Jennifer Jones, MD, knows about MDMA.
“There’s a local trial that I worked on,” said the psychiatrist and assistant professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. The Phase 3 trial, the final step in the pre-approval process, tested MDMA – a synthetic psychedelic also known as ecstasy and molly – as a treatment for people with post-traumatic stress disorder.
Yes, that means MDMA could be part of therapy for certain conditions in the not too distant future. “If all goes as planned, the Food and Drug Administration will review the results in late 2022 or early 2023. So yeah, exciting times with MDMA-based work,” Jones said.
Exciting times for the psychedelics field as a whole, too, from his perspective. Drugs banned decades ago are set to make a comeback, with research reframing them as potentially beneficial rather than a nuisance, when used in therapy sessions for hard-to-treat mental health conditions.
“There are several reasons for the renewed interest. First, culturally, people are more open, I think, to alternative treatments. And two, over the past 15 years, mental health has really had a renaissance in the way we talk about it among ourselves. It’s not entirely destigmatized, but it’s a lot less stigmatized than it was.
Jones said psychedelics were associated with the counterculture movement in the past, one of the key factors that led to laws against them. And concerns about psychedelics persist to this day. For example, the National Institute on Drug Abuse claims that MDMA was purchased on the street may contain other drugs that the buyer is not aware of, including methamphetamine, heroin and cocaine. The agency also claims that psychedelics may have negative side effects such as high heart rate, nausea, panic, paranoia and psychosis.
Jones is well aware of all this. “In uncontrolled environments, there can be a risk associated with the use of these substances. In a perfect world, individuals would only use these psychedelics in a highly supportive context. But this is not always the case. And there is potential for psychiatric harm, in theory, when used in unsupportive contexts or by people with certain medical or psychiatric conditions,” she said.
“It’s really important to note that they can be seen as catalysts for change, hopefully in a positive way. This change often comes through the therapy built into these treatments and making sure it is safe.
Jones said MDMA and psilocybin, the active compound found in so-called magic mushrooms, are the psychedelics that are getting the most attention from researchers, including some at MUSC. “We are still finalizing trial details for psilocybin and MDMA. I think this is something that we can safely say is in the works and will hopefully happen in 2023.”
Psychedelics are thought to affect serotonin receptors in the brain. Serotonin plays an important role in regulating mood, memory and perception. Jones said psychedelics can help people see things in a new way when combined with therapy.
“There are the effects of the compound, but really it’s more about what the compounds catalyze for someone. They take stock of different areas of their lives where things may not be optimal. One of the reasons I think we see such broad effects for psychedelics on so many different conditions is that it probably doesn’t speak as much to the underlying neurobiology as helping people in the context of therapy to understand what it is in their life in which they have to move forward. How should they change?
Jones became interested in the potential of psychedelics several years ago. “I did my residency at MUSC in psychiatry and internal medicine. And then I did a postdoctoral fellowship on “the road less traveled in research”. I was researching new therapies for PTSD and substance use disorders. And I was reading older literature from the 50s and 60s, with ketamine and psychedelics, and even then the data was very exciting.
Psychedelics have been around for thousands of years, according to the American Psychiatric Association. Indigenous peoples used them for healing and religious purposes. In the United States, the federal government funded over 100 clinical trials testing psychedelics as a treatment for a range of mental health conditions between the 1950s and 1970s until they were banned.
More recent research cited by the American Psychiatric Association found that MDMA “had a large effect size” for people with PTSD, and that psilocybin had “lasting and potent effects” in reducing depression. in clinical trials.
But in a Act of June 2022the association also noted that research on psychedelics is still at a relatively early stage. Jones’ work is no exception. The data is still being analyzed in the MDMA trial she mentioned. But the psychiatrist is encouraged to see psychedelic-assisted therapies, with their potential to help alleviate many hard-to-treat mental health issues, get a serious shake-up.
If they become approved treatments, they will join ketamine, which is already used in psychotherapy at MUSC Health’s Centerspace Clinic. What is the difference between substances? According to a report published in Psychology Today“ketamine works by relaxing the inhibitory architecture of the brain”, while “psychedelics work by neutralizing it”.
Jones put it this way. “I usually formulate this idea because while ketamine works primarily on a different type of neurotransmitter than MDMA and psilocybin, all of these compounds can have psychedelic effects, depending on the dose taken.”
She said she’s excited to see where research on psychedelics will go. “These therapies have been studied in many conditions, including depression, PTSD, obsessive-compulsive disorder, substance use disorders and anorexia, as well as for optimizing well-being. Seeing psychedelics in the context of helping people, which is what I love to do – helping people understand what part of their life they would like to progress to and helping them understand how to get there – that’s every clinician’s dream. .”