Introduction

Post-traumatic stress disorder (PTSD) is a severe mental health disorder that occurs after experiencing single or repeated extreme traumatic events [1]. PTSD is characterized by a combination of hyperarousal symptoms (hypervigilance, anxiety, and sleep disturbance), disturbing re-experiencing of traumatic experiences (intrusive memories, nightmares, or flashbacks), and avoidance symptoms (emotional numbing and withdrawal). PTSD patients exhibit a significant impact on cognition and emotional processing, leading to a decline in the functions of daily living and interpersonal and social relationships [2].

The current treatment for PTSD is either pharmacological or psychotherapy based on the patient’s preference, and, to date, there are only two approved FDA medications for PTSD treatment [3].

Some patients respond effectively to PTSD treatment and experience a reduction in symptoms; however, according to several studies, 40–60% of patients do not respond to treatment adequately [4,5]. Research for effective treatment has been underway for many years to reinforce exposure-based therapy and various other psychotherapies [2].

One such pharmacological drug, 3,4-methylenedioxymethamphetamine (MDMA), has shown promising results in treatment-resistant PTSD. According to a study by Mithoefer et al. [6], even 3.5 years after undergoing an MDMA-assisted psychotherapy trial, patients showed a long-term durability reduction in PTSD [1]. MDMA-assisted psychotherapy is designated as a “breakthrough therapy of treatment-resistant PTSD” [7].

In this brief narrative review article, we discuss what PTSD is and what the current treatments are, with a particular focus on the most effective psychotherapies. Additionally, after discussing the history of MDMA, its mechanism of action, and pharmacokinetics of MDMA, we evaluate the studies on the efficacy of MDMA-assisted psychotherapy in PTSD.

Conclusions from Report

The MDMA-assisted psychotherapy trial has had long-term durability for the reduction of symptoms in PTSD. MDMA-assisted psychotherapy is designated as a breakthrough therapy of treatment-resistant PTSD. The therapeutic alliance between the patients and the therapists is essential to establishing a holistic client-centered therapy that is the key to obtaining the desired effects of MDMA-assisted psychotherapy for both patients and clinicians.

However, the use of MDMA is now restricted because of its high risk of abuse potential and side effects. Therefore, the clinician should always weigh the risks vs. benefits of treatment. However, MDMA-assisted psychotherapy, if available, must be considered for treatment-resistant PTSD, but it can even exacerbate some other mental health disorders, so it should be used cautiously. Currently, MDMA-based psychotherapies are randomized controlled trials monitored by the FDA and overseen by the IRB.