- Dr. Samuli Kangaslampi. MDMA-Assisted Psychotherapy for PTSD in Adolescents? Rationale, Potential, Risks, Considerations. INSIGHT 2023. 01/09/2023 11:30-12:00.
Translated from the original Italian version.
The approval of MDMA-assisted therapy (MDMA-AP) for the treatment of post-traumatic stress disorder in adults seems imminent. However, a crucial issue that emerges is the extension of this therapy to adolescents, aged between 15 and 17 years. PTSD among adolescents is a significant problem, with millions of young people battling the debilitating symptoms of this condition. Treatments such as cognitive-behavioural therapy and EMDR (Eye Movement Desensitisation and Reprocessing), which have been shown to be effective for adults, are not always suitable for the specific needs of adolescents. Adolescence is a crucial phase of development, characterised by unique challenges related to identity, independence and social relationships, and these factors can complicate the treatment of PTSD.
The potential risks of this innovative therapy and the considerations involved in applying and adapting MDMA-AP to adolescents with PTSD were discussed by Dr. Samuli Kangaslampi at INSIGHT 2023, during the session 'MDMA-Assisted Psychotherapy for PTSD in Adolescents? Rationale, Potential, Risks, Considerations'.
MDMA therapy is emerging as a potential revolutionary treatment for PTSD. In contrast to its recreational use, MDMA assisted therapy involves the controlled and supervised intake of the substance in a therapeutic environment. MDMA (3,4-methylenedioxymethamphetamine) is an amphetamine analogue with stimulant and hallucinogenic effects. MDMA acts mainly on neurons that produce and release serotonin, but it also acts on dopaminergic neurons. MDMA for recreational use is usually taken in pill form; the effects begin 30 to 60 minutes after ingestion and typically last 4-6 hours.
The effects of MDMA include reduced anxiety, decreased reactivity to stress, and increased confidence and empathy. These effects could be particularly beneficial for adolescents suffering from PTSD.
One of the critical aspects of MDMA therapy is the ability to reduce avoidance of traumatic input (the avoidance of thoughts, feelings, conversations, activities, places or people that evoke memories of the trauma). Many people with PTSD try to avoid painful memories and situations associated with their trauma, but this behaviour can hinder the healing process. MDMA may allow them to deal with the traumatic input in a more direct and less distressing way, paving the way for deeper healing.
In addition, MDMA therapy could greatly enhance the therapeutic alliance, a crucial element in any treatment for PTSD. Adolescents, particularly those with early trauma or experiences of betrayal, may have difficulty trusting therapists and establishing an emotional connection with them. MDMA may facilitate the creation of a stronger therapeutic relationship by increasing empathy and trust between patient and therapist.
Another potential benefit of MDMA therapy is its ability to reduce anxiety and emotional resistance. This is particularly important for young patients with PTSD, who often experience intense anxiety and fear in relation to their trauma. MDMA therapy may enable them to explore traumatic memories more safely and openly, paving the way for greater understanding and healing.
However, there are important ethical and safety issues to consider when it comes to administering MDMA to adolescents. For instance, the long-term effects of MDMA on the developing brain are not yet well understood, and there are concerns about the possibility of abuse of the substance. It is crucial to conduct rigorous clinical trials to evaluate the safety and efficacy of MDMA therapy in young patients.
Another important aspect to consider is the temporary nature of MDMA's effects. Unlike long-acting psychotropic drugs, MDMA has a short-term impact on the central nervous system. This may be an advantage in that young patients do not have to worry about the long-term side effects associated with many other drugs.
However, it also means that MDMA therapy requires multiple sessions during the course of treatment. This may offer therapists more opportunities to work with patients and address trauma in depth.
MDMA therapy can be seen as a complementary approach to existing treatments for PTSD in adolescents. While cognitive-behavioural therapy and other traditional therapies are often effective, MDMA therapy could offer a different and potentially deeper way of dealing with trauma.
However, there are risks and concerns related to the use of MDMA and MDMA-AP specifically in adolescents, and these require careful evaluation. Dr. Samuli Kangaslampi mentions acute physiological risks, such as changes in heart rate and blood pressure, but emphasises that these can be managed with careful planning and rigorous patient selection.
In addition, Dr. Samuli Kangaslampi highlights the challenges related to the high emotionality of adolescents, their limited ability to regulate emotions, and the increased tendency towards risky and impulsive behaviour. To address these challenges, she suggests drawing inspiration from existing trauma-focused treatments for adolescents, including TF-CBT, PE-A and KidNET, in designing the psychotherapeutic component of MDMA-AP for use with this age group.
Dr. Samuli Kangaslampi emphasises the importance of conducting measured studies with high ethical standards to evaluate the safety, feasibility and efficacy of MDMA-AP among adolescents. Such an approach is preferable to off-label use or extrapolation of results from studies conducted in adults. This rigorous research is essential to ensure that traumatised adolescents receive the care they need while protecting their health and well-being.
In conclusion, the possibility of extending MDMA-assisted therapy to adolescents is a topic of increasing relevance. While this option offers significant opportunities for the treatment of adolescent PTSD, it is crucial to carefully evaluate the specific risks and challenges associated with the application of this therapy in this age group. Future research, implemented with rigour and attention to ethical standards, will be crucial to determine whether MDMA-AP can indeed offer an effective and safe solution for traumatised adolescents who need it.