← Huberman Lab

The Science of MDMA & Its Therapeutic Uses: Benefits & Risks

Episode 128 Jun 12, 2023 2h 13m 13 insights
In this episode, I discuss Methyl​enedioxy​methamphetamine (MDMA), which is also commonly known as “ecstasy” or “molly,” including how it works in the brain to cause short- and long- term-shifts in emotional processing and its clinical applications for the treatment of post-traumatic stress disorder (PTSD), alcohol and other substance-use addictions. I discuss the neuronal mechanisms for how MDMA elevates mood, empathy, motivation, social engagement, and reduces “threat detection” and how these effects can synergistically support talk therapy. I also explain the ongoing debate about the potential neurotoxicity of MDMA, myths about the origins and treatments for post-MDMA “crash,” the evolving legal landscape around MDMA use for clinical purposes, and I caution recreational users about the extremely dangerous additives (e.g., fentanyl) now commonly found in black market MDMA. This should be of interest to those curious about MDMA, neuropharmacology, the origins of emotional processing in the brain, empathy, PTSD, neuroplasticity, mental health and psychiatry. For the full show notes, visit hubermanlab.com.
Actionable Insights

1. Do Not Use Recreational MDMA

Recreational MDMA is illegal and often contaminated with deadly fentanyl, posing extreme safety risks. The sourcing of MDMA is extremely important and its safety issues cannot be overlooked.

2. MDMA Augments PTSD Talk Therapy

MDMA taken on its own does not cure PTSD; instead, it significantly boosts the effectiveness of talk therapy for PTSD by engaging specific neural circuits. This combination has shown remarkable results in clinical trials.

3. Follow MDMA-Assisted Therapy Protocol

The clinical protocol for PTSD involves three preparatory 90-minute talk therapy sessions, followed by three 8-hour MDMA sessions (with initial and booster doses) alongside two therapists, and then three 90-minute follow-up talk therapy sessions spaced one week apart. This structured approach helps patients reframe traumatic events in a supportive environment.

4. Avoid SSRIs Before MDMA

Taking a Selective Serotonin Reuptake Inhibitor (SSRI) prior to MDMA can block its prosocial and empathogenic effects. These effects are crucial for the therapeutic outcomes of MDMA-assisted therapy.

5. Avoid Caffeine During MDMA Use

Taking caffeine within hours or on the same day as MDMA can increase its potential toxicity, according to animal studies. Restricting caffeine intake on the day of and around MDMA ingestion is advantageous.

6. Control MDMA Environment & Hydration

During MDMA use, avoid settings that greatly increase blood pressure or body temperature, such as hot environments or intense physical activity. Ensure adequate fluid and electrolyte intake to prevent neurotoxicity from temperature effects.

7. Avoid 5-HTP/L-Tyrosine Post-MDMA

Do not take 5-HTP or L-tyrosine to buffer the post-MDMA crash, as there is no evidence of benefit and potential for detriment. These precursors could further deplete serotonin and dopamine, contrary to popular belief.

8. Consider P5P for MDMA Crash

P5P (a metabolite of vitamin B6) is being explored to suppress prolactin, which is dramatically increased by MDMA and contributes to the post-MDMA crash symptoms like lethargy and lack of motivation. While human data is limited, this approach has a mechanistic basis.

9. Seek Quality Talk Therapy

Engage in talk therapy with a psychologist or psychiatrist who fosters good rapport and a supportive, safe environment. This allows for effective exploration of trauma and its impact on current behaviors and emotional states.

10. Utilize NSDR for Energy Restoration

Engage in Non-Sleep Deep Rest (NSDR) or Yoga Nidra, even for short 10-minute sessions, to greatly restore cognitive and physical energy. The Waking Up app offers various programs for this purpose.

11. Ensure Proper Hydration Daily

Dissolve one packet of Element in 16-32 ounces of water upon waking and during physical exercise. This ensures adequate hydration and electrolyte balance (sodium, magnesium, potassium) vital for optimal brain and body function.

12. Take AG1 for Foundational Nutrition

Consume Athletic Greens (AG1) once or twice daily to support gut health with probiotics and meet foundational nutritional needs. It contains adaptogens, vitamins, and minerals crucial for overall well-being.

13. Read ‘Trauma’ by Paul Conti

For a comprehensive understanding of trauma and its treatment, read Dr. Paul Conti’s book ‘Trauma.’ It provides valuable insights into the definition of trauma and effective patient care.