Could MDMA Someday Be Used to Treat Anxiety and Depression?
Key takeaways:
MDMA is an illegal, synthetic drug that causes increased energy, pleasure, and self-awareness.
When combined with talk therapy, MDMA may be helpful for certain mental health conditions, like PTSD, end-of-life anxiety, and social anxiety in people with autism.
MDMA-assisted therapy (MDMA-AT) is only available in some states and in very specific situations. Soon, it will likely receive FDA approval for treating PTSD.
More research is needed to understand whether MDMA-AT could be helpful for treating other kinds of anxiety and depression.
You may have heard of MDMA (3,4-methylenedioxy-methamphetamine). It’s a human-made drug that goes by many other names, including “molly” and “ecstasy.” It increases energy and feelings of happiness, empathy, and openness.
Though MDMA is illegal today, in the 1970s it was actually used as a tool in psychotherapy. Even though it showed benefits in psychotherapy, MDMA got a bad reputation when it became a popular recreational drug. By 1985, it became illegal in most countries. From then on, MDMA-assisted therapy (MDMA-AT) could only legally be used as part of a clinical trial.
Since then, there has been more research and renewed interest in psychedelic-assisted therapy. In fact, one day soon, MDMA may even become FDA approved for treating post-traumatic stress disorder (PTSD). Although most recent research on MDMA-AT focuses on people with PTSD, there’s also research looking at how MDMA may help in the treatment of other mental illnesses — including anxiety and depression.
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What is MDMA?
MDMA is a synthetic (human-made) drug, in the same family as amphetamines. It creates feelings of euphoria (happiness), openness, and social connection. It can lead to changes in perception, just like LSD (“acid”) and psilocybin (“magic mushrooms”). But MDMA can also cause serious side effects, like a dangerous increase in body temperature.
Though MDMA is still illegal to use, in 2017 the FDA gave it special status as a “breakthrough therapy” for PTSD. This means that it’s not FDA approved, but there’s enough proof that it works better than current treatments. More research is needed to prove whether MDMA may be helpful for treating other mental health conditions as well.
What does MDMA do to the brain?
When someone takes MDMA, it boosts the activity of certain chemical messengers in the brain and body, including:
Serotonin: Serotonin has many different jobs in the body, including balancing mood. MDMA causes nerve cells to release a lot of serotonin, which may be what leads to euphoria and an increased sense of connectedness.
Norepinephrine: This is a chemical that increases energy and alertness while raising heart rate and blood pressure.
Dopamine: Dopamine plays a role in pleasure, motivation, and focus.
Oxytocin: This “love hormone” plays a role in feelings of love, sociability, sexuality, trust, and empathy.
Cortisol: This hormone helps people deal with stress by boosting heart rate, blood sugar, and breathing.
MDMA also affects activity in areas of the brain that control thinking, mood, emotions, and memory. It decreases activity in the amygdala, the part of the brain that responds to fear. And it may also help the amygdala and hippocampus (the brain’s memory center) communicate better. These effects may make it easier to talk about stress and trauma or to reprocess painful memories.
What is MDMA-assisted therapy?
MDMA-assisted therapy (MDMA-AT) is therapy combined with MDMA.
MDMA was first used in psychotherapy in the 1970s, before it became illegal in the U.S. Early psychedelic therapists reported that it allowed people to open up about feelings or memories that were too hard to talk about. Therapists experimented with MDMA-AT to treat survivors of trauma, people with addictions, and people with terminal illness.
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Today, MDMA can only be used legally in a DEA-approved research setting (clinical trial). When doing MDMA-AT with study participants, researchers use guidelines based on methods created by those early psychedelic therapists.
Let’s take a look at what that process looks like.
Preparatory session(s)
This lays the groundwork for the MDMA-AT process. It might include:
Medical screening
A meeting between the therapist and participant to establish a relationship, create a safe physical and mental environment, and set goals
Education about the possible physical and psychological effects of MDMA
Participants may have more than one preparatory session until they — and the therapist — feel ready to progress to the next step.
MDMA-assisted session
The MDMA-assisted session begins with the study participant taking a capsule of MDMA (usually between 75 mg to 125 mg). The full session lasts anywhere from 4 to 8 hours, though some participants stay overnight at the clinic or with informed friends or family.
During the session, participants sit or lie down in a comfortable room, wearing eye shades and headphones with a preset music playlist. Music is often used in psychedelic therapy and is shown to help improve the experience and outcome of the session.
The session may alternate between periods of introspection (thinking to oneself) and periods of interaction with the therapists. There is a therapist or other facilitator with the participant at all times.
While everyone’s personal experience will be different, many participants report rethinking aspects of their lives from a new perspective. MDMA does not usually cause people to see or hear things that aren’t there, but it can change the way things look and sound (i.e. brighter, louder, clearer).
MDMA may also make people feel like they’re reliving or reexperiencing past experiences. Because MDMA reduces feelings of fear, it may make it easier for participants to address difficult memories or feelings that may be causing anxiety or depression. Nevertheless, many people often admit the experience can be challenging.
Therapists do not lead the session. They are there to listen, encourage trust, and to make sure participants are safe. Therapists are also there to take notes or recordings, as it can be hard for participants to remember and/or describe everything they experience during the session.
In most cases, people will have more than one MDMA-assisted session — typically with periods of time and integration in between.
Integration
After the session, it may not be clear right away what the outcome is. That’s because the psychedelic experience can be confusing and hard to describe. The participant and therapist(s) will work together to make sense of the experience.
There are many definitions of integration, but generally it’s the process of identifying important insights and awareness gained in the psychedelic session and working it into one’s life. This process usually involves methods of talk-therapy. Different models focus on spiritual aspects, relationships, self-reflection, the body, or nature. A range of practices may be part of the process, like exercise, meditation, healthier habits, or art therapy.
Keep in mind, the number of sessions for each step may vary. For example, the program used in the Multidisciplinary Association for Psychedelic Studies (MAPS) research involves two MDMA sessions, separated by a month. There are three preparatory sessions and three or four integration sessions before and after each MDMA session.
Does MDMA-AT work for depression and anxiety?
Experts don’t know yet. There’s good evidence that MDMA-AT may be helpful for treating PTSD, but it hasn’t been studied as much for depression and anxiety.
Scientists wonder if MDMA-AT may help with anxiety and depression in different ways, including:
A positive mood and lower stress levels
Less defensiveness when talking about difficult experiences
More trust and openness toward others
Ability to see problems in a new way
Better ability to remember and confront memories
More awareness of social/emotional relationships
But keep in mind: MDMA can sometimes also cause anxiety, depression, and panic attacks, especially in the days or weeks after using it (more on this below).
And so far, most of the research using MDMA-AT for anxiety and depression has been limited to two groups of people: people with end-of-life anxiety and people with autism who have social anxiety. More research is needed to understand if the benefits can apply to wider populations.
Can MDMA help with end-of-life care?
Nearly half of people with a life-limiting illness experience anxiety and/or depression. This causes many to isolate themselves and disconnect from friends and family. It also makes it difficult to enjoy the time they have left. Depression and anxiety are even linked to shorter life expectancies in people with life-threatening illnesses.
Current treatments include therapy and medications like antidepressants and antianxiety medications. The problem is that these medications can take a long time (weeks to months) to work, which is not fast enough for people who don’t have long to live. They also don’t address the spiritual or emotional issues that may be the root cause.
With this in mind, many healthcare providers and scientists are interested in whether MDMA can play a role in end-of-life care. MDMA-AT might help ease death-related anxiety or help people who are dying find a sense of meaning and purpose. And MDMA may even become legally available to people who are terminally ill under “right-to-try” laws, even if the FDA doesn’t approve it.
Can MDMA help social anxiety?
Possibly. There’s some evidence that MDMA-AT may help treat social anxiety disorder (SAD). But, so far, most of the research on SAD has been in adults with autism. A small trial tested the MAPS MDMA-AT program on people with autism and social anxiety. For at least 6 months, social anxiety improved more after taking MDMA than a placebo in therapy.
There are different theories of why MDMA might be helpful for social anxiety:
MDMA enhances reconsolidation of negative memories. This is a window of time during reactivation of a memory when someone can change their associations with it. This might be able to help some people with SAD if they have memories that make them feel bad about themselves and relationships with others.
MDMA may be able to promote positive emotions, including toward yourself. This could help people with SAD feel better about themselves.
MDMA may be able to reduce fear in social situations and increase feelings of connection to others.
What are the risks of MDMA?
According to the National Institutes of Health (NIH), the side effects of MDMA include:
Appetite loss
Dizziness
Nausea
Jaw clenching
Rise in body temperature (hyperthermia)
Increased heart rate and blood pressure
Disorganized thinking
Headache
Joint or muscle stiffness
In the days or weeks after taking MDMA, people can also experience:
Heart problems
Mood changes, like irritability, anxiety, and depression
Sleep problems
Memory and concentration problems
Appetite loss
Loss of interest in sex
And it can be risky to combine MDMA with other drugs. Many medications — like antidepressants, opioids, and stimulants — can cause dangerous interactions with MDMA.
Experts don’t know for sure. According to the NIH, there’s some evidence that MDMA could cause neurotoxicity (brain damage). But one of the studies claiming this ended up being retracted (taken back), and another used a higher dose than intended.
It’s also not clear whether MDMA may cause neurotoxicity in high or repeated doses. A study comparing people who used MDMA long term to those who didn’t use it did not find much proof. This risk might be lower in MDMA-AT, as the dose and number of sessions is limited.
In short, more research is needed to understand how MDMA affects the brain.
Yes. In the days or weeks after using MDMA, it’s definitely possible to experience a “comedown” (like having trouble thinking or feeling depressed, irritable, or sleepless).
Some researchers believe that these negative effects aren’t from the MDMA itself. Instead, they may be caused by taking too much MDMA or accidentally taking a contaminated substance. But other scientists aren’t so sure.
Hopefully, as MDMA continues in clinical trials, researchers will continue to learn more about the after-effects of MDMA in a therapeutic setting.
Experts don’t know for sure. Though people have reported addiction symptoms from MDMA use, the science isn’t clear. Research results vary because of different populations and measurements in different studies.
It’s also confusing because some early reports and ongoing studies have shown that MDMA-AT might even help treat addictions, like alcoholism. In addition to lower alcohol use, people reported no interest in using illegal MDMA after their sessions. More research is needed to better understand MDMA and addiction.
Yes. Though overdoses are rare, there are some cases of people dying after taking MDMA. But many of these deaths happened during recreational use because of contaminated MDMA or dangerous interactions with other prescription and/or recreational drugs.
In MDMA-AT, a medical screening helps to lower the risks by ruling out people with underlying medical conditions. The dose and purity of MDMA are also carefully monitored. And healthcare providers are present to make sure participants are safe.
Experts don’t know for sure yet. One small study tested the safety of 75 mg and 175 mg of MDMA (without psychotherapy) in healthy people and found no serious side effects. And in a larger study of MDMA-AT for PTSD, MDMA sessions were safe and well tolerated. Another study of MDMA-AT for alcohol use disorder had similar results using an even higher dose (187.5 mg) of MDMA.
The bottom line
Experts don’t know enough about MDMA yet to say for sure whether it can treat anxiety and depression. But there is good evidence that MDMA-AT might be helpful for PTSD, end-of-life anxiety, and social anxiety in people with autism. The same benefits might apply to a broader group of people with anxiety and depression, but more research is needed to confirm this.
And remember: MDMA is not approved for any medical use yet. As researchers learn more about MDMA-AT, they’ll be able to better understand its role in mental health treatment. In the meantime, you can learn more about the clinical trials underway by visiting psychedelic.support for a directory of psychedelic-AT trials.
Why trust our experts?
DISCLAIMER: Keep in mind that MDMA-AT is only legal in some states when used as part of a government-approved clinical trial under limited circumstances, but not in others. MDMA is still illegal under federal law.
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For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
