The medicinal benefits of psychedelics, including MDMA, are currently being explored by researchers from both UBC campuses.
In 2015, The Ubyssey first published an article introducing the potential use of MDMA, also known as ecstasy, to treat symptoms of posttraumatic stress disorder (PTSD). In the six years since, there has been increasing evidence showing the effectiveness of psychedelics in treating PTSD, including the work of Dr. Zach Walsh and his colleagues from the UBC Okanagan’s department of psychology.
‘A debilitating disorder'
PTSD is a condition characterized by symptoms that include intrusive memories and flashbacks, negative emotions, irritability and hyperreactivity which manifest following a traumatic experience, according to the government of Canada’s “Federal framework on posttraumatic stress disorder.” The document details that the diagnosis of PTSD requires symptoms that make it harder for the individual to function and be present for longer than one month.
According to the DSM-V, the gold standard for psychiatric diagnosis, PTSD can arise from both firsthand experiences of trauma, as well as indirect exposure.
With approximately 9.2% of Canadians predicted to suffer from PTSD in their lifetime, according to a 2008 nationally-representative study, a better understanding of this disorder has become a focal point for researchers.
Walsh emphasized the strain that PTSD can place on patients as well as those around them.
“Beyond PTSD, we know there's heightened risk of suicide, of relationship conflict, all the other things that go with PTSD. So it is something very important for society to treat not only for those who suffer but for their loved ones as well,” he said.
But despite this distress, treatment options for PTSD are limited.
Current treatments include cognitive reprocessing therapies, such as cognitive behavioural therapy (CBT), eye movement, desensitization and repressing (EDMR) therapy, and some selective serotonin reuptake inhibitors (SSRIs) that are generally used to treat depression, according to Walsh.
“The thing with PTSD is that, while there are some really effective behavioural treatments, there are still a lot of people who either can't access those or they try them and they don't work,” said Walsh. He also added that antidepressants “are not terribly effective.”
“So we need more treatment options for PTSD. And if we can add something that's going to help some folks, that's huge, because it's a difficult-to-treat, very debilitating disorder.”
A psychedelic promise
Walsh was involved in a 2019 study showing that psychotherapy, also known as talk therapy, administered alongside MDMA was more effective in reducing symptoms in patients suffering from treatment-resistant PTSD compared to psychotherapy administered with a placebo.
Further support for this treatment strategy has been provided by a 2021 article published in Nature Medicine which also tested MDMA-assisted psychotherapy in comparison to psychotherapy accompanied by placebo in patients with severe PTSD. According to Walsh, the success of this treatment is thought to be rooted in the patient reprocessing their trauma, which is needed for symptoms to “resolve.”
Psychotherapy often involves a form of exposure therapy in which patients revisit cues attached to the traumatic memory with the aim of removing the “conditioned fear” that is associated with it, according to a 2020 review from the International Journal of Neuropsychopharmacology. MDMA is believed to assist in this process by reducing fear responses in patients as they revisit their trauma. It is also important for therapists and patients to establish a relationship, which MDMA may contribute to by facilitating trust and increasing introspection.
Yet another theory, suggested in a 2021 article in Frontiers Neuroscience, is that psychedelics in general may induce a neurological state that makes the brain more malleable to external influences, which may allow psychotherapies to have a greater effect.
Although the mechanism by which MDMA might be working is not yet known, the research so far is showing encouraging results.
“The initial studies that we've done so far have been remarkably promising,” said Walsh.
A Centre for Clinical Excellence
One particular group that would benefit from the development of an additional treatment option for PTSD includes veterans and first responders who, by nature of their profession, can be exposed to highly traumatic events. According to the government of Canada, an estimated ten per cent of war zone veterans will suffer from PTSD. Similarly, research has shown that first-responders are at a higher risk of developing PTSD, with one 2005 study from the British Journal of Clinical Psychology revealing that up to 22 per cent of paramedics will suffer from the disorder.
A project that aims to facilitate further research into PTSD treatment, in addition to the physical disabilities widely suffered by this population, is the Legion Veterans Village (LVV) and its Centre for Clinical Excellence.
According to Rowena Rizzotti, the project lead of LVV, the purpose of the project is “to bring together the consortium of researchers, scientists and clinicians that were particularly interested in how we best support veterans and first responders and their families relative to mental health, relative to PTSD, but also into innovative interventions relative to their physical rehabilitation.”
To explore additional treatment options for PTSD, LVV is working with the Knowde Group, a multinational contract research organization specializing in investigating the potential uses of plant-based therapeutics, which includes psychedelics.
Jaspreet Grewal, cofounder and CEO of Knowde Group, explained that Knowde Group “view[s] psychedelics as another investigational product that [they’re] looking to investigate through phase one through phase three clinical trials.”
Amongst the LVV Centre for Clinical Excellence’s Leadership Team is Dr. Ashok Krishnamoorthy, a clinical associate professor in psychiatry at UBC.
When asked about the barriers that veterans face in accessing treatment for PTSD, Krishnamoorthy mentioned that the main barrier has to do with issues surrounding access, such as long wait times, not enough outreach to screen for PTSD or educate the population to recognize PTSD symptoms and stigma surrounding mental illnesses.
Krishnamoorthy also noted the difficulties in treating PTSD, especially chronic PTSD, as it can be accompanied by “some other comorbid issues like mental depression, risk of suicide, substance use disorders [and] cognitive problems.”
Regarding the use of psychedelics, Krishnamoorthy commented on the need for further research. “Some of the studies are showing some exciting results. But it needs to be replicated, it needs to be replicated enough. And that's where the Centre for Research and Clinical Excellence come into play.”
“It needs to be replicated with good, quality research with adequate power and number of patients and also sustainability of that effect and benefit, but definitely it looks promising in terms of filling in a particular gap in the PTSD treatment.”
A conditional acceptance
Although research so far has been showing promising results, psychedelics might not be suitable for all PTSD patients.
The 2019 study from Walsh and colleagues on MDMA-assisted therapy reported side effects of MDMA use including dizziness, jaw clenching, nausea and loss of appetite. Psychedelics are also highly psychoactive substances, which may lead to accidents if not utilized properly.
However, according to Walsh, if used under proper supervision in the clinical setting, psychedelics should be safe to use therapeutically. “From a toxicity perspective, they’re incredibly safe, so it’s very difficult to overdose,” he said.
In addition, there is a low potential for abuse, unlike many other drugs used recreationally.
“In terms of clinical application, the risks are quite small; the worst is that it's unpleasant. And then people come out the other side, you know, pretty much unscathed is my experience,” said Walsh.
“Again, it's not something where we've got adequate treatment. So that's why it's so exciting when there's a new opportunity.”