Ecstasy as a cure for depression? Yes, but there is a catch

Psychotherapies using psychedelic substances like LSD and ecstasy offer hope for trauma patients for whom nothing else works. But if the American regulatory authority remains suspicious, in Switzerland, there is now a therapeutic recommendation for exceptions.

Jean-Martin Büttner / ch media

American researcher Rick Doblin looked shocked when he had to announce the setback to his research. The dismay, shared by his colleagues around the world, is linked to a decision by the American Medicines Agency (FDA), made public in August. The authority refused to license MDMA – known by the brand name Ecstasy – as a treatment method for patients suffering from post-traumatic stress disorder (PTSD).

Instead, it requests a new clinical study on the effectiveness and safety of the substance. The duration of such a study would extend for years and trigger additional costs in the millions. This decision has serious consequences, because the FDA’s position serves as an international signal.

Rick Doblin does not let this discourage him. He confided to Washington Post that he and his colleagues at the American non-profit organization MAPS (Multidisciplinary Association for Psychedelic Studies) would continue to engage in the use of consciousness-altering substances such as MDMA and LSD. They are in fact convinced that such substances can help trauma patients.

Switzerland is pioneer

A study carried out in 2023 by Swiss researchers Peter Gasser and Daniel Liechti confirmed that therapies based on substances such as LSD or MDMA offer hope: Targeted delivery of LSD significantly reduces symptoms of depression and anxiety disorders in combination with psychotherapy. And this, even a year after treatment. The rejection by the American FDA shows, according to Peter Gasser, “that it will take longer to standardize such therapies than we had thought in the euphoria of the first studies which encouraged us all”.

Although no other drug agency in the world has approved a psychedelic as a medicine, there are exceptional regulations in Switzerland. Some psychiatrists may use psychedelics with corresponding authorization from the FOPH.

And Switzerland, a pioneer country in therapies of this type, is now also the first country to have published treatment recommendations for psychedelic therapies. These include a correct diagnosis of patients who do not respond to established therapeutic methods, as well as an interview before and after the session in which the patient takes the active substance. It is also about protecting yourself against possible sexual assault. But this exceptional regulation does not make it possible to treat a large number of patients.

If countries like Switzerland are hoping for so many active substances like LSD, ketamine, psilocybin or MDMA (which does not have hallucinatory effects) – known as ecstasy – it is because experience shows that these products work as a sort of catalyst in therapy. And thus facilitate access to mentally ill people. This is particularly true for a difficult-to-treat disorder: post-traumatic stress disorder. Traumatized patients are terrified by the horror of what they have experienced and it is precisely for this reason that they cannot let a therapist near them.

In such cases, research hopes that low-dose psychotropic drugs, administered only a few times, can already help. “There is evidence that hallucinogens relax synapses in the brain and cause them to reform,” explains physician and biochemist Franz Vollenweider, who has published several studies on hallucinogens.

Hallucinogens, a problem for research

An unresolved methodological problem in studies with substances like LSD or MDMA is that of the “removal of the blind”. The principle of double blindness is required in scientific studies: the experimental group to which the new drug is administered is confronted with a control group which receives a placebo, without neither the experimenter nor the subjects knowing who is receiving what. In this way, the effect of a substance must be measured in a comprehensible way.

The problem with measuring these substances is their acute psychological effect. Many test subjects notice what they have received, so the desired blindness disappears. On the other hand, there is not yet a consensus on an optimal placebo, called active, which would sufficiently mask the effect of the psychedelics to be studied in the control group.

The FDA is also aware of this, say the specialists interviewed. And yet the authority would insist on such unrealistic studies. This would be all the less credible since research also studies other symptoms without double-blind studies, such as colds, diarrhea or poor hearing.

Therapeutic studies with LSD and others are clear. As they are very expensive, only large pharmaceutical companies can finance them. But the giants of the sector show little or no interest yet. “We are not investing in this form of therapy”responds a Novartis spokesperson. Other major companies have issued similar opinions.

Big Pharma attend

There are several reasons for this. One of them is that substances like LSD or MDMA cannot be patented. Certainly, a company could develop substances with similar effects and patent these derivatives. But since such psychotropic drugs are only dispensed for a short time and in relatively small doses, another financial incentive disappears for the giants of the pharmaceutical industry. “Big Pharma wants to make money and waits first”summarizes hemp pharmacist Manfred Fankhauser – as soon as a small company shows demonstrable success, a large company buys it, which often happens with new drugs.

Behind the defense of the American authorities and the disinterest of the pharmaceutical industry, the pioneers see yet another problem which complicates their research. Franz Vollenweider, Zurich doctor and researcher specializing in the brain, puts it this way:

The ecstatic hopes of new psychedelic treatments are in any case currently greatly disillusioned.

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(Translated and adapted by Chiara Lecca)