A Skeptical Look at MDMA From a PTSD Expert

CLINICAL CONVERSATIONS

Investigational MDMA-assisted therapy for posttraumatic stress disorder (PTSD) will be evaluated by the US Food and Drug Administration (FDA) Advisory Committee Meeting tomorrow on June 4, 2024. However, some clinicians are skeptical about its potential. We spoke to David N. Osser, MD, an expert on PTSD, about his thoughts on this treatment.

PT: Investigational MDMA-assisted therapy for PTSD has the potential to make waves in psychiatry. As an expert in PTSD, are you excited by this potential development?

David Osser, MD: I lived through the previous era of excitement about psychedelics. When I was in medical school, classmates were using them and spacing out during boring classes. They were not better off after doing so. The research that was done was not impressive. All this has biased me to be skeptical about them. So I am not very excited.

PT: Would you as a clinician consider giving your patients MDMA?

Osser: I will not be giving any patients MDMA in the near term. I do work full time at a VA where I think it unlikely that it will be adopted any time soon. However, if it is I will educate myself about it and probably use it, but not eagerly. I would want to see patients have an adequate trial of prazosin, our most evidenced medication treatment for PTSD, before considering it.

PT: What do you think of the safety and efficacy of MDMA-assisted therapy?

Osser: The efficacy is extremely hard to determine when you cannot do adequate placebo-controlled studies. It is nearly impossible to devise a control that can result in a successfully blinded study of these substances which produce such obvious hallucinogenic effects. As for adverse effects, I lived through the era of seeing people in emergency rooms that had “bad trips.”I am not looking forward to seeing more of that. However, if the FDA, after considering the evidence, considers it worthy of approval I will take it more seriously—but not until then.

PT: Thank you!

Dr Osser is associate professor of psychiatry at Harvard Medical School and codirector, US Department of Veterans Affairs, National Bipolar Disorder Telehealth Program, in Brockton, Massachusetts. The author reports no conflicts of interest concerning the subject matter of this article.