To Unravel PTSD, She Took MDMA. A Promising Therapy Offers Hope
EDITOR'S NOTE: This story contains some sensitive material and may not be appropriate for all audiences.
Living With PTSD: ‘My Disorder Became Who I Was’
Lori Tipton had recounted the details of her mother’s death many times, always with the same detachment as that first 911 call.
“I was the one who discovered their bodies in her home,” Tipton says of that night in 2005. “I completely just disassociated. … I couldn’t believe what I was seeing.”
A murder-suicide, her mother had killed a lover and a close family friend.
It wasn’t Tipton’s first encounter with trauma.
When Tipton was 20 years old, her brother came to visit her in New Orleans for his 21st birthday. He died of an overdose that night in her home.
“In the wake of that experience, I didn’t really allow myself to process any of that, because I immediately began to take care of my mother,” Tipton, now 39 years old, remembered.
Her mother had struggled with mental illness for many years and took a sharp decline after her son’s death.
But Tipton’s diagnosis of post-traumatic stress disorder didn’t come until later, and only by accident when Hurricane Katrina hit.
She was displaced and spent weeks in and out of hotels. Her life felt like a steady stream of loss — the tragedy only compounded by the devastation of the storm and its aftermath.
“Nearly everybody returning to New Orleans was being diagnosed with PTSD,” Tipton said. “I think that partly led me to believe that, maybe, I didn’t have this affliction.”
She describes the years that followed as “seeing the world through dirty goggles.”
“Imagine your brain, you go down a road and to the left is like happiness and joy, and to the right — anxiety,” she said. “No matter what the circumstances were in my life, my brain would always go right, every single time.”
What happened to Tipton the following year cemented the sense that she was somehow broken, “unable to be saved,” as she describes it.
A close friend of Tipton’s, someone she trusted, raped her.
“I ended up pregnant from that rape and had an abortion,” she said.
Tipton avoided talking about the assault. She says she tried to mask her fear and isolation.
Heart-pounding panic attacks and unexplained dread became a daily part of her life. A specific word or touch, even from someone she loved, could overwhelm her with fear.
“When you have PTSD, you are living in this constantly triggered environment,” she said. “ My disorder had become so much a part of who I was.”
She felt as if the universe was punishing her.
“Anytime I felt I could trust myself, I was proven wrong,” she said.
"When you have PTSD, you are living in this constantly triggered environment. My disorder had become so much a part of who I was."
— Lori Tipton
For more than a decade, Tipton searched for a remedy.
She tried everything offered — or that she could think of — to mitigate the symptoms of PTSD: antidepressants, psychotherapy, acupuncture, meditation and hypnotherapy.
She became a yoga teacher, tried Rolfing (a type of deep-tissue massage) and even saw a witch doctor.
Nothing really worked.
Amid A Renaissance In Psychedelic Research, New Treatments Emerge
In 2017, Tipton came across an online ad for something different: researchers from the Multidisciplinary Association for Psychedelic Studies, also called “MAPS,” were looking for people with chronic, treatment-resistant PTSD.
It was an opportunity to participate in Phase 2 clinical trials for an experimental, yet promising model of treatment: MDMA-assisted psychotherapy.
Tipton was unsure at first.
“I went in there being as open as possible, but with a great deal of skepticism,” she said.
First synthesized in the early 1900s, MDMA is a psychoactive drug that boosts neurotransmitters like serotonin and also dials down activity in the amygdala, a part of the brain that processes fear. It can increase empathy and social connection.
The therapeutic benefits were explored throughout the 1970s, including in contexts like couples therapy. But those efforts stalled when the federal government — alarmed by the rise of the club drug “Ecstasy,” which can contain MDMA — classified it as a Schedule 1 drug in 1985.
Now research into psychedelics has picked up again in the U.S and that is offering hope for treating a variety of mental illnesses — from substance use disorder to depression.
MDMA is on the front line of these emerging treatments. A new drug hasn’t come onto the market to treat PTSD in more than a decade.
In 2017, the U.S. Food and Drug Administration granted Breakthrough Therapy designation to MDMA-assisted psychotherapy, developed by MAPS.
According to the FDA, the designation is reserved for a drug with preliminary clinical evidence indicating that it “may demonstrate substantial improvement over existing therapies on one or more clinically significant endpoints, such as substantial treatment effects observed early in clinical development.”
Phase 3 trials are taking place across the country, as well as in Canada and Israel.
“Seeing what was possible, you can’t go back,” said psychotherapist Saj Razvi of sessions aided by MDMA. “Things that may take months or even years to accomplish, or may never get accomplished, we see people are able to work into that territory.”
Razvi is director of medical education at Innate Path, a clinic based in Colorado. He was also clinical investigator in the Phase 2 trials for treatment-resistant PTSD.
“MDMA allows you to contact feelings and sensations in a much more direct way,” Razvi said.
The MAPS protocol typically consists of two to three sessions when MDMA is administered, each eight hours long. Those are bookended by sessions of therapy to integrate what the person has discovered while under the influence of MDMA.
Razvi, who has observed hundreds of hours of these sessions, says only by returning to the origin of the trauma can you “unpack this material, feel your way through it and get to the other side.”
“These are fundamentally powerful experiences that are corrective in nature, going back to these places where we were crushed,” he said.
It can look painful, he says — what some might call “a bad trip” — but only through this process can the quality of these traumatic experiences change.
“When we are being traumatized, we are fundamentally alone,” he said. “One of the things that MDMA does is, really, lets you know that you are not alone.”
Trauma Revisited In The Embrace of MDMA
Lori Tipton knew the story of her mother’s death well, but it always felt like it was happening to someone else.
That changed while on MDMA.
“I was able to remember all of those things, like truly able to remember these little pieces that were missing before,” she said.
She could stay present in the most terrifying moment of her life, safe in the “loving embrace of MDMA.”
As those memories emerged, they formed something new — forgiveness.
“I was able to find such empathy for myself. I realized how much I was thinking this was my fault and I should have done something,” she said.
Then she told herself to let it go
“This is a terrible thing that happened, but you carrying the fear and shame over this, it’s worthless.”
Tipton unearthed other memories, too, feelings of joy and peace that had been sealed away. She was playing in the snow with her brother when they were children.
"I was able to find such empathy for myself. I realized how much I was thinking this was my fault and I should have done something."
— Lori Tipton
“I could remember exactly how I felt, that excitement of the first snow,” she said.
But as her last session was coming to an end, one moment still remained out of reach: her rape.
When she spoke of it, the heaviness would return. There was no catharsis.
Her therapists, a male-female duo, suggested something.
“How would you feel about potentially going into one of these poses and seeing what happens?”
Years of practicing yoga, even teaching it, and certain poses Tipton could never do; it took her back to the assault.
She lay on the floor and took the pose, her legs draped over her shoulders.
As the panic surfaced, they offered her a simple question..
“Can you ask what that feeling needs?”
“It needs to be heard,” Tipton replied without thinking. “I had felt so silenced for so many years, people didn’t believe me … that, I needed that moment for them to understand me.”
They stayed with her, crouched on the floor, and let her know they did believe her.
“It was the first time I had told that story and that had been the response,” she said.
That was the end of Tipton’s treatment with MDMA.
More than a year later, she no longer fits the diagnostic criteria for PTSD. That was the case for nearly 70 percent of those who were given MDMA in the Phase 2 trials. It was a small group, fewer than 100.
Still, the potential of achieving durable remission could be a paradigm shift for millions with PTSD.
Tipton says it saved her life.
“Everything is at my fingertips for me in a way that it never was before,” she said. “I want that for everybody.”
Psychedelic Clinics Taking Root In The Desert
Even under construction, the site of Dr. Sue Sisley’s future psychedelics clinic has a fairy tale quality.
In early spring, the log cabin was awash in yellow wildflowers and the longtime PTSD researcher’s optimism.
“We wanted a natural environment,” Sisley said as she climbed the stairs of the rustic five-bedroom facility. “A place where people feel in touch with nature and not just some sterile hospital environment.”
Sisley eventually envisions llamas and dwarf goats roaming the property.
“In order to retain people in therapy, you have to create an environment where people want to return,” she said.
Sisley is president of the Scottsdale Research Institute and a physician. She has spent her career working with this population — people with severe PTSD like combat veterans.
She also has a reputation for trying alternative approaches.
Sisley recently completed the first-ever clinical trial to test cannabis for PTSD, which took years to complete after the University of Arizona cut ties with her as she was preparing to launch the study.
Sisley intends to continue testing cannabis at her new clinic on the edge of the Sonoran Desert north of Phoenix, but now the early results from the studies of MDMA-assisted psychotherapy have caught her attention, too.
"Many of the patients had no detectable PTSD. And that was astonishing because even with the best pharmaceutical regimen, you rarely ever see patients go into remission."
— Dr. Sue Sisley
“Many of the patients had no detectable PTSD. And that was astonishing because even with the best pharmaceutical regimen, you rarely ever see patients go into remission,” Sisley said.
Mental health providers like Sisley see the emerging treatment as a possible lifeline for those with severe PTSD and hopes to begin offering it as soon as possible.
She’s applied to the Multidisciplinary Association for Psychedelic Sudies (MAPS) for approval to use MDMA through the FDA’s fast-tracked program known as Expanded Access.
“There are certain illnesses that are just intractable and not responsive to traditional therapy, and we need to start thinking more broadly and empower patients to pursue their own path,” she said.
FDA Approval On The Horizon
Brad Burge, who works for MAPS, likes to characterize MDMA as “a chemical security blanket.”
“People with PTSD have an especially hard time with psychotherapy because they’re being asked to recall in detail and process and think about literally the scariest thing that’s ever happened to them,” Burge said.
Most people still know MDMA by other names like "Ecstasy" and "Molly," club drugs that usually contain other substances like meth or bath salts.
It’s an association that persists, even though Burge says it’s far different from what happens during these sessions.
“It’s not about just feeling better, it’s not about just covering up the symptoms,” Burge said. “It’s actually quite the opposite.”
Burge notes those who participated in the Phase 2 trials had PTSD for an average of 19 years, and the benefits of the therapy only increased in the months following treatment.
The source of the PTSD doesn’t seem to matter, either.
“Often the symptoms are very much the same, whether it was an improvised explosive device or a longtime sexual trauma,” Burge said.
A 'Perfect Storm'
With Phase 3 trials underway, Burge says the FDA could grant approval as soon as 2021. Once that happens, the treatment could only be administered under the supervision of a trained therapist.
Public interest in psychedelics has blossomed in recent years.
“I get a lot of telephone calls and emails from people who want to access psychedelic facilitated treatments,” said Albert Garcia-Romeu who teaches at Johns Hopkins University School of Medicine.
“What we really have to emphasize is only a handful of fairly small studies have really been done in this area in the last 20 or so years.”
But Garcia-Romeu says MDMA-assisted psychotherapy is “on the right pathway,” and the Phase 2 results are encouraging.
"We knew this wave was coming, but it was further away than I expected."
— Kate Hawke, trauma therapist
“It is likely that if the results of these larger Phase 3 trials are positive, then you’ll be seeing a shift where these kinds of treatments are more accessible and approved,” he said.
It’s still unclear whether public funding for this kind of research will be forthcoming.
Longtime trauma therapist Kate Hawke also plans to open a clinic in Arizona where she can offer MDMA-assisted psychotherapy.
She has spent decades waiting for this “wave” — the possibility of legal psychedelic therapy.
“Some of us have been out there paddling, treading water,” Hawke said. “We knew this wave was coming, but it was further away than I expected.”
As that has approached, Hawke says so has another — “the recognition of the critical importance of dealing with trauma.”
“That wave is hitting,” she said, “so we’re in a perfect storm right now.”