3,4-Methylene-dioxymethamphetamine (MDMA), is the active ingredient in the recreational drug ecstasy. MDMA acts by rapidly increasing the availability of extracellular 5-hydroxytryptamine (5-HT) also known as serotonin. Serotonin is a mono-amine neurotransmitter that is derived from tryptophan. Serotonin is especially important when considering the psychological health of a patient. This is because serotonin is believed to have a direct effect on mood, anxiety, psychosis, and cognition. In fact in individuals with serious levels of depression, selective serotonin re-uptake inhibitors (SSRIs) are commonly prescribed. These inhibitors help reduce the re-uptake of serotonin in the central nervous system and allows its affects to be amplified for longer periods of time. This amplification commonly reduces symptoms associated with depression and anxiety. Unfortunately, an SSRI typically takes about six weeks before any change in mood or anxiety may occur. This long delay time could mean the difference between a safely adjusted individual to an individual that is contemplating suicide or other life threatening actions.
It has been hypothesized that MDMA can possibly bypass this long adjustment time simply because it has such a rapid release of serotonin within the central nervous system. This article explored multiple positive and negative aspects regarding the implication and suggested therapeutic use of this class A controlled substance.
Most individuals would typically regard any content matter dealing with MDMA and ecstasy as negative. However, new research suggests that if used correctly and at lower controlled levels, MDMA can help significantly reduce the time for antidepressants to fully work on individuals with treatment-resistant depression (TRD). In fact a new trial regarding the treatment of post traumatic stress disorder (PTSD) with MDMA is already in clinical trial.
The ethical question regarding this imposed study is: should MDMA be used as a rapid-onset antidepressant? Honestly there is a lot of bad media regarding the recreational use of MDMA amongst young adults and the "party" scene. Most reports suggest an uncontrolled rate of incidences regarding injury and even death of those who have used MDMA. However, most of the reports are exaggerated and deaths only related to MDMA use are extremely rare. Additionally, most research studies previously reported extreme neurotixicity and long term neurological damage due to MDMA use has been proven to be incorrect or only true in regards to extremely high rates of use with uncontrolled dosage levels.
Ethically if the use of MDMA can be safely and easily administered to patients with PTSD or TRD, then we should be pushing for the use and developmental research of this drug. If used properly in the future and after much much more research, MDMA could potentially be used as a common antidepressant in medicine.
Patel, Rachel, and Daniel Titheradge. “MDMA for the Treatment of Mood Disorder: All Talk No Substance?” Therapeutic Advances in Psychopharmacology 5.3 (2015): 179–188. PMC. Web. 7 Nov. 2017.
Awesome post! Something I always think about when looking at how to regulate which drugs ought to be used as medications, in light of overcoming negative stigmas, is to compare it alongside the everyday choices we have the freedom to make. There are always going to be people that abuse the system, but to what end does that outweigh the benefit of approving a substance as therapeutic for patients when it could end up being life-saving? While most approved therapeutics won’t be void of side effects, similarly, recreational drugs such as MDMA and marijuana may also have their pit-falls, but not necessarily any more than what we currently prescribe. Being familiar with depression, I can definitely understand the importance of having a quick acting substance to ensure the safety of the individual. Along with ensuring the safety, as we’ve learned from TBL, chronic stress can have a variety of negative effects on the body and perhaps being able to have a quick turn-around during depressive or anxiety episodes might mitigate long-term physiological consequences induced by stress as well. This is definitely an area of research that needs to be further developed to move forward in considering this as a treatment.
ReplyDeleteAlthough the potential benefits of MDMA are certainly worth studying, it is important not to gloss over the potential side effects or note the lack of data. The mentioned article states that there is not yet great experimental evidence that MDMA can provide antidepressant effects; in fact, only a single rodent study has confirmed this acute effect of MDMA. In the other animal studies, there were some indications of long-term behavioral changes and possible anxious/depressed phenotypes. In self-reported human studies, the frequency of depression of MDMA users ranged from 4% to 55%. There were also indications that MDMA may actually have the opposite intended effect and may cause negative changes to long-term mood (possibly correlated to sleep loss).
ReplyDeleteAn interesting comparison was to the prior use of amphetamines as "rapid-onset antidepressants," which were later linked to high patterns of abuse. I'm not necessarily slamming the potential benefits of MDMA, which include increasing feelings of empathy due to the release of oxytocin. But it is worth noting that there has been a precedence set by using other drugs without large consideration of downstream effects. As we like to say in class- "more research is needed!"
When considering the ethics related to medical MDMA administration, I think both you and Alysha raise great points- the need for a fast-acting substance to assist in the treatment of depression and possibly suicidal ideation is needed. The study of MDMA's effects may be warranted in that regard. But as the article mentions, it is imperative to determine a safety profile and therapeutic index, which is a foreseeable difficulty.
Also, as Alysha mentioned, what makes these side effects greater or different than other drugs? I tried to do some research into the matter and what I found was varied and appeared biased at times. Some sources suggested that MDMA itself was not harmful, but could cause preventable but dangerous side effects such as dehydration (1), one study noted that MDMA-related fatalities were largely due to toxicity (2), a government agency noted that overdoses were rare but could have life-threatening side effects (3). I am interested to see where this area of study goes to in the future!
(1) MDMA-Related Deaths: Stop Calling Them Overdoses, https://dancesafe.org/mdma-related-deaths-stop-calling-them-overdoses/. https://dancesafe.org/mdma-related-deaths-stop-calling-them-overdoses/.
(2) Kaye, S. (2009) Methylenedioxymethamphetamine (MDMA)-related fatalities in Australia: Demographics, circumstances, toxicology and major organ pathology http://www.sciencedirect.com/science/article/pii/S0376871609002014
(3) NIH: MDMA Abuse. https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-are-effects-mdma