Moving beyond the party scene: why MDMA therapy is about to receive FDA approval

MDMA therapyCC: Nik Shuliahin at Unsplash

Many people associate MDMA with parties and eventual electrolyte imbalances. However, behind the scenes, researchers have been looking at the drug’s role in PTSD recovery. Most recently, two studies on opposite sides of the Atlantic Ocean have highlighted how MDMA therapy is sliding closer toward receiving FDA approval.

What is MDMA and how does it work?

Are you ready for a lot of syllables? MDMA stands for methylenedioxymethamphetamine. Some people may refer to it as ecstasy, Mandy, or Molly. It’s worth knowing now that if you encounter MDMA under any of those names, it’s likely neither safe nor entirely made of its namesake.

In its true form, MDMA does induce feelings of ecstasy. Those who take it gain more enjoyment from small experiences, they feel energized, they open up to others, and they may even hallucinate. How does it achieve this? It increases the activity of three neurotransmitters: serotonin, dopamine, and norepinephrine.

It’s thought that the increase in serotonin is the main reason MDMA elevates the user’s mood. Dopamine enhances focus and stimulates the brain’s reward center, while norepinephrine boosts your energy. For those who use it in an uncontrolled environment, it’s unwise to assume that the brain has a plentiful supply of these chemicals to spare. MDMA makes a significant withdrawal from your happy hormone bank, primarily because those who use it in an uncontrolled setting do so in an uncontrolled manner.


When overuse of MDMA occurs, the days and weeks that follow become troubling. A depletion in serotonin means your outlook becomes significantly less positive. You may also find that your decision-making skills suffer. Reaction times can also become slower until the brain is able to restock its neurotransmitters to a normal level.

Because of this, it’s unwise to use MDMA therapy alone. Reassuringly, the latest research shows that it isn’t only safe when used in a controlled setting; it’s life-changing.

What are the proposed benefits of MDMA therapy?

The lack of inhibition that accompanies MDMA therapy is thought to make it easier for those suffering from PTSD to recover from their trauma. As a highly complex condition affecting niche groups such as members of the armed forces, PTSD is notoriously difficult to tackle. While newer therapies such as EMDR have made headway, many still find they’re unable to overcome the communication hurdles that make reducing trauma challenging.

At King’s College in London, a study focusing on MDMA therapy revealed the ways it affects the brain. Using a therapeutic dose of the drug and an MRI machine, researchers exposed participants to a challenge that required trust, empathy, and loyalty. Participants could either cooperate to make their peers’ lives easier, or cheat and take the selfish route.

The study was a blind trial, which means there were two groups: the MDMA therapy group and a placebo group. Neither group was aware of which therapy they were receiving. In the MDMA therapy group, the participants were less likely to trust sneaky individuals. However, they demonstrated a greater sense of trust in those who supported them. These findings were solidified with the following MRI revelations:

  • More activity in the temporal cortex and mid-cingulate cortex, which play a role in how we understand others and their beliefs.
  • Increased activity in the right anterior insula, which plays a role in risk-based decision making.
  • Decreased activity in the right anterior insula when dealing with untrustworthy people.

So far, the biological results demonstrate how MDMA therapy could sharpen someone’s sense of trust, openness, and understanding. The MRI revelations only came when participants were given a situation to appraise, which meant the MDMA enhanced decision making rather than shaping it.

Research from the U.S. found that MDMA therapy could prove effective in traumatized individuals who don’t respond to current medications. The research looked at 28 adults with PTSD who hadn’t responded to other therapies. Forty-two percent of those who took the 125mg dose that’s therapeutic rather than the 100mg dose that isn’t entered PTSD recovery after one month. By month three, that figure rose to 76-percent. Other studies show how the remission rates are low.

Are there any risks? If so, what do researchers have to say about them?

MDMA therapy is controversial, primarily due to the responses people have to street doses. When taken excessively, it can cause electrolyte imbalances such as hyponatremia and hypokalemia, which become fatal past a certain point. Additionally, the disinhibition could lead to greater risk-taking behavior.

The key difference here is that MDMA therapy takes place in a controlled environment. The drug administered is MDMA, not a baffling blend of cocaine, ketamine, and bath salts. The person taking the dose is pre-assessed for suitability. Additionally, they’re not using other substances that increase the likelihood of taking big risks. Namely, alcohol. Finally, it’s possible to assume that MDMA therapy wouldn’t be offered to those who are already at risk of electrolyte disturbances, nor would a psychiatric team give the enhanced doses that cause them.

With the drug in Phase 3 of FDA approval, it’s likely it will hit the medical world in a safe way. When it does, it could transform the lives of those struggling to cope with trauma.

About the Author

Laura McKeever
Laura has been a freelance medical writer for eight years. With a BSc in Medical Sciences and an MSc in Physician Assistant Studies, she complements her passion for medical news with real-life experiences. Laura’s most significant experience included writing for international pharmaceutical brands, including GSK.