MDMA for PTSD: Systematic Review & Meta-Analysis
Abstract
Background: Posttraumatic Stress Disorder (PTSD) is a common psychiatric diagnosis that can develop following a traumatic experience. PTSD is related to significant disability and is associated with a large economic burden. Despite the range of therapies to treat PTSD, response to antidepressants is limited. A growing body of clinical research suggests the efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in individuals with treatment-refractory PTSD. Objectives: To assess the effectiveness and safety of MDMA-assisted psychotherapy for reducing symptoms of PTSD. Search methods: Cochrane, MEDLINE, EMBASE, PsycINFO, CINAHL, and PubMed databases were searched from inception to June 2018; searches were repeated in December 2018 to capture recently published articles. Reference lists of relevant articles were manually searched as well as electronic sources of ongoing trials and conference proceedings. Researchers active in the subject were also contacted. Selection criteria: Eligible studies included randomized and quasi-randomized clinical trials using MDMA-assisted psychotherapy for PTSD in comparison with other medications, placebo or no medication (supportive care). Data collection and analysis: We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors assessed studies for inclusion and extracted data. Using random-effects meta-analysis with Cochrane’s Review Manager 5.3, we obtained standardized mean differences [SMD] and rate ratios [RR] for reduction in PTSD symptomatology. Main results: A total of 5 trials met inclusion criteria, totaling 80 participants, with the average age ranging from 35 to 40 years. Approximately 70% of study participants were female. Overall, the studies were rated as moderate to high quality. MDMA demonstrated a high rate of clinical response (RR = 3.31, 95% CI: 1.72, 6.38), with a large effect size at reducing the symptoms of PTSD (SMD = 0.85, 95% CI: 0.23, 1.46). Available evidence indicates that MDMA was well-tolerated, with few serious adverse events reported across studies. Conclusions: MDMA-assisted psychotherapy appears to be a potentially safe, effective, and durable treatment for individuals with chronic, treatment-refractory PTSD. However, future studies involving larger samples and longer durations of treatment and follow-up are warranted.
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