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MDMA-assisted Psychotherapy for Adults with Autism

MDMA, also commonly known as ecstasy or molly, is a drug that creates feelings of social affiliation, increases social approach, and decreases social rejection. Compared to MDMA for recreational use, medical MDMA releases mainly serotonin and norepinephrine and less dopamine which are neurotransmitters that have calming effects. MDMA also induces release of the neurohormone oxytocin which is connected to social affiliation and reduces the response to anxiety stimuli.

In previous studies, MDMA has shown positive effects in conjunction with psychotherapy for treating patients with posttraumatic stress disorder (PTSD). These results paved way for new studies on MDMA for treating people with ASD with a focus on Social Anxiety Disorder (SAD) which overlaps many symptoms of autism. SAD is categorized as a fear of scrutiny and avoidance of social interaction which is extremely prevalent in the autistic community as they are at a much higher risk of developing it. Due to the lack of effective therapeutic approaches and psychiatric medications for treating anxiety in individuals with autism, Alicia Danforth and Charles Grob conducted a randomized, double-blind, and placebo-controlled study on the effects of MDMA-assisted psychotherapy in reducing social anxiety in autistic adults.

In this clinical trial, there were 12 participants who all had severe social anxiety with a Leibowitz Social Anxiety Scale (LSAS) score greater than 60 which is an interview aimed at evaluating the severity of social anxiety symptoms. The participants were randomly assigned into either the MDMA or inactive placebo group. Each participant received a total of 9 non-drug preparatory psychotherapy sessions lasting 60-90 minutes and two blinded experimental sessions of either MDMA or placebo given one month apart. The results were evaluated using LSAS and it showed that the reduction in LSAS score from the primary evaluation to the endpoint was significantly bigger in the MDMA group compared to placebo group. These results were also similar in the 6-month follow-up where the decline in LSAS scores was bigger in the MDMA group. However, from the primary endpoint to the 6-month follow-up, there were minimal reductions in the scores. Further, the participant self-reported an increase in confidence in social settings such as school or work, reduction in barriers to social interactions, and increase in comfort with self-expression and social interactions which reflect the decrease in LSAS scores.

Additionally, safety, being one of the biggest concerns with using MDMA, was carefully monitored throughout the whole treatment process. The commonly reported problems by the participants were mild to moderate with no severe cases. These include anxiety, difficulty concentrating, fatigue, and headache. In addition to these problems, there were reports of depressed mood and suicidal ideation which were also mild to moderate. Although, the suicidal ideation could also have stemmed from previous medical history of depression and suicidal behavior.

Overall, this clinical trial shows that MDMA-assisted psychotherapy has promising effects on improving anxiety and social functioning in autistic adults. This is especially important for the people with ASD that suffer from severe problems with social interactions and anxiety because currently, there are little effective treatments for these symptoms. However, even though there were no severe psychological or physical health problems, individuals with autism considering this treatment option should proceed with caution because each person’s response can be different. Additional clinical trials should be completed with a larger sample of participants with ASD and SAD to determine whether these results can be generalized to the ASD community.

Danforth, Alicia L et al. “Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study.” Psychopharmacology vol. 235,11 (2018): 3137-3148. doi:10.1007/s00213-018-5010-9

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