Ecstasy.

Mention of the drug conjures a diverse array of images: of sweaty teens writhing till dawn at all-night dance parties; of 20-somethings huddled together after hours, deep in intimate conversation; of grave danger, even death.

But for Boulder psychotherapist Marcella Ot'alora, MDMA, better known as ecstasy, signifies something much different. She sees the drug as a critical tool for treating post-traumatic stress disorder and other mental illnesses, and has dedicated much of her life to seeing it legalized as a prescription drug.

A patient herself once, she says the now-demonized substance saved her sanity.

"It was the beginning of my life turning around," says Ot'alora, 43, one of thousands treated with MDMA as an adjunct to psychotherapy before it was banned in 1985.

After 17 years, the campaign to legalize it for prescription use is beginning to move forward. On Friday, the Food and Drug Administration gave preliminary approval to the first-ever U.S. clinical trial testing the efficacy of MDMA in treating people with post-traumatic stress disorder. Ultimately, the Multidisciplinary Association for Psychedelic Studies, which filed the FDA request, would like to conduct a broader, nationwide study, including a test site working with veterans in the Denver area.

Advocates of the therapy stress that they are not out to legalize ecstasy for recreational use. Instead, they say standardized doses given during a few supervised psychotherapy sessions can prompt deep self-exploration that can otherwise take years.

"I think people are being hurt by ecstasy quite a bit, but I think it also has some real psychiatric potential," says Dr. Julie Holland, a psychiatrist at New York's Bellevue Hospital and author of a new book, "Ecstasy: The Complete Guide Ñ A Comprehensive Look at the Risks and Benefits of MDMA."

Skeptical scientists and mental health professionals point to a raft of research suggesting that prolonged MDMA use can cause brain damage, and that even a few doses might cause some lasting impairment. Some local psychiatrists say even if it were legal, they wouldn't use it because the health risks are still too unknown.

Ot'alora questions the research methods used in the studies. But she acknowledges there may be some risk.

"I do believe it has side effects. Every medication has side effects," she says. "The question is, are those side effects worth it for what you will gain?"

For her, the answer was unequivocally, yes.

She had been raped twice by the time she turned 17. By age 25, the suppressed trauma had led her to attempt suicide. She went in and out of the hospital, and through years of talk therapy and various medications, all without results.

She had never smoked pot or done other street drugs. When a friend offered her a hit of ecstasy, she said OK.

It was anything but fun.

"I completely lost it," she says. "All my bad experiences came up, they were all right there in front of me for the first time and I had a complete nervous breakdown. I ended up in the hospital."

The experience was horrifying, but enlightening. What if she could face those experiences so vividly in a safe environment, in the presence of a trained professional who could take notes, talk her through it, and make it productive?

She connected with one of the many "underground" psychotherapists using MDMA in their practices at the time, and tried again. She took a standardized 125 milligram pill and began a 12-hour marathon therapy session. When she came out of it, she knew what she needed to do to change her life.

"It made me realize I had control over my life, as opposed to letting the past control me," she says.

According to Holland, MDMA (methylenedioxymethamphetamine) has been in existence since at least 1912. That year, pharmaceutical giant Merck filed a patent for a new medication to stop bleeding. MDMA was included in the patent application as an "intermediate chemical" created in the process.

It was used briefly in the 1950s, as part of the U.S. Army's chemical warfare investigations, but saw little use outside the laboratory until the 1980s, when it began to emerge in the club scene. Users describe the drug as evoking an overwhelming sense of empathy, acceptance, closeness, insight and a feeling of general well-being without the confusion and cloudiness that comes with other drugs.

People could order it by calling a 1-800 number, or buy it over-the-counter at nightclubs. And hundreds of psychotherapists and psychiatrists, who called it "Adam," were quietly giving it to their patients.

"It gave people a sense of ease, that everything was all right and they were all right. They could uncover material they could then process for months and years afterward," Holland says.

But on July 1, 1985, the federal government made MDMA a Schedule 1 substance, meaning it is prohibited for every application, has no recognized medical use and cannot be prescribed by a physician.

The reason: It was being widely abused, and studies had suggested it causes brain damage. Since then, hundreds of follow-up studies have suggested the same thing.

"It clearly has the ability to damage neurons," says Glen Hanson, director of the division of neuroscience and behavioral research for the National Institute on Drug Abuse. "It has substantial potential for addiction and harm."

A 1999 NIDA-supported study using advanced brain imaging techniques associated chronic MDMA use with structural damage to neurons that release serotonin, a chemical messenger in the brain. A related study found that heavy MDMA users had memory problems for at least two weeks after they stopped using the drug. Other studies suggested that chronic MDMA use may lead to impaired ability to reason or sustain attention.

According to the Drug Abuse Warning Network, a national surveillance system, at least 3,000 emergency visits were related to ecstasy in 1999. Between 1994 and 1998, at least 27 people died after taking what they thought was MDMA.

Boulder residents have been particularly aware of the potential dangers since the February death of Brittney Chambers, who died from drinking too much water after taking ecstasy on her 16th birthday.

But advocates of legalizing MDMA for clinical use say those studies and anecdotes don't address the way in which they would use the drug.

Most of the studies done on animals study chronic MDMA use. Those done on humans seldom take into consideration whether the subjects use other drugs as well. And deaths or hospitalizations related to ecstasy often involve other factors, such as overheating, says Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies, a nonprofit lobbying for the legalization of MDMA for clinical use.

Doblin was part of the underground psychotherapy community using MDMA-assisted therapy in the early '80s. When it was banned, he went back to school and earned a doctorate in public policy at Harvard's Kennedy School of government, so he could learn the ropes and fight to make it legal.

He thinks once the clinical trials get going, if approved, it would take five years and $5 million to see ecstasy legalized for clinical use. He thinks someday it could also be used in couples therapy and for pain relief in cancer patients.

He agrees that ecstasy can be extremely dangerous in certain settings.

Studies have shown that high temperatures can increase the toxicity of the drug in the body. So an all-night dance party, for instance, is a particularly dangerous place to take it.

As Ot'alora's first experience illustrates, taking it outside of a clinical setting can be traumatic for some people.

But therapeutic users would be treated in a temperature-controlled room by licensed professionals.

"We are not talking about high (or frequent) dosages. We are talking about one, two, three times max in the course of a year," says Ot'alora, who conducted a clinical trial using MDMA with rape victims in Spain last year.

Adds Doblin:

"The evidence suggests that therapeutic use causes absolutely zero brain damage."

Hanson declined to comment on whether he thinks MDMA should be legalized for clinical use. There is still much to be learned about the drug, he says, and the existing research speaks for itself.

"The conditions under which it is used and the individual can really vary," he says. "You may have a fraction of people who are so vulnerable that all they have to do is take two or three tablets and have long-term consequences."

Ot'alora says she had none, aside from some sleeplessness and depression the next day. But her experience prompted her to embark on a 10-year-journey that has helped her recover.

After two MDMA-assisted sessions, she never took it again. She went back to school and earned her master's in psychotherapy from Naropa University. Her experience working with PTSD patients in Spain confirmed for her that she's on the right track.

"I'll never forget this one woman's face," she says. "She suddenly realized that she had held her bad experiences as a badge for not being happy. She just kept saying 'Thank you.'"