Six Month Follow up of one of the First Patients to Complete MDMA-Assisted Therapy for PTSD Outside of Clinical Trials in Australia: Implications for Translating Clinical Research to Clinical Practice

Abstract

Purpose: The goal of this case report is to illustrate the implementation of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for posttraumatic stress disorder (PTSD) and learning points for health professionals in the translation of psychedelic assisted therapy research into clinical practice. We present our key learnings and 6-month follow up data from one of the first patients to complete MDMA-assisted therapy for PTSD outside of clinical trials, in an Australian outpatient clinic setting.

Methodology: The patient described in this case report had chronic PTSD, depression and anxiety due to experiencing domestic violence, including sexual, physical, and psychological abuse in her adolescence. Treatment was informed by the Multidisciplinary Association of Psychedelic Studies (MAPS) MDMA-assisted therapy manual. After completing treatment, she enrolled in our weekly integration peer support group, including meditation workshops and family support sessions. Data was gathered using the Australian National University (ANU) Psychedelic-assisted therapy Australian national outcome database (https://medicine-psychology.anu.edu.au/research/research-projects/australian-interventional-pharmacotherapy-psychedelic-assisted-psychotherapy), which collates de-identified questionnaire data and outcomes from MDMA, psilocybin and ketamine assisted psychotherapy. Outcome data was gathered at baseline, the beginning of preparation, in the week after each dosing session, at the end of the program. Follow up data is collected at 3-, 6-, 9- and 12-months post-treatment. At the time of writing, she had completed 3 and 6 month follow up. Tables and figures are used to present the outcome data.

Findings: Our patient no longer met DSM-V criteria for PTSD or major depressive disorder at the end of treatment, and at 6-month follow up. Her Impact of Events Scale – Revised (IES-R) score was 61 at intake, reduced to 0 after the second dosing session and remained 0 at 3 and 6-months follow up. There were no adverse events, with the only side effect reported being loss of appetite in the first 24 hours after each dosing session. All scores on depression and anxiety measures reduced to the normal ranges after the second dosing session and remained in the normal ranges at her six month follow up. After the second dosing session reported having greater self-compassion and being less troubled by the trauma memories. After the third dosing session, she began to feel comfortable leaving her children with their father or trusted family member to run errands for the first time, and an increased sense of connectedness with herself and with others. All these gains were maintained at three- and six-months post-treatment, illustrating a case of safe and effective implementation of MDMA-assisted therapy for PTSD in an outpatient mental health service.

Unique Contribution to Theory, Practice and Policy: Our case study offers one model of clinical practice, contributing to Australian practitioner’s implementation of safe and effective MDMA-assisted therapy in mental health services. We reflect on learning points for practitioners such as whether MDMA or psilocybin would be the most effective treatment, for a patient with both PTSD and treatment resistant depression. Recommendations for practitioners include the importance of working in a dyad, accessing ongoing supervision in the early stages of implementation, and the benefits of the having had legal experience with psychedelic medicines as part of therapist training.