November 22, 2012
Dr. Ben Sessa Responds to U.K. Psychologists Not “Convinced” by Scientific Research
In response to an article criticizing our recent research into treating PTSD with MDMA-assisted psychotherapy, Dr. Ben Sessa offers his comments on the article, providing detailed rebuttals to unfounded claims made by Mancunian Matters.
Originally appearing here.
The illegal street drug MDMA is not an appropriate treatment for post traumatic stress disorder (PTSD) sufferers despite an American study suggesting otherwise, according to leading Greater Manchester clinical psychologists.
A recent study in the US suggested the drug – commonly known as ‘ecstasy’ – can reduce the symptoms of PTSD and improve its sufferers’ quality of life.
However, Dr Hannah Bashforth and Dr Sophie Halliday of The Clinical Psychology Practice in Hale Village, Altrincham have serious doubts about the method.
“We are not convinced at all with the robustness of actual relevance of these findings,” they told MM.
“We are concerned at the use of illegal substances in the treatment of vulnerable individuals who have already been through trauma in their lives.”
These findings were published this week in the Journal of Psychopharmacology by South Carolina psychiatrist Michael Mithoefer.
However, the small control group and sample size – 20 PTSD sufferers were tested – allow criticisms to be levelled at the results.
Additionally, Dr Bashforth and Dr Halliday believe this treatment approach has the potential to directly contravene traditional methods.
“There is evidence to suggest that the use of alcohol and recreational drugs interfere with the brain’s ability to process trauma,” they added.
“Given that talking therapies have been shown to be effective in Randomised Controlled Trials for helping individuals to process trauma, this would be counterintuitive.”
A belief the drug can help sufferers of PTSD and other mental disorder is nothing new – some American doctors have preached the powers of MDMA for more than a decade.
And there is support for the treatment within the UK, notably from David Nutt, former chief drugs adviser for the government.
“[MDMA] allows people to talk about emotional experiences without such an enormous emotional response that the brain shuts down,” he told the BBC recently.
“Normally to get over trauma people have to relive it and get a cognitive control of it.”
However, the doctors at The Clinical Psychology Practice emphasised the importance of not getting carried away with this radical method.
They said: “There are specific guidelines for the treatment of PTSD which do not include the use of MDMA, and it is our opinion that this should remain the case.
“We will not be altering our practice in any way.”
Dr. Ben Sessa:
It appears the two who are critical of Dr Mithoefer’s MDMA for PTSD Phase Two pilot study seem to have missed a number of important points. I feel it is necessary to correct them; as to leave their misinformed comments unchallenged would be unfair to the population of patients with PTSD who may benefit from this new approach. These patients deserve the opportunity to respond to this, or any other, novel approach to their disorder - whether it is superficially considered controversial or not.
Firstly, on that point, the fact that clinical MDMA has an (unhelpful) historical association with the recreational drug ecstasy is entirely irrelevant. MDMA is simply a medical tool - a pharmacological agent. The manner and context in which a drug is used on a patient means everything. Non-pharmacologists may not understand that.
So to presume that the medicine MDMA has no positive pharmacological potential simply because it presents a challenge to a dated socio-political agenda is bad science. If, as medical doctors, we were unable to do that then we would never treat pain with opiates or anxiety with benzodiazepines. So rule number one is: Clinical MDMA does NOT equal recreational ecstasy.
Secondly, this study by Mithoefer is a PILOT study. So yes, the numbers are small – just 20 patients. It is a pre-cursor to further studies - many of which are now underway. The Mithoefer results were very favourable indeed - with an 85% drop in CAPS scores in the experimental group compared to just 15% in the placebo group. That means 85% of the people who carried out the study no longer met the criteria for a diagnosis of PTSD at the end of the study.
Let’s not forget that MDMA-Assisted Psychotherapy is essentially psychotherapy. It is easy to get hung up on the drugs aspect of it – but what the course primarily consists of is a very involved and intense course of talking therapy – with three out of the 12-16 sessions boosted with MDMA – at a dose that is demonstrated to cause no side effects or toxicity problems.
The Mithoefers are about to publish their long-term follow-up study, which showed that up to four years later that 85% of the participants are STILL free of PTSD – with no further inputs with MDMA since their original intervention. And these are all patients whose PTSD was so severe that they had struggled for years – decades in some cases – with multiple traditional treatments until they entered the study and tried MDMA.
Those who know about treatment-resistant PTSD will know that Mithoefer’s pilot study is therefore very important indeed and certainly needs further examination and repetition in larger populations of patients.
Finally, the psychologists’ comments that “there are specific guidelines for the treatment of PTSD and we will not be altering our practice to include MDMA therapy” are puzzling. There are indeed treatment guidelines for PTSD and we clinicians follow them. But we also carry out research to explore whether new guidelines can be created. I support the psychologists’ suggestion to carry on with their current non-MDMA practice for now; as to veer from that and use MDMA would be illegal!
The studies looking at MDMA for PTSD are part of a long-term experimental research programme. Those of us involved in this exciting and very optimistic research are diligently carrying out all the appropriate testing and studies. We certainly have long-term plans to have MDMA Psychotherapy become part of the mainstream treatment for PTSD. If that happens we hope this new treatment can bring relief from suffering from tens of thousands of untreated cases PTSD in the UK. That population of patients are crying out for any new approach that can be shown to work safely and effectively to manage their disorder.
I am part of a planned study in the UK to look again at Mithoefer’s pilot study. I recognise the extreme treatment-resistance of PTSD and I am prepared to think outside the box. As a medical doctor and a psychopharmacologist I am not blinkered by pre-conceived politically motivated and unscientific agendas that tell us “if a drug is illegal it can’t part possibly be of clinical benefit”.
MDMA started its life in medicine before it was forced out of the clinics by an irritating association with recreational use. As clinicians we need to rise above such petty political agendas and look at the science. But this is a hard road to travel. I urge other scientific colleagues to rise above the knee-jerk popular media representation of this medicine and take time to truly explore the science. We owe that much to our patients.
Dr Ben Sessa
Consultant Psychiatrist and MDMA Researcher
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