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Most promising PTSD treatment may use ‘ecstasy’ or ‘magic mushrooms’ alongside psychotherapy
Post-COVID trauma and the war in Ukraine means that millions of people
are suffering or are at an increased risk of developing an ‘epidemic’
of post-traumatic stress (PTSD). Now a new review suggests that
combining established psychotherapy methods with newer
pharmaceuticals may offer the best therapeutic approach to deal with
the large-scale problems faced by the healthcare systems in different
countries in coping with mass trauma. Psychedelic medications
including MDMA (‘ecstasy’) and psilocybin (‘magic mushrooms’) show
the greatest promise. This work is published in the August edition of
the peer-reviewed journal European
The study is the first to review the use of novel treatments
alongside already accepted psychotherapy and psychological
counselling. It shows that combining these therapies seem to offer
the best hope for treatment, particularly in cases of mass trauma
where there are limited resources, such as we are seeing at present.
The most prominent effect of trauma is PTSD, which is a persistent
and severely distressing neuropsychological condition triggered by
witnessing or experiencing a traumatic event. Symptoms include
intrusive memories, recurrent nightmares, avoidance, mood swings, and
changes in physical and emotional reactions.
Lead author Dr. Xenia Gonda (Semmelweis University, Budapest,
still the first choice for PTSD treatment. There is no effective
established pharmacological treatment specifically for PTSD. However,
psychotherapies may have a limited availability, are very lengthy and
expensive. In addition, there are several different psychotherapeutic
methods and only very few evidence-based interventions.
We are beginning to
see new approaches to PTSD treatment, which combines psychotherapy
and medication. Both the psychotherapy and the drug treatment have an
effect independently, but they often work together synergistically.
There are several such drugs in development, but our review
shows that newer psychedelic drugs seem to be the stand-out
candidates in this treatment. It’s important to say that it’s not the
psychedelic nature of the drugs that seem to have the beneficial
effect in PTSD, these drugs seem to work, at least in part, by
enhancing the actions of psychotherapy at a neurological level”.
There are several
treatments in development for use alongside psychotherapy in treating
PTSD. The most promising drugs are psychedelics, such as MDMA
(3,4-methylenedioxy-methamphetamine, commonly known as ‘ecstasy’, and
psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine, commonly known as
‘magic mushroom’). The review found that MDMA-assisted psychotherapy
showed the greatest promise so far, with 4 trials showing
significantly superior outcomes to those experience by patients
receiving only psychotherapy. Trials on the use of psilocybin, found
naturally in certain mushrooms, also show promise, though additional
data are still needed to validate the therapeutic benefits of
psilocybin in the treatment of PTSD”.
Commenting, Dr Santiago Madero (Hospital Clinic, Barcelona)
article comes at a moment where President Biden’s administration has
said they anticipate regulators approving MDMA within the next two
years for designated breakthrough therapies for PTSD, surely to be
followed by the European regulatory agencies. If this is so, as the
author states: “MDMA may revolutionize the treatment of PTSD and may
provide much needed novel pharmacotherapy that provide therapeutic
benefits beyond all current and existing pharmacotherapies”.
This is an independent comment, Dr Madero was not involved in this
The paper Invisible
wounds: Suturing the gap between the neurobiology, conventional and
emerging therapies for posttraumatic stress disorder
(authors Xenia Gonda, Peter Döme, Berta Erdelyi-Hamza, Sandor Krause
and Livia Priyanka Elek from Semmelweis University in Budapest,
Hungary; Samata Sharma and Frank Tarazi from Harvard Medical
School in Boston, USA), is published in European Neuropsychopharmacology.
The paper can be seen at: https://www.sciencedirect.com/science/article/abs/pii/S0924977X22002103
Neuropsychopharmacology is an official journal of the
European College of Neuropsychopharmacology (ECNP).