MDMA: Why demonised drug ecstasy is making waves as treatment for psychiatric conditions

The therapeutic benefits of MDMA, or ecstasy, are increasingly being recognised and scientists are now calling for extensive research into the drug to work out how it could be harnessed as a treatment for psychiatric conditions like depression and schizophrenia.

Boris Heifets and Robert Malenka, from Stanford University School of Medicine, say the status of MDMA as a Schedule 1 drug should not put scientists off experimenting with it or studying its effects. Schedule 1 drugs are compounds that have no accepted medical use and are at high risk for their abuse potential. Other drugs in this category include heroin and LSD.

MDMA is known as an empathogen as it promotes feelings of empathy and positive social feelings. First discovered in the 1970s, clinical research into the drug was swiftly curbed after recreational use skyrocketed. Despite some restrictions on its use being lifted in 2004, scientists still do not know how it works in humans, what brain regions it targets or the pathways it affects.

Writing a commentary piece in the journal Cell, Heifets and Malenka say an understanding of how MDMA works is of paramount importance. Not only could it shed light on why we feel empathy, it could also pave the way for new treatments for conditions like PTSD (post-traumatic stress disorder), for which (at present) there is no effective therapy.

Malenka said: "We've learned a lot about the nervous system from understanding how drugs work in the brain − both therapeutic and illicit drugs. If we start understanding MDMA's molecular targets better, and the biotech and pharmaceutical industries pay attention, it may lead to the development of drugs that maintain the potential therapeutic effects for disorders like autism or PTSD but have less abuse liability.

"Studying the response of the brain and nervous system to any drug is no different than running an animal through a maze and asking how learning and memory work, for example. You're trying to understand the different mechanisms of an experience. Drugs like MDMA should be the object of rigorous scientific study, and should not necessarily be demonised."

Malenka is currently looking to undertake a large project to examine the effects of MDMA in humans. "There are going to be certain areas of the brain in which MDMA's actions are critical for its behavioural effects," he said, adding tests can be carried out in controlled and carefully monitored clinical environments. Building up a "knowledge base" from animal and human studies will help scientists start to understand the drug's potential, he added.

In their letter, the scientists say test results are increasingly showing that listing MDMA as a Schedule I drug is "no longer a rational societal policy". They said that while they do not condone its recreational use in any way, as an object of scientific study it "should be encouraged and perhaps facilitated".

"As a probe of brain function, it is a remarkably simple but powerful tool that can be used to advance our understanding of the neural basis of empathy, social reward and related pro-social behaviours," they said. "Such understanding can only benefit individuals and the human interactions in which they engage. The world's populations need more compassion and empathy for one another. The study of MDMA provides one small but potentially important step toward reaching that goal."