, increasing cortisol, oxytocin, testosterone, and other hormone levels. The release of oxytocin may facilitate psychotherapy, whereas cortisol may increase stress and be counterproductive. MDMA administration is followed by a period of neurochemical recovery, when low serotonin levels are often accompanied by lethargy and depression. Regular usage can also lead to serotonergic neurotoxicity, memory problems, and other psychobiological problems. Proponents of MDMA-assisted therapy state that it should only be used for reactive disorders (such as PTSD) since it can exacerbate distress in those with a prior psychiatric history. Overall, many issues need to be considered when debating the relative benefits and dangers of using MDMA for psychotherapy.