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Ecstasy to Treat PTSD? Not so Fast

By Docta, Dec 27, 2012 | Updated: Dec 28, 2012 | | |
  1. Docta
    A new study suggesting psychedelics could help treat veterans suffering from PTSD might bring hope to many, but the findings don’t hold weight, writes Kent Sepkowitz.
    Drugs and soldiers have a long, close and very sad relationship. In the Vietnam War, for example, up to 20% of returning soldiers had developed a drug problem during their time overseas. Easy availability and participation in a dizzying war made use irresistible to many. Generally, the addiction was to street drugs – cheap, pure and plentiful in Asia – which, as so many discovered, lead to nothing but legal and medical trouble back in the States.

    There is, therefore, a strange logic in the notion that psychedelics might be beneficial for war-related psychiatric distress. After all, the grand-daddy (a young grandfather, at that) of all synthetic psychedelics, LSD, was used extensively in the 1960s by the CIA and U.S. military to explore new frontiers in truth and brain control right out of bad sci-fi pulp novels. Indeed, the various schemes of the golden age of the CIA, now declassified, seem to be providing Hollywood with some of their best scripts: Argo, Men Who Stare at Goats, and even corners of Homeland come to mind.

    So it is no surprise to hear of studies that examine the possible utility of MDMA, more commonly known as Ecstasy, in conjunction with psychotherapy to treat soldiers still emotionally crippled by post-traumatic stress disorder (PTSD).

    A recent report has provided follow-up information on a small placebo-controlled trial that commenced years ago when 20 patients were randomized to MDMA (12 patients) or placebo (8 patients). In the original study, a suggestive but not statistically significant improvement was seen. (12 of 20 responders with MDMA versus 2 of 8 receiving placebo: p=0.17, statistical shorthand for saying that the likelihood that the result was due to the drug was 83% and to random chance, 17%. For any medical publication, a “p value” of 0.05 reflecting 95% likelihood that the drug caused the change is necessary to pass muster. An 83% score is not even glanced at twice.) In the new dispatch, evidence for durable improvement was noted. The same sort of interesting but not significant finding was reported by a Swiss group that also studied a small number of patients.

    If confirmed by larger trials, this finding would be welcomed. But the hunger for something – anything – that portends good news for sufferers of PTSD should not prevent us from bringing the same yardstick to these studies as we might to any drug-based therapy. And from this perspective, there is very little here here. Or worse yet, there is lots here – lots of conflict of interest: as the authors state at the article’s end, “Our sponsor [a non-profit called The Multidsciplinary Association for Psychedelic Studies (MAPS)] played a role in the study design, data analysis and writing of the report… Three authors…are employed by the sponsor. [Two lead researchers] received payment from the sponsor for conducting this research.” Like any non-profit, MAPS probably needs good news and promising findings to keep donors interested.

    The MAPS team clearly believes in what they are doing. There is no money to be made here; the scientists seem moved by the plight of the soldiers with PTSD. And so they are trying to push a pet theory forward – always a gigantic problem in science where affection distorts and absolute affection distorts absolutely. Indeed almost all of the literature on MDMA to treat PTSD and other conditions comes from this group of researchers, one a shrink in private practice in South Carolina and another running central HQ in Santa Cruz California. But though their fervor and good intentions cannot be questioned, their objectivity surely can and must be. Were this Big Pharma funding salaried Pharma people to release a statistically insignificant happy-time story about soldiers, accusations would fly that they were just squeezing the Department of Defense for even more tax-payer dollars in another amazingly audacious display of high finance chutzpah. There may be more enthusiasm in the press for MDMA as a wonder drug than among patients who theoretically might benefit. 

    In 2004, a psychiatrist affiliated with Harvard announced plans to enroll terminally ill cancer patients into a trial of MDMA. The goal was to let the "ego-friendly" drug work its magic: "increase empathy...relieve anxiety...and quell thoughts of suicide" for those at life's end. Years later, though, the study closed down, citing "enrollment challenges," after only two patients signed on.

    In the case of the PTSD study, the very topic – trying to help anguished American soldiers – almost precludes criticism of the studies. Furthermore the hipness factor – Ecstasy leaves the gutter to save the day! – renders any critic completely L7 if not a total doofus if he tries to look under the rock to determine if the glitter that flashes is indeed gold. Plus, given the nature of the study and the intervention, any serious criticism is easily deflected by claims of bullying, of automatic disrespect of the iconoclast, of general weenie-ness. After all, an original thinker would not wince at the thought of a party drug actually saving soldiers’ pain.

    Improving the plight of the soldiers suffering from PTSD should be a national priority; our collective sense of right and wrong demands it. Yet these are small, preliminary and inconclusive studies that nevertheless feed the frantic hopes of thousands. Though the information is released in the name of kindness, disclosure of vague results gathered vaguely is, in the long run, not humane at all, but cruel.

    Like The Daily Beast on Facebook and follow us on Twitter for updates all day long.

    Kent Sepkowitz is an infectious-disease specialist in New York City. He has contributed to The New York Times, Slate, and, oh-so-briefly, O magazine. He also writes academic medical articles that are at times pretty tough sledding.


    Adding the MAP studies article as an attachment


  1. MrG
    I don't understand the purpose of this article.

    If he has genuine data that suggests problems with the claimed validity of the MAPS research he should present it. Otherwise this piece is utterly pointless and appears to only be, "yeah, well it's probably wrong and you can't say shit about it because nobody involved has their fingers in the pharma pie so, like, the fact you can't criticise 'em must mean they're up to no good, or something".

    I don't even get why he cites the failure of 2004 study due to 'enrolment challenges'? Is he alluding to the sociopolitical climate of the time as providing for some sort of evidence against MAPS, or the psychiatrist affiliated with Harvard?

    "Kent Sepkowitz is an infectious-disease specialist" - Who apparently has no idea how to write an article that actually says anything of any substance.
    We know that drugs help depression so people that have major depression will rely on taking more drugs to make them feel good.
    I know that heroin and opiates are readily available and can easily be addictive where as MDMA is less addictive and seems to lower my stresss and depression and is harder to get cause of ridiculous government policies.
  3. titaniumhunter
    The results from these small pilot experiments clearly have impied that more extensive trials and studies should be done with MDMA assisted physiotherapy for PTSD patients.

    No one is claiming 83% success rate due to the drug alone,its drug plus therapy. They have trained therapists to administer the drug or placebo in, I believe, a single trial therapy sessions with additional non medication sessions.

    No one is saying they are ready to treat PTSD with ecstasy, they are saying they need to do more studies.
    Kent Sepkowitz is known to be very rigid & hypercritical of anything non-mainstream.
    Plus he seems to not produce well thought out articles or substantiated views.
  4. Docta
    What you see here MrG is the paranoia that results from decades of war on drugs conditioning that has begun to skew the vision of even the most dedicated healthcare professionals. If MDMA was a patent drug with a name on it like Bayer or GlaxoSmithKline, Dr Sepkowitz would not have said any of this. I'm shore that in the light of the furor that has erupted in the wake of this article that Dr Sepkowitz's friends and colleagues are saying "Kent what were you thinking!".


    This article has generated a great deal of chatter on the internet forums and blogs with responses starting to appear from MAPS and industry professionals (not aligned with this drug study). My favorite line from a blog is "Dr Kent Sepkowitz does not know the difference between a clinical trail and a Salem witch trial".

    The following responses are verbatim from the comments posted to the original article, they appear on other message boards so I'm un shore of there exact origin.

    First a non biased industry professional giving a personal critique of Dr Sepkowitz's article, the tone and substance of Dr Lieberman's post is representative of the majority.
    Second in from a MAPS Director who has subsequently been quoted as saying "'ll just reiterate here that our study did produce statistically significant results. Kent Sepkowitz misread the abstract in his haste and didn't bother to read the entire article".

    Critique of Dr Sepkowitz's article
    MAPS rebuttal of Dr Sepkowitz's article
    MDMA has saved the lives of many of my friends that were addicted to heroin. MDMA stopped them from relapsing.
    Also my friend after a week of cold turkey slit his wrists three days in a row, Mdma helped him to a stage where he holds a normal job and no heroin habit.

    Mdma is a life saving medicine in my books and it will help many in the future.

    Being an illegal substance the illegality side of the substance is out weighed by it life saving characteristics.
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