MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations.

MDMA-assisted psychotherapy (MDMA-AP) may soon be approved for adults with PTSD, but adolescents also commonly suffer from PTSD and current treatments have limitations. As an adjunct to therapy, MDMA may reduce avoidance, strengthen therapeutic alliance, enhance extinction learning and trauma reappraisal. Adaptations for adolescents include reinforcing motivation, building a strong therapeutic alliance, adding emotion and behavior management techniques, using more directive exposure methods during sessions, supporting concomitant challenges, and involving family. Potential risks include physical and psychological side effects, toxicity, misuse, and ethical issues. Clinical trials are needed to determine safety and efficacy for adolescents rather than off-label use or extrapolating from adult studies.

Study at a glance

Abstract

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.