Is MDMA Therapy A Safe Option If Taking Antidepressants?
MDMA therapy refers to a form of psychedelic-assisted psychotherapy in which clients take MDMA in the presence of one or two therapists. The point of doing so is that the MDMA experience involves reductions in fear, more emotional honesty, greater feelings of empathy, and less defensiveness. All of these effects can aid the therapeutic process and help patients face difficult emotions.
MDMA therapy is particularly useful in the treatment of post-traumatic stress disorder (PTSD). When combining MDMA with psychotherapy, according to several high-quality studies, it is more effective in alleviating PTSD compared to traditional treatments. Additionally, MDMA can also help reduce the symptoms of depression.
If taking antidepressants (say, for PTSD or depression), a person may be wondering if this matters in the context of MDMA therapy. As we will see, taking MDMA in combination with common antidepressant medication can present some dangers and downsides. This article will describe these risks, and explain how to proceed with MDMA therapy if currently taking antidepressants.
MDMA Therapy And SSRIs
Selective serotonin reuptake inhibitors (SSRIs) are one of the most common classes of antidepressants. SSRIs include:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
According to one study, taking MDMA alongside an SSRI can lead to a rapid increase in the chemical serotonin in the central nervous system. This is because both MDMA and SSRIs act on the serotonin system. A significant rise in the concentration of serotonin in the body can result in a condition known as serotonin syndrome. This can be a potentially life-threatening condition.
However, other researchers have noted that “substances that inhibit serotonin re-uptake are less likely to lead to life-threatening elevations in serotonin when used with ecstasy.” Of course, if taking a high dose of an SSRI medication and/or MDMA and then combining the two, the risk is greater.
Besides potential physical risks, being on SSRIs can prevent a person from experiencing the full effects of MDMA. Many people taking SSRI antidepressants describe this issue. A study published in the journal Psychopharmacology has confirmed that the recent use of SSRIs blunts the effectiveness of MDMA therapy. This effect is due to the different ways that SSRIs and MDMA affect the serotonin system.
Looking At The Therapeutic Benefits
The therapeutic benefits of MDMA depend on the way the compound changes subjective experiences. Having MDMA therapy on an SSRI antidepressant may, therefore, prove ineffective. Dr. Ben Sessa, a leading MDMA psychotherapist, notes a person may get the physical effects of MDMA, but none of the important psychological ones. He thinks is pointless, saying, “all you’re doing is taking MDMA to just feel hot, which is a bit crazy, really.”
Plus, MDMA can lead to a “comedown” the next day or some days after. Users experience this as low mood and energy. And it can be related to several different factors, including the chemical imbalances caused by MDMA. If a person already has depression, then the comedown could just worsen symptoms. And all this for reduced effects of MDMA. It may not be worth it.
MDMA Therapy And MAOI Antidepressants
Some monoamine oxidase inhibitors (MAOIs) are used in the treatment of depression and PTSD. Common MAOI antidepressants include the following.
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
- Tranylcypromine (Parnate)
MAOIs work by inhibiting the activity of one or two enzymes in the body known as monoamine oxidase A and monoamine oxidase B. People will typically try an MAOI antidepressant when other antidepressants don’t work. This is because MAOIs have a higher risk of drug interactions compared to SSRIs.
A person should also be wary about undergoing MDMA therapy if taking an MAOI antidepressant. MAOI and MDMA can be a risky combination. MAOIs — when combined with MDMA — pose a higher risk of serotonin syndrome compared to SSRIs. A number of people have had fatal reactions after taking MDMA while on an MAOI antidepressant.
Doctors do not usually prescribe MAOIs for mental health conditions. But if someone is taking an antidepressant and are thinking of utilizing MDMA therapy, then it’s critical to understand what type of antidepressant being used. Point blank: Avoid using MDMA while on an MAOI antidepressant.
Taking Antidepressants Doesn’t Prohibit Trying MDMA Therapy
Being on antidepressants does not mean a person has to avoid MDMA therapy. It just means her/she might need to discontinue their use. And, hopefully, if the MDMA therapy is highly effective, then the person may not need to carry on taking antidepressants when the treatment is over.
While stopping to take antidepressants is an option this reason, remember to consult with a health provider first. Stopping antidepressants too quickly may lead to some unpleasant withdrawal symptoms.
Instead, it is usually best to taper off the use of antidepressant medication. This will help avoid any severe withdrawal symptoms. It may be tempting to quit using antidepressants overnight in order to undergo MDMA therapy as quickly as possible. But this may not be the best decision for a person’s mental health. It’s better to slowly and gradually reduce any antidepressant dose to avoid any side effects.
Tapering off an antidepressant can take weeks, sometimes months. The harm reduction site DanceSafe recommends quitting the use of an MAOI antidepressant for at least two weeks prior to using MDMA. This is for safety reasons.
How To Safely Examine Options
Meanwhile, remember to taper off SSRIs in order to experience the full effects of MDMA. But as the research published in Psychopharmacology shows, participants who had recently tapered off SRRIs had less beneficial outcomes from MDMA therapy than participants who had not been taking the medication. Here’s how PsyPost reports on the research:
“Among those who tapered off antidepressants, only 25 percent no longer met the diagnostic criteria for PTSD after MDMA-assisted therapy. In contrast, about 64 percent of participants who were not taking the medications no longer met the diagnostic criteria for PTSD after treatment.”
For this reason, it may be worth being off SSRI antidepressants for a longer period of time (i.e. months) before taking MDMA. This is to maximize the benefits of treatment.
MDMA therapy can certainly be a good option even if somebody’s already taking antidepressants. It’s just important to taper off any medication in a controlled, supervised way. This is to protect well-being, as well as present the best chance possible of mental health recovery following MDMA therapy.
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