MDMA-assisted therapy could improve neurorehabilitation of injured service members beyond PTSD

A UCLA Health analysis of MDMA-assisted therapy research suggests that the drug could improve outcomes of treatment for a wider range of trauma-related conditions experienced by military personnel beyond the current focus on post-traumatic stress disorder by increasing a collaborative and trusting relationship between a client and therapist.

The review paper, authored by UCLA Health assistant clinical professor of psychiatry Walter Dunn and published in the journal NeuroRehabilitation, explains that even in the absence of PTSD, military service members who have sustained a neurological injury in training or combat, such as a traumatic brain injury, can experience emotional and cognitive challenges that can complicate their treatment and recovery.

Dunn, a U.S. Marine Corps veteran and staff psychiatrist at the Veterans Affairs Greater Los Angeles Healthcare System, said the abrupt transition, especially for young, healthy service members, from the rigorous demands of military service to facing the possibility of medical discharge can lead to feelings of isolation, self-doubt and other emotions that can interfere with the neurorehabilitation process.

Clinical trials of MDMA-assisted therapy in treating patients with PTSD suggest it may improve their ability to tolerate treatment and reduce dropout rates, Dunn said. The results from these trials and other studies among healthy populations suggest the drug's effects in facilitating social connections, improved self-esteem and increased neural and behavioral plasticity could also benefit service members undergoing neurorehabilitation for other conditions and injuries, Dunn said.

"These are service members who are in peak physical condition and they suddenly suffer a catastrophic injury, one that could dramatically change the course of their life," Dunn said. "MDMA-assisted therapy could be very helpful in this context.

Namely, Dunn said the drug's effects could improve the relationship and trust between therapist and patient through its amplification of social reward in doses of 75 milligrams to 125 milligrams. No studies have directly investigated MDMA's effects on therapeutic alliance in the context of neurorehabilitation. MDMA may also work to counter the impacts of low self-esteem that lead to emotional dysfunction and poor coping strategies.

Dunn also cites a need for more study on MDMA's effects on neuroplasticity - which is the brain's ability to adapt and change - in humans. Mouse studies cited in the review found MDMA reduced anxiety behavior, improved working memory and social reward learning through neuroplastic mechanisms.

The review paper was published following the decision by the U.S. Federal Drug Administration in August to reject an application for the use of MDMA-assisted therapy to treat PTSD. The U.S. Drug Enforcement Agency classifies MDMA as a Schedule I narcotic, which is considered to be a drug that has "no currently accepted medical use and a high potential for abuse."

Dunn served as a member of the FDA's independent advisory board that reviewed the application for MDMA-assisted therapy for PTSD. Dunn was the only member who voted in favor of recommending approval of the application based on both safety and efficacy.

"By its very nature, military service involves exposure to stressful and adverse experiences," Dunn said. "It is an inherently dangerous profession. This reality highlights the critical need for a sustained commitment to developing new treatments to support those who serve in the armed forces."