A South Carolina psychiatrist and his wife, a nurse, have taken an uncommon, controversial approach to helping war veterans who suffer from post-traumatic stress disorder by treating them with MDMA, a pure form of the party drug known as Ecstasy.
Their studies have found that the psychoactive stimulant decreases fear and defensiveness while increasing trust in those who take it as part of a therapy program, say Dr. Michael Mithoefer and Ann Mithoefer.
The MDMA-assisted therapy could eventually provide relief for thousands of Iraq and Afghanistan veterans who suffer from combat trauma, the Mithoefers say, noting that nearly 300 military personnel from around the country have contacted them seeking help.
Though concerns may arise about creating drug dependence or abuse by administering a tightly controlled substance, Dr. Mithoefer said he hasn't seen that problem. The couple's use of MDMA in studies has been approved by the U.S. Food and Drug Administration and the U.S. Drug Enforcement Administration, he said.
MDMA "does cause some euphoria. But for people with PTSD, it can be pretty intense anxiety as well," he said. "You need to have the support there. This is not a take-home medicine."
Not everyone is convinced the benefits outweigh the potential dangers.
Ron Acierno, director of the PTSD clinical team at the Ralph H. Johnson VA Medical Center in Charleston, said the Mithoefers' results were interesting, but he remains skeptical of the treatment.
"I don't think any VA is going to touch this with a 10-foot pole because of the type of drug it is," Acierno said. "It's hard to switch conceptual gears that it might actually be very useful for a relatively common emotional disorder."
"Because the abuse potential is high, we have to be very careful about it," he said.
Dr. Mithoefer, an assistant professor in the Medical University of South Carolina's department of Psychiatry and Behavioral Sciences, said he has long been interested in experiential techniques that help patients shift their consciousness to revisit their traumas.
He developed the protocol for MDMA-assisted therapy in 2001 and published the first completed study of its effect on patients with trauma in 2010. He found that after two months of treatment, at least 74 percent of the patients, including rape victims and a veteran, no longer qualified for a PTSD diagnosis.
A follow-up review of those patients, published last month in the Journal of Psychopharmacology, showed more than 80 percent of them still had lasting benefits 3-1/2 years after treatment.
The Mithoefers currently are treating 24 veterans, firefighters, police officers or victims of military sexual trauma who have chronic PTSD that hasn't been helped by other kinds of treatment. This three-year study will be completed in 2014.
The participants travel to Dr. Mithoefer's private practice in Mount Pleasant, South Carolina, for treatment over a period of five to eight months. After being screened to eliminate anyone with cardiovascular problems or a psychotic disorder, patients are given a series of doses of MDMA.
The Mithoefers are both present for the eight-hour drug-assisted sessions, which include therapy and support. The patients also participate in therapy before, in-between and after the medication sessions, they said.
Those who suffer from PTSD often can't sleep, have nightmares, isolate themselves emotionally and avoid "anything that reminds them of Iraq," including crowds, fireworks or overpasses, Ann Mithoefer said.
The use of MDMA seems to help the brain learn to process traumatic memories without becoming overwhelmed by emotion or fear, Dr. Mithoefer said.
"People have said things like, 'It's changed my relationship to my emotions,'" he said. "They realize, 'I don't have to be so afraid of the fear anymore.'"
Other studies that might include veterans are pending in Colorado and Canada and are being planned in the United Kingdom, Israel and Australia, said Brad Burge, a spokesman for the nonprofit Multidisciplinary Association for Psychedelic Studies, which funds the research efforts.
The Santa Cruz, California-based organization said the pure MDMA used in treatment is different from Ecstasy, which often contains other harmful substances. Ecstasy's recreational use has caused deaths from heat exhaustion or over-hydration, Dr. Mithoefer said.
Medical use of recreational drugs has been taboo since the 1960s, but the nonprofit is investing $10 million over 15 years in an effort to win FDA approval for MDMA as a prescription medicine in the United States.
"The taboos are lifting, and people are getting practical about science," Dr. Mithoefer said. "If we took away everything in medicine that is being abused outside of medicine, we wouldn't have too much left."
Roland Griffiths, a professor in the psychiatry and neuroscience departments at Johns Hopkins University, called the Mithoefers' research "groundbreaking."
"It's a potentially important, new application of use for a set of compounds that have not been available for clinical research for decades now," Griffiths said. "PTSD is an awful, awful disease ... I don't think we should stick our heads in the sand."