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MDMA-assisted psychotherapy associated with sleep improvements among PTSD patients

MDMA-assisted psychotherapy might help improve sleep in patients suffering from post-traumatic stress disorder, according to a secondary analysis of data collected from randomized, double-blind Phase 2 trials. The new findings appear in the Journal of Traumatic Stress.

“People with PTSD have disrupted sleep, and we were interested in seeing whether MDMA-assisted therapy could reduce sleep difficulties. Intrusive thoughts and being at high alert (hypervigilant) likely make it hard to get to sleep, and slumber may be interrupted by trauma-related nightmares,” said study author L. (Ilsa) Jerome of the MAPS Public Benefit Corporation, a subsidiary of the Multidisciplinary Association for Psychedelic Studies.

“My colleague Linnae Ponte has been interested in sleep research. Her interest led MAPS to add a measure of self-reported sleep quality, the Pittsburgh Sleep Quality Index – the PSQI – to MAPS’ Phase 2 studies that were investigating the safety and efficacy of this treatment. Reduction in PTSD symptoms was the primary outcome in these studies, but we wanted to see if sleep would improve as well. We could then pool, or combine, data from these studies, once they were done, to learn whether MDMA-assisted therapy could resolve poor sleep in people with PTSD.”

So far, researchers have published six Phase 2 clinical trials, with 103 participants, examining the impact of MDMA-assisted psychotherapy on chronic, treatment-resistant PTSD. The previous studies found that participants who received MDMA-assisted psychotherapy reported improved PTSD symptoms compared to control participants.

The new analysis, based on data from 63 participants who completed the PSQI, found that MDMA-assisted psychotherapy was also associated with improvements in sleep quality, sleep latency, and daytime dysfunction.

“People in randomized, placebo-controlled, double-blind studies who had MDMA-assisted therapy with 75 to 125 mg MDMA reported having better sleep than people who given zero to 40 mg. Over half of the participants given an initial dose of 75 mg MDMA showed clinically significant improvement in sleep,” Jerome told PsyPost.

“In the PSQI, lower scores are a sign of better sleep overall, and a drop of 3 points is ‘clinically significant’. Improved sleep included falling asleep faster and less daytime drowsiness. These positive changes in sleep remained 12 months later, alongside improvements in PTSD. Improved sleep is one way in which MDMA-assisted therapy improves the lives of people with PTSD.”

As with any study, the new research includes a few limitations, which could be addressed in future studies.

“The PSQI is a measure of self-reported sleep, which means people are doing their best to tell you about their sleep quality. It would be helpful to measure sleep in other ways. The easiest and cheapest might be through an app or device (like a FitBit) that records motion; a more accurate but also more burdensome and expensive way to measure sleep is through electroencephalography (EEG), which measures brain waves through electrodes on your skull,” Jerome said.

“The sample we examined is still relatively small and homogenous in terms of race or ethnicity, with most participants indicating they were White.”

MDMA is believed to be an important catalyst for psychological change (when used in a controlled psychotherapeutic setting) because it helps patients to experience pro-social feelings, such as compassion and a sense of connection with others. These pro-social feelings can also be directed at oneself.

But the short-term effects of the drug are generally not good for sleep.

“MDMA acutely disrupts sleep, making it harder to fall asleep and changing the type of sleep immediately after taking it, reducing REM sleep. However, sleep should return to ‘normal’ after drug effects are gone, and this seems to be the case. Yet afterward, people with PTSD who received an active dose of MDMA reported better sleep,” Jerome explained.

“This is not surprising, since we expect sleep to fully return to normal, but it is an important reminder that not all changes seen after a treatment are directly due to drug effects on brain chemistry. Rather, these changes in sleep are a sign that other effects of MDMA-assisted therapy, such as coming to terms with emotionally charged memories or thoughts, or feeling more compassionate toward yourself, can and will change processes such as sleep.”

The study, “Sleep Quality Improvements After MDMA-Assisted Psychotherapy for the Treatment of Posttraumatic Stress Disorder“, was authored by Linnae Ponte, Lisa Jerome, Scott Hamilton, Michael C. Mithoefer, Berra B. Yazar-Klosinski, Eric Vermetten, and Allison A. Feduccia.