On Monday at Hay Festival, the Government’s former Chief Scientific Adviser, Sir Patrick Vallance, suggested that MDMA should be seriously studied as a new treatment for depression. And the former chair of the Covid vaccine taskforce, Dame Kate Bingham, who was on the panel, agreed. They both pointed out how much more research on novel treatments for depression was required given the huge burden of depression in the UK today, learning from the success of organised investment in research that proved so successful in developing the Covid-19 vaccines.
This remarkable statement would come as a shock to most people who have been brought up on the knowledge that MDMA, when known as ecstasy, is a recreational social drug that underpinned the rise of rave scene in the 1980s. However, before that, MDMA was a popular and legal aid to therapy in the USA. Its ability to enhance positive feelings between couples who had fallen out of love was found to be a powerful tool in couples marital counselling.
This healing effect was the motive for Maps (the Multidisciplinary Association for Psychedelic Therapy) working for the past 30 years to get MDMA approved as a medicine by the US Food and Drug Administration. They have focussed on the more severe mental illness of PTSD where current treatments fail for a large proportion of patients and where wars in the Middle East have led to thousands of military veterans in a state of chronic unremitted trauma. Now with nearly one thousand patients treated in controlled trials with just two or three MDMA treatment sessions, the results are so promising that it seems almost certain that MDMA will be recognised as a medicine by the US regulators next year. This should mean that the UK could also approve it as a medicine in a year or so.
But MDMA has potential in other mental health problems too. For example, my group at Imperial College London recently conducted a small open study in people dependent on alcohol. They were all de-toxified and when abstinent from alcohol, were given two MDMA sessions a few weeks apart during their eight week abstinence-based psychotherapy course. Remarkably, most stayed abstinent or had levels of drinking within the recommended limits for the following nine months. In contrast, in a group of similar patients given just the same psychotherapeutic intervention, two-thirds relapsed to heavy drinking in the next three months. These results support the experience of many addiction specialists that a large fraction of people with alcohol dependence drink to escape their memories of trauma. Dealing with these issues can help them reframe their attitude to alcohol and so gain control their drinking.
But trauma doesn’t always lead to PTSD – in fact half of all the people who develop a mental health issue as a result of trauma become depressed. We don’t know why this is, though perhaps prior low mood predisposes to this outcome, as stress is a major factor in all forms of depression.
What we do know is that MDMA treatment for PTSD and also alcohol dependence improves mood – so it is plausible that it might work in people who are just depressed. In fact, in my clinical practice, as a specialist in the treatment of depression, I heard from a number of patients whose depression responded to MDMA when it hadn’t to conventional antidepressants.
Of course, because of the illegal status of MDMA I couldn’t recommend this approach, but I think it supports the rationale for developing a proper study. This will not be easy given the current position of MDMA as a Schedule 1 controlled drug, which adds a great deal of extra time and costs for research.
Just a couple of weeks ago there was a back-bench debate on the need to re-schedule MDMA and psilocybin, a psychedelic drug that has also shown efficacy in mental illnesses. There was cross-party agreement that such a change was urgently needed and a representative of the Home Office agreed to explore this. As about 450 people in the UK die by suicide each month, and the majority will either have depression or addiction, it is essential that they do so quickly.
David Nutt is a professor of neuropsychopharmacology at Imperial College London