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Study asks if ecstasy can help trauma patients get more from therapy

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Something was broken in Nachum Patschenik after his father abused him as a child. "It's a kind of death in your life. You breathe in and out, but you're not living your life - for years," says Patschenik, now 47 years old, in a cafe in Jerusalem.

He became fearful, ashamed; he would go out of his way to avoid people; he lost his will to live and developed post-traumatic stress disorder (PTSD). Psychotherapy didn't help the father of four - until he took part in a therapy study involving the use of MDMA in 2014.

MDMA, also known as ecstasy or molly, is a synthetic psychoactive drug. Studies have shown that MDMA can improve the therapy process for people suffering from PTSD, according to the US-based Multidisciplinary Association for Psychedelic Studies (MAPS).

This could be because MDMA has been shown to reduce anxiety and defensiveness, improve communication and introspection, and increase compassion, says MAPS.

PTSD can be triggered by wartime experiences, sexual abuse, kidnappings or assault. Its symptoms include sleep disturbances, poor concentration, nightmares or feelings of guilt and shame.

A US study published in The Lancet Psychiatry in 2018 showed that psychotherapy combined with MDMA can help patients with PTSD.

The study involved 26 patients, mainly veterans and firefighters. They were given the drug in two to three therapy sessions. Twelve months after their therapy was complete, 16 of the 26 patients no longer met the criteria for PTSD.

An analysis of five other su\ch studies published in the journal Psychopharmacology in 2019 confirmed these results.

However, the studies still need to test the safety of such therapy. Some of the participants experienced anxiety, fatigue, headaches and sleeping problems. Whether it can become a normal part of psychiatric treatment is still unknown; hence the goal of MAPS' phase-three study, involving some 300 patients, which is aimed at obtaining official approval for the procedure in the United States in 2021.

Psychologist Keren Zarfati is responsible for the MAPS study in Israel. Since the beginning of 2019, there have been 14 participants in the Israeli phase-three study, says Zarfati. Each one has a total of 15 sessions, always with a male and female therapist. In three of the sessions, the patients receive an MDMA pill - or a placebo.

The effects of MDMA last for roughly eight hours, during which the two therapists remain with the patient and work with him or her. In total, the patients are under constant observation at the hospital for 24 hours during these sessions, with their blood pressure and temperature measured, among other statistics.

"MDMA creates a pathway," says Zarfati. "The first thing the MDMA allows the patients to do is to come in contact with their trauma, in a controlled manner." Normally PTSD patients can't face their experiences - "it's too much for them," according to Zarfati.

MDMA increases dopamine and serotonin levels, the chemicals that make people feel secure and loved. But Zarfati adds: "MDMA doesn't do the work. The client has to do the work along with the therapist."

For some participants, according to MAPS, the MDMA has had negative effects. Some patients have suffered from nausea, fatigue or elevated body temperature. But: "We didn't have any serious incidents in the phase-two trial. It seems like a very safe treatment," Zarfati confirms.

The purchase, trade and production of MDMA is prohibited in Israel. But the Health Ministry is also testing the therapy concept, and in view of the demand, working on a pilot project with 50 participants.

Bella Ben Gerschon, the ministry psychotherapist responsible for the project, predicts that it will start next year. At the moment, the focus is on training the therapists and attracting funding.

She adds that despite Israel's many veterans, there's not a higher number of PTSD patients in the population than in any other country.

Experts beyond the countries taking part have also expressed an interest in the combination therapy. "I believe that the approach is promising, but we don't know enough yet about which patients in particular [it works for]," says Ingo Schaefer, head of the trauma unit at the university hospital in northern Germany's Hamburg-Eppendorf.

"We're always happy to see every potentially helpful approach, especially with illnesses with a high tendency of being chronic."

Patschenik says that he no longer has PTSD these days and that his life has fundamentally changed since his therapy experience with MDMA. "Afterwards I said to myself: OK, from today on I know that my feelings are not as dangerous as I thought they were. Now I can mourn what happened, that I lost my father at that point. It's a way of letting go of the past."