Tag: MDMA

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MDMA and the Brain: Is Ecstasy Neurotoxic?

by Ruthie Poizner

MDMA, ecstasy, molly, E (Sharifimonfared & Hammersley, 2020) – no matter what it’s called, this popular club drug has found its way into our collective vocabulary. Ecstasy, which has been a mainstay on the party scene since the early 1990s, is now one of the most commonly used illegal drugs. In fact, over 18 million Americans have reported using MDMA at least once in their lifetime (SAMHSA, 2017). Since this drug has become so widespread, it is important from an individual and public health standpoint to understand both the short- and long-term effects of its use. This article will explore these issues, as well as providing resources for safer ecstasy consumption.

How Does MDMA Affect the Brain and Body?

People mostly use ecstasy because it can produce enjoyable short-term effects. MDMA stimulates the release of neurotransmitters like dopamine and serotonin, which can produce euphoric feelings such as heightening of the five senses and increased empathy (Mustafa et al., 2018). On the flip side, however, it can also cause insomnia, appetite loss, restlessness, jaw clenching, and in rare cases, overdose and death (Curran, 2000).

Ecstasy is generally not considered physically addictive, meaning that although people may crave the high, their bodies will not become dependent on the substance and experience painful withdrawals when they stop using it. For this reason, people rarely require psychological treatment for their use (Sharifimonfared & Hammersley, 2020). But does this mean we don’t have to worry about its long-term effects?

Although researchers have been studying ecstasy toxicity for years, some of the evidence is mixed (Mustafa et al., 2018). This issue is a bit confusing, but it may be more relevant now than ever: not only is MDMA a drug of choice for millions, it is also a potential medicine of the future. While notorious for its recreational use, MDMA was actually first studied as a treatment for psychological disorders (Müller et al., 2019). In recent years, researchers have been taking a second look at this possibility, and are specifically interested in whether it could be an effective treatment for post traumatic stress disorder (PTSD) (Mustafa et al., 2018). This makes it even more important to understand how this drug affects the brain and body. Though MDMA neurotoxicity studies aren’t perfect, they can still provide valuable insight into the possible risks of this drug and how they can be reduced. With that in mind, let’s take a look at what the research says and why these findings are so important.

What is Neurotoxicity?

Neurotoxicity describes a given substance’s harmful effects on the brain and the rest of the nervous system. This can include damage to nerves and neurons, which are responsible for communicating signals (messages) in the brain. Neurotoxins can be found in a variety of substances such as heavy metals, pesticides, and drugs. The severity of neurotoxicity depends on the substance and how it is consumed. There is a significant range in how these neurotoxins affect us, and how much they harm our bodies and functioning (Robertson, 2019).

Is MDMA Neurotoxic?

The short answer is yes, most research suggests that this drug is neurotoxic. MDMA is thought to cause damage to brain cells by disrupting the flow of neurotransmitters, the messengers that allow cells to communicate with one another. It also causes an overflow of free radicals: molecules with an unstable structure that eat away at cells. These molecules can kill brain cells by limiting the cell’s ability to produce energy. Although our bodies are built to flush out free radicals, ecstasy can overload the detoxification process, which puts a strain on the system (Mustafa et al., 2018). Free radicals are possibly linked to the development and/or worsening of a variety of diseases, such as cancer and Alzheimer’s (Halliwell, 2001).

Examining the Evidence

Most of the evidence on MDMA neurotoxicity comes from either animal studies or correlational research, which looks at whether there is an association between two variables. In animal studies, MDMA has consistently shown to be toxic to serotonin structures. This has been observed in every animal tested, and while some animals recover normal serotonin function over time, many suffer lasting effects (Curran, 2000). Additionally, correlational research has found associations between MDMA use and neurotoxicity in humans. This means that MDMA use can predict changes to the brain.

In most correlational studies, researchers use something called SERT (serotonin transporter) density to measure MDMA neurotoxicity. Serotonin is a neurotransmitter that plays a key role in mood regulation, and is often described as producing feelings of wellness and happiness. Studies have shown that ecstasy use can reduce SERT in many parts of the brain, such as the hippocampus and temporal lobe (both of which are associated with memory function) (Müller et al, 2019). There is also evidence that MDMA users have less 5-HT, a receptor that is responsible for binding to serotonin and receiving its signals. This decrease seems to be linked with the amount of MDMA use: in other words, the more MDMA a person has done, the fewer 5-HT receptors they seem to have (Curran, 2000).

What Does this Mean?

If MDMA is technically neurotoxic, does this mean it affects people’s thoughts, behaviour, and daily life? Some research, as described by Mustafa and colleagues (2018), suggests that people who have used ecstasy over long periods of time perform worse on memory tasks (Wunderli et al., 2017). It is also believed that ecstasy can negatively affect the working memory, the system that allows us to pay attention to and manipulate information before we commit it to our long-term memories. In a 2013 study, Potter, Downey, & Stough found that MDMA users performed significantly worse than non-drug users on spatial working memory tasks, which required them to remember visual information. The MDMA group averaged a score of 0.85, while the non-drug group averaged a score of 0.96. The MDMA group also had longer reaction times across tasks, averaging 302.47 milliseconds compared to 286.00 milliseconds in the non-drug group.

Psychological Impact

It is possible that these changes to the brain also have psychological consequences. Even though relatively few people require psychological treatment for their MDMA use, this does not necessarily represent a lack of impact on mental health. In a turn-of-the-millennium study on ecstasy users in the UK, researchers found that 83% reported midweek “low mood”, and 80% reported concentration or memory problems. which are often related to low mood (Curran, 2000). These changes in mood and functioning could be linked to serotonin toxicity, as well as damage to brain regions involved in key tasks such as learning and memory. Interestingly, Potter and colleagues found that the average depression level (as measured by the Beck Depression Inventory) was 13.35 in people who used MDMA, 7 points higher than that of non-drug users (2013). Although this difference was not large enough to be significant, it is still important to note since MDMA users commonly report low mood.

Is the Damage Permanent?

The good news is that the effects of MDMA neurotoxicity might be reversible over time. Researchers have found a link between SERT density and the length of abstinence, a period where the drug is not being used. This means that, without MDMA, serotonin and 5-HT levels may be restored in the brain (Müller et al., 2019), which in turn could possibly lead to improved mood and memory.

What Else Should We Know?

Although these studies share important findings about how MDMA interacts with the brain, there are limits to their design and how well their results can be applied to real life. Let’s explore some of these limitations:

  • Most researchers study heavy or long-term ecstasy use, but are unable to describe the long-term effects of the drug on people who use it occasionally and moderately. It’s currently believed that the more severe neurotoxic effects are linked to binges, which requires taking lots of ecstasy at once (Müller et al., 2019)
  • It’s extremely difficult to determine a cause-and-effect relationship between MDMA and neurotoxicity in the human brain, because there could be a variety of other factors that cause these changes. Human participants have unique and complicated lifestyle factors that can be difficult to control for in experiments. For example, many people who use ecstasy also use other recreational drugs that could be responsible for cell damage
  • The findings from animal studies do not necessarily apply directly to humans, since each animal’s brain functions differently
  • It is impossible to compare dosage between participants, since it’s unlikely they know the exact amount of ecstasy they have taken in their lifetime (Curran, 2000)
  • The drugs used in labs are very different from street drugs. Street ecstasy has developed a reputation for its impurity, since it is often cut with drugs like methamphetamine, cocaine, and bath salts (Curran, 2000). Sometimes it doesn’t contain any MDMA at all! This makes it even harder for people using the drug to get a sense of what they’re taking and how it might affect them in the short- and long-term

What Can I Do with This Information?

Like any recreational drug, there are significant risks to using MDMA. Neurotoxicity studies can help us understand how common and severe these risks are in the long run. Since MDMA may soon become legal as a treatment for PTSD, it is also helpful to learn more about how different types of use have different effects. Therapeutic MDMA would be used differently than recreational ecstasy (for example, doses would be small and given by a psychiatrist or doctor), so it is very unlikely that it would have concerning neurotoxic consequences (Müller et al., 2019).

If you do decide to use ecstasy, researchers Sharifimonfared and Hammersley (2020) have outlined some helpful harm reduction tips:

  • Stay informed about this drug and its effects- it is important that you are making an informed decision, and that you can create harm reduction strategies that best suit you. This can also help you prepare for unwanted side effects
  • Test your drugs- since ecstasy is often mixed with other substances, it’s important to ensure that you know what you’re putting into your body to prevent a bad trip or accidental overdose
  • Drink a healthy amount of water while using ecstasy- sweating will cause you to lose fluid, so it’s important to stay hydrated- but make sure not to overcompensate by drinking too much, as this is also dangerous
  • Don’t mix ecstasy with other drugs- this could increase the risk of a negative outcome
  • Don’t use too much at once, and don’t use the drug too often

In addition, websites such as www.rollsafe.org provide nonjudgmental advice that helps ecstasy users stay updated and educated. If you are struggling with ecstasy use, strategies such as tapering off the drug, making positive lifestyle changes, or seeking professional help may be useful. Helplines such as ConnexOntario (1-866-531-2600) and therapy providers such as the Centre for Addiction and Mental Health (https://www.camh.ca/) are valuable resources for individuals struggling with their own or a loved one’s drug use.

References

Business Tech. (2015). Ecstasy [Stock image]. Businesstech. https://businesstech.co.za/news/lifestyle/96707/96707/

Camh. https://www.camh.ca/

Canadian Centre on Substance Use and Addiction. https://ccsa.ca/addictions-treatment-helplines-canada

Center for Behavioral Health Statistics and Quality (2017). 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. 1-2889.

Curran, H. V. (2000). Is MDMA (‘ecstasy’) neurotoxic in humans? An overview of evidence and of methodological problems in research. Neuropsychobiology, 42(1), 34-41. 10.1159/000026668

Halliwell, B. (2001). Role of free radicals in the neurodegenerative diseases: therapeutic implications for antioxidant treatment. Drugs & Aging, 18(9), 685-716. 10.2165/00002512-200118090-00004

Müller, F., Brändle, R., Liechti, M. E., Borgwardt, S. (2019). Neuroimaging of chronic MDMA (“ecstasy”) effects: A meta-analysis. Neuroscience and Biobehavioral Reviews, 96, 10-20. https://doi.org/10.1016.j.neubiorev.2018.11.004

Mustafa, N. S., Bakar, N. H. A., Mohamad, N., Adnan, L. H. M., Fauzi, N. F. A., Thoarlim, A., Omar, S. H. S., Hamzah, M. S., Yusoff, Z., Jufir, M., Ahmad, R. (2020). MDMA and the brain: A short review of the role of neurotransmitters in neurotoxicity. Basic and Clinical Neuroscience, 11(4), 381-388. http://dx.doi.org/10.32598/bcn.9.10.485

Potter, A., Downey, L., Stough, C. (2013). Cognitive function in ecstasy naïve abstinent drug dependants and MDMA users. Current Drug Abuse Reviews, 6(1), 71-76. 10.2174/1874473711306010008

Robertson, S. (2019, September 16). What is neurotoxicity? News-Medical Life Sciences. https://www.news-medical.net/health/What-is-Neurotoxicity.aspx

Rollsafe.org. https://rollsafe.org/

Sharifimonfared, G., Hammersley, R. (2020). Harm reduction and quitting techniques used by heavy MDMA (ecstasy) users. Addiction Research & Theory, 28(3), 222-230. https://doi.org/10.1080/16066359.2019.1622684

Vectormine. (2018). Serotonin vector illustration [Stock image]. iStock. https://www.istockphoto.com/vector/serototin-vector-illustration-labeled-diagram-with-gut-brain-axis-and-cns-gm1053647528-281517929

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Destigmatizing MDMA-Assisted Therapy: Unlocking Why Legal PTSD Treatments Do Not Always Work

By: Victoria Donkin

Approximately 76% of individuals in Canada experience or witness a traumatic event in their lifetime.1 Of those individuals, approximately 10% will be diagnosed with posttraumatic stress disorder (PTSD).1 Individuals diagnosed with PTSD often avoid thoughts and feelings related to their trauma; however, despite this avoidance, the traumatic event is often re-experienced through nightmares, flashbacks, and intrusive recollections.5 This can be highly debilitating for the individual, impairing every day activities such as sleep and work and can lead to harmful coping strategies such as isolating oneself, addiction, and self-harming behaviours.2

Therefore, receiving treatment is critical! However, of the individuals that are able to receive treatment, only 32% of patients actually recover from their PTSD and demonstrate healthy functioning.3 4 5  Due to the low amounts of treatment success, researchers aim to identify new treatment methods to alleviate PTSD symptoms for individuals who do not respond well to traditional treatment. This includes the assistance of MDMA.

Infographic by Victoria Donkin, template from CANVA is licensed under a CC BY-NC-ND 2.0.

What are traditional treatments used to treat PTSD?

  1. Medication 

Although specific medication for PTSD does not exist, some psychologists recommend PTSD patients to take antidepressants to target certain mood symptoms associated with PTSD; however, this method of treatment shows low to modest effects in helping the overall disorder. Therefore, evidence-based psychotherapies are often the first-line of treatment.6

  1. Evidence Based Therapy (EBT) 

There are several evidence based treatment methods used to alleviate PTSD severity, predominantly: Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), Cognitive-Behavioural Conjoint Therapy (CBCT) and Prolonged Exposure Therapy (PE). 

Limitations to Current Treatment Methods 

Although the aforementioned treatments can be effective for many individuals with PTSD, the dropout rates from these treatments are fairly high, averaging to about 30% of patients. However, some patients may not even be able to obtain treatment due to high costs, inaccessibility, or stigmatization. Of the individuals able to obtain treatment, approximately 58%  still have diagnosable levels of PTSD after going through with their treatment.2 4 5  

Although many treatment options exist in treating PTSD, they often require a long-term commitment to attend multiple sessions, which can be financially costly, and difficult to maintain alongside family and work-related commitments. Additionally, to be able to engage in this healing process, patients need to be able to retrieve the emotions, thoughts, and memories central to their traumatic event; however, not all patients have the emotional ability to handle the distress that comes with treating PTSD. This distress can cause patients to resist treatment, distrust their clinician, or quit altogether. 7  

Therefore, clinicians have now begun to explore alternative treatment methods, such as MDMA assisted therapy, to help patients feel safe, open and trusting to the treatment process. 

The Mind on MDMA (Conner, 2020)

What is MDMA and how does it work? 

MDMA is a monoamine releaser that promotes the release of serotonin (stabilizes mood and feelings), dopamine (pleasure), noradrenaline (regulates arousal and vigilance), and oxytocin (encourages social-bonding and connection). Therefore, the bodily effects of MDMA allow patients to enter an “optimal arousal zone” where their distress and anxiety are mitigated, and they can better respond to therapy by feeling more open to trusting their therapist and partner if engaging in conjoint therapy.8

By including MDMA in psychotherapy treatment, patients can decrease their fear response without blocking their accessibility to trauma-related memories so that they can engage in the process of identifying their emotions and thoughts without feeling distressed by them. This is because MDMA has also shown to decrease activity in the fear processing system of our brain  (where PTSD individuals have increased levels), and an increase in areas responsible for processing information.8 However, it is essential to clarify that MDMA-assisted therapy is not for ALL patients with PTSD. It is ONLY recommended for those that are physically, emotionally, and mentally unable to process their trauma in regular treatment.6

MDMA-Assisted Therapy Session (MAPS Europe, n.d.)

How was MDMA introduced into the therapeutic setting? 

MDMA was combined with therapy starting from the 1970s, where psychotherapists acknowledged its ability to allow patients to have insight into their own problematic patterns, heightening their self-reflection. However, the euphoric, pro-social feelings that MDMA provides garnered traction as a recreational substance within night-club settings rather than a therapeutic one. This became problematic, as the drug itself can moderately increase body temperature and blood pressure, which, combined with other substances and the warm atmosphere of dance clubs, led to several heatstroke deaths. This contracted some concern leading to its criminalization in 1985. However, many physicians, clinicians, and researchers protested and testified in favour of using MDMA in a therapeutic setting, gaining special permission and regulation to use MDMA for research purposes within the last 15 years for clinical testing.9

What is MDMA assisted therapy? 

MDMA assisted therapy incorporates the substance “3,4- methylenedioxymethamphetamine” (also known as MDMA) into regular evidence-based psychotherapies.10  For example in CBCT there are 15 sessions in total that enable a traumatized individual and their close other to engage in cognitive work to address what thoughts are central to their trauma, and develop skills to communicate effectively with one another. 

When performing MDMA-assisted CBCT, two additional MDMA sessions are added to the original protocol. The protocol guidelines of MDMA assisted sessions are regulated broadly across all research.8 In these sessions participants are given 75 mg of MDMA, and are offered an option half-dose (37.5 mg) after 90 minutes of the first dose (the approximated time that the first-dose takes to display full effects) due to potential differences in substance tolerances. 

Participants are then seated in reclinable lounge chairs, where they are encouraged to spend time alternating from independent “inside” time (with headphones playing pre-selected music and eyeshades) and “outside” time where their headphones and eye shades are taken off and they converse with their partner and or therapists. The alternations between “inside” and “outside” time are six hours long. Their feelings of distress and blood pressure/temperature are checked to ensure safety during substance consumption. The participants then stay overnight during the night of the MDMA-assisted session, where they are checked on by a night assistant to ensure continuous safety. They then are debriefed and assigned out-of-session assignments by their two therapists, that continue to work on the skills taught in the CBCT sessions. The second MDMA session follows the same protocol, but participants are offered a choice between 75mg or 100mg to start, and once again, an additional half-dose after 90 minutes.11 

Patient During “Inside Time” (Horton, 2016)

Is MDMA safe to use alongside treatment?

MDMA-assisted therapy is carefully controlled and has been shown to be safe in the therapeutic setting. Particularly, because MDMA is typically only used in 2-3 sessions, health concerns are constantly monitored when taking the substance. Additionally, several studies have used drug screens after treatment to test whether the use of MDMA within a few sessions could cause dependence or recreational use outside of treatment. It was found that no participants used MDMA following treatment or during treatment. 8 12 13

How Has MDMA Shown To Be Successful in Treating PTSD? 

In a study by Mithoefer and colleagues (2013), 74% of the participants who underwent MDMA-assisted therapy demonstrated long-lasting relief of PTSD symptoms. 89% of the participants also had continued self-awareness and understanding post-treatment, 68% had increased emotional ability, and 58% of the participants had improved relationships with their close others. Mithoefer and colleagues (2018) continued their MDMA-assisted therapy research, examining veteran and first responder patients. 85% of the participants treated with 75 mg of MDMA no longer met PTSD diagnoses at the end of treatment. Two-thirds of those participants had continued remission after one full year.8

Of those participants, an individual identified as Lubecky provided his thoughts on how the therapy helped him. Lubecky expressed that his suicidal ideation disappeared after treatment, and his depression was now almost 70% gone, whereas his PTSD reduced by 50%. He states that he feels like a better father, son, and husband to his family. The treatment allowed him to function in his everyday life, enabling him to return to work. His goal post-treatment is that everyone with PTSD knows that this MDMA-assisted treatment is coming and that there is hope, and that others don’t get to the point that he was, where he wanted to take his own life.14

There are some barriers preventing wider use of assisted therapy:

If MDMA-assisted therapy is so beneficial, why is it not widely used? 

1.The criminalization of MDMA makes funding for research difficult, which can serve as a barrier to making MDMA-assisted therapy accessible!

2. Stigmatizing myths that perpetuate criminalization misinform the public on the effects of MDMA, further creating barriers to making this treatment widely available!

Common Misconceptions about MDMA

1. Researchers examining the effects of MDMA-assisted therapy are NOT attempting to pass MDMA as a sole PTSD medicinal treatment. If MDMA becomes approved for general clinical practice, it would not be something prescribed to patients to pick up independently at the pharmacy, it would be given to specialized clinics under supervision.8 Therefore it should always be referred to as MDMA-assisted therapy, as MDMA itself is not the treatment. 

2. MDMA is NOT “ecstasy” or “molly.” When MDMA-assisted therapy research entered mainstream media, individuals were using MDMA and ecstasy interchangeably. Street substances sold under the name ecstasy, molly, or even MDMA, often do not contain pure MDMA and are made from unknown and dangerous components. In research utilizing MDMA, a purified substance is used, where small to moderate doses are given. The doses given are scientifically measured to be of safe human consumption. Media suggesting that MDMA-assisted therapy utilizes ecstasy, undermines the success of these treatments, and makes it harder to decriminalize the substance for clinical use. 6

3. The use of MDMA in clinical settings does NOT cause substance-abuse post-treatment. Several studies utilizing drug-tests have examined if MDMA-assisted therapy enables other recreational drug use, and they have all shown that it does not. 8 12 13

BIPOC Representation (PTSD Health, 2020)

Limitations of MDMA-Assisted Therapy 

Much research has identified that trauma and PTSD disproportionately affect BIPOC individuals as well as low-income communities. However, these populations also demonstrate higher rates of comorbid substance use disorder with their PTSD diagnoses. Due to these dual disorders, it is unlikely that these populations were used in MDMA-assisted therapy research trials. Individuals with active-substance use disorders were excluded from research to date as the effects of MDMA causing addiction post-treatment had not been examined. However, by decriminalizing MDMA from clinical settings, more funding for research can be provided to better support marginalized communities through this treatment method. 15 16 17 18

Future Steps

1. Help legalize the use of MDMA in clinical settings to provide more accessibility to marginalized communities. Clinicians must advocate for this form of treatment and support novel research that demonstrates a significant alleviation of PTSD severity.

2. Train various forms of “therapists” to administer MDMA-assisted therapy to reach different communities. Different mental health practitioners such as social workers, psychotherapists, psychiatric nurses, clinical psychologists, and psychiatrists reach diverse populations with varying incomes. By training various professionals, more populations will be able to receive this treatment.  

3. Be vocal to local administrators and government representatives on the necessity of a diverse range of treatments! Having a “one treatment fits all” mentality actually worsens society’s mental health; by educating the public on different modes of treatment and how they benefit their target recipient, we can de-stigmatize treatment and mental illness! 

References

  1. Van Ameringen, M., Mancini, C., Patterson, B., & Boyle, M. H. (2008). Post‐traumatic stress disorder in Canada. CNS neuroscience & therapeutics, 14(3), 171-181.
  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
  1. Bisson, J. I., Cosgrove, S., Lewis, C., & Roberts, N. P. (2015). Post-traumatic stress disorder. Bmj, 351.
  1.  Cloitre, M. (2009). Effective psychotherapies for posttraumatic stress disorder: a review and critique. CNS spectrums, 14(1), 32-43.
  1. Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds.). (2010). Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies. Guilford Press.
  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
  1. Zepinic, V. (2015). Treatment resistant symptoms of complex PTSD caused by torture during war. Canadian Social Science, 11(9), 26-32.
  1. Lawrence, J. (2018). Like a hug from everyone who loves you- how MDMA could help patients with trauma. The Pharmaceutical Journal. Doi: 10.1211/PJ.2018.20205586
  1. Hutchison, C. A., & Bressi, S. K. (2018). MDMA-Assisted psychotherapy for posttraumatic stress disorder: Implications for social work practice and research. Clinical Social Work Journal, 1-10.
  1. Danforth, A. L., Struble, C. M., Yazar-Klosinski, B., & Grob, C. S. (2016). MDMA-assisted therapy: a new treatment model for social anxiety in autistic adults. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 64, 237-249.
  1. Wagner, A. C., Mithoefer, M. C., Mithoefer, A. T., & Monson, C. M. (2019). Combining cognitive-behavioral conjoint therapy for PTSD with 3, 4-methylenedioxymethamphetamine (MDMA): A case example. Journal of psychoactive drugs, 51(2), 166-173.
  1. Lawrence, J. (2021, February 12). ‘Like a hug from everyone who Loves you’ – How MDMA could help patients with trauma. https://pharmaceutical-journal.com/article/feature/like-a-hug-from-everyone-who-loves-you-how-mdma-could-help-patients-with-trauma. 
  2. Feduccia, A. A., Holland, J., & Mithoefer, M. C. (2018). Progress and promise for the MDMA drug development program. Psychopharmacology, 235(2), 561-571.
  1. Mithoefer, M. C., Mithoefer, A. T., Feduccia, A. A., Jerome, L., Wagner, M., Wymer, J.,… & Doblin, R. (2018). 3, 4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. The Lancet Psychiatry, 5(6), 486-497.
  1. Slopen, N., Shonkoff, J. P., Albert, M. A., Yoshikawa, H., Jacobs, A., Stoltz, R., & Williams, D. R. (2016). Racial disparities in child adversity in the US: Interactions with family immigration history and income. American journal of preventive medicine, 50(1), 47-56.
  1. Roberts, A. L., Gilman, S. E., Breslau, J., Breslau, N., & Koenen, K. C. (2011). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological medicine, 41(1), 71.
  1. McGuire, T. G., & Miranda, J. (2008). New evidence regarding racial and ethnic disparities in mental health: Policy implications. Health Affairs, 27(2), 393-403.
  1. Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2012). Physical health conditions associated with posttraumatic stress disorder in US older adults: results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of the American Geriatrics Society, 60(2), 296-303.

Image References

Conner, C. (2020). [The Mind on MDMA]. The New York Times. https://www.nytimes.com/2020/07/25/fashion/weddings/me-my-relationship-and-ptsd.html

Horton, A. (2016). [Patient During “Inside Time”]. Stars and Stripes. https://www.stripes.com/feel-good-drug-ecstasy-one-step-closer-to-approval-as-ptsd-treatment-1.445361

MAPS Europe. (n.d.). [MDMA-Assisted Therapy Session]. MAPS Europe. https://mapseurope.eu/

PTSD Health (2020). [BIPOC Representation]. Health Magazine. https://www.health.com/condition/ptsd/relationship-ptsd