Talk:MDMA-assisted psychotherapy

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 24 August 2020 and 11 December 2020. Further details are available on the course page. Student editor(s): Mledx.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 00:22, 18 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 16 September 2020 and 25 November 2020. Further details are available on the course page. Student editor(s): JihunLyu.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 00:22, 18 January 2022 (UTC)

Untitled

This is a university assignment that I will be constantly working on in the coming week.

Aud study update

I'm not the right person to make the edit, but there is an update to the Imperial College London AUD study: https://pubmed.ncbi.nlm.nih.gov/33601929/ Psychlohexane (talk) 07:10, 4 August 2021 (UTC)

Hi @Psychlohexane I've updated it now CT55555 (talk) 01:06, 14 December 2021 (UTC)

Recreational use is not clinical use

The intro says The research is controversial due to the risks of taking MDMA, made evident by the illegal and unregulated use of MDMA in the form of ecstasy.[5]

This doesn't make sense. Use of MDMA in psychotherapy is precisely not unregulated, so that risks linked to unregulated use don't appy.

There were 92 MDMA related deaths in England and Wales in 2018, up from 56 the year before,[6] and 10,000 hospitalizations for MDMA related illness/injury in 2011 in the US.[5]

To my knowledge, there isn't even a single fatality reported in the many ongoing and concluded trials. So again, there is no obvious connection here.

The use of psychedelics for therapy has been characterized as 'countercultural' in Western cultures.[7]

What does this even mean?

I would suggest to delete this entire paragraph, as it is not related to the subject under discussion.--Johannes Rohr (talk) 06:21, 25 December 2021 (UTC)

Deleted the paragraph now. --Johannes Rohr (talk) 06:58, 25 December 2021 (UTC)

The "meaning" of this paragraph simply is to give evidence for the controversy. Using a drug that is not medically approved and has unknown and unpredictable effects but has caused serious health hazards as a consumer drug is per se controversial. This issue is central to the subject of the article and should be part of the leading section. It is therefore reinstalled and slightly extended. --Saidmann (talk) 22:06, 29 December 2021 (UTC)

Non sequitur. The figures are about recreational use, not controlled clinical use. The referenced article actually makes this distinction: “But its use under medical supervision is a world away from someone necking a load of pills at a rave.. So, this is quotemining. You also don't judge the safety of opiates used in palliative care by the number of heroin addicts dying in our cities. All systematic reviews I could find judge the controlled clinical use as "safe and effective" with "minimal adverse effects". To my knowledge, there are exactly zero fatalities reported. --Johannes Rohr (talk) 12:24, 30 December 2021 (UTC)

The fact that a drug has shown to be dangerous in uncontrolled use automatically makes it a potential risk drug also in therapies. Well, the large scale opiate problems also in the medical sector are a good analogue. --Saidmann (talk) 13:12, 30 December 2021 (UTC)

Non sequitur. How is the fact that the uncontrolled use is dangerous evidence for danger in controlled use? You see, if it was, wouldn't we expect this to be reflected in data from clinical trials? How come it is simply not there? The linked article itself points out that recreational use is a world away from clinical use. And again, there have been, to my knowledge, exactly zero fatalities reported from clinical use, there is no dependency problem, there are minimal adverse effects. --Johannes Rohr (talk) 13:22, 30 December 2021 (UTC)

BTW, have you realized what your statement implies: Due to the opiate crisis in the US, opiates should no longer be used in palliative care or for other legitimate purposes. I very much hope that this is not what you want. Same with MDMA. Its abuse in recreational use is not an argument for withholding it from patients who can substantially benefit from it. --Johannes Rohr (talk) 14:46, 30 December 2021 (UTC)

Sorry, it appears that you might have misread the word "controversial". This word does not say the drug should be "withheld from patients". It simply says that it is discussed controversially because of the risks. --Saidmann (talk) 15:04, 30 December 2021 (UTC)

Still it just doesn't make logical sense, just as knife stabbings don't make the use of scalpels in the surgery room "controversial". Technically, you could say that it is "discussed controversially". Yet it isn't for valid reasons: As the clinical data shows, substance abuse in the wild isn't mirrored in MDMA assisted therapy. There are no fatalities, no dependency problem, minimal adverse effect. Therefore this shouldn't be in the lead as it gives the wrong impression. --Johannes Rohr (talk) 15:36, 30 December 2021 (UTC)

Sir, the scope of adverse effects in clinical use is not yet established at all. It is still an open question. Therefore the controversy is an ongoing one. I regard this issue as settled. --Saidmann (talk) 15:44, 30 December 2021 (UTC)

Please point to any peer-reviewed publication that reports significant adverse effects in controlled clinical use. Well, actually, please point to an eligible source that says that "the research on using MDMA in psychotherapy is controversial", and then cite the reasons it lists for it being controversial. --Johannes Rohr (talk) 21:40, 30 December 2021 (UTC)

The linked Guardian article does not say that MDMA assisted psychotherapy "is controversial", it simply doesn't. It says that there is substance abuse in the wild and that use in clinical settings is something different altogether. Please provide an eligible source that actually supports your claim. --Johannes Rohr (talk) 07:45, 31 December 2021 (UTC)

Two secondary sources are now added. Just read. --Saidmann (talk) 15:59, 31 December 2021 (UTC)

I think that the problem is in the words "due to".

The Morgan paper is open-access, and it seems to indicate that the research is controversial specifically because the substance is currently classified as an illegal drug ("Research into the clinical use of illegal substances is highly controversial"). This type of controversy would be equally applicable to the research into Dronabinol (now an FDA-approved drug), Cocaine (two brands are FDA-approved), or anything else. It has nothing to do with "the risks of taking MDMA recreationally" or any "unpredictable neurochemical effects".

Morgan also says that the research has been mis-described, which has led to a sort of moral panic over recreational use ("This misunderstanding has led to critics of MDMA-assisted psychotherapy citing research showing the dangers of recreational drug use as a reason not to approve this research [41, 45, 46], which is not comparing like with like" – the "misunderstanding" in the sentence is whether the thing your neighbor's boss's friend's teenager bought at the party was actually pharmaceutical-grade MDMA, because it almost certainly was not). I'm not sure that this justifies a claim that "the research is controversial due to recreational use"; it might justify a claim that "critics have talked about the dangers of uncontrolled recreational drug use".

The Guardian article doesn't really support the claim that it is controversial due to recreational use; it merely says that overdoses can cause dangerous body temperature dysregulation. Similarly, I don't see anything in the Karlsen source that says this is a concern for clinical use. It's talking about drug side effects, but not about why this research is controversial. WhatamIdoing (talk) 21:42, 3 January 2022 (UTC)

If a drug causes considerable harm - no matter where - it is unavoidably regarded as controversial. The same applies to the research. This is no WP:SYNTH case. --Saidmann (talk) 12:27, 4 January 2022 (UTC)

I don't think your premise is true. Have you heard any "controversy" about hospitals using ethanol to manage acute withdrawal symptoms in alcoholics? I haven't, even though the harms of alcohol are both undeniable and enormous. Consider, too, cytotoxic chemotherapy: it causes considerable harm, and yet it is not regarded as controversial.

The SYNTH problem is picking up one source that says it's controversial, and another source that says recreational use has harms, and adding those two sources up into a statement that says it's controversial because recreational use has harms. My reading of that source suggests that the main source of the controversy (the "because") is the mere fact of its legal classification: upstanding citizens don't want to break the law, and this feels like law-breaking (even though it's technically not, assuming you do the relevant legal paperwork). WhatamIdoing (talk) 16:23, 4 January 2022 (UTC)

The "because" has already been deleted from the text. --Saidmann (talk) 21:39, 4 January 2022 (UTC)

Which "unpredictable neurochemical effects"?

I have looked into the referenced article and it really doesn't specify. The article body contains the word "unpredictable" two times,

1. "There may also be potential legal issues if a powerful and unpredictable CNS stimulant such as MDMA were to be used for medical purposes. "

2. "Hence, there may be clinical reactions to this powerful and unpredictable drug (Greer & Tolbert 1986; Parrott 2007)."

This isn't saying anything about specific "unpredictable neurochemical effects". Where is the research? Parrott 2007 contains the word a single time, referring to yet other research.

Obviously, the authors of the four systematic reviews on MDMA in psychotherapy didn't identify this as an issue, which is why I don't think it should be in the lead. --Johannes Rohr (talk) 12:35, 30 December 2021 (UTC)

"unpredictable neurochemical effects" need not be specified. It is sufficient that they are stated as a general observation in a review. --Saidmann (talk) 13:04, 30 December 2021 (UTC)

The linked article doesn't even say that much. Please look for the phrase "unpredictable neurochemical effects". And even its source doesn't reveal very much. --Johannes Rohr (talk) 13:08, 30 December 2021 (UTC)

Added further sec source. Added quotations from both sources to the refs, which describe specific effects. I regard this issue as settled. --Saidmann (talk) 15:38, 30 December 2021 (UTC)

That source again says nothing about clinical use and re-emphasizes that the issues that arise are related to recreational use, where multiple substances are mixed: "On admittance, the intoxicated MDMA user is typically under the influence of additional drugs, and this observation has instigated controversies regarding the toxicity of MDMA alone. In a survey of 202 ecstasy-related deaths in the UK in the period 1996–2002, MDMA was the sole drug detected in merely 17% of cases" So again, it also does not say that clinical / therapeutic use is "controversial" and it does not cite any cases that have been observed in such settings. --Johannes Rohr (talk) 07:44, 31 December 2021 (UTC)

Just read the sources: pmid 18047478: "Because of the profound effects of MDMA on serotonin storage and synthesis in the central nervous system, exposure may result in sub-acute effects that may last for days or weeks. There is a considerable body of evidence suggesting that low levels of serotonin is associated with poor impulse control and enhanced levels of aggression, and several investigations have demonstrated that transient depressive and/or aggressive behaviour is a feature in MDMA-exposed individuals."

pmid 24830184: "MDMA administration induces neurotransmitter activation across the main neural pathways, including serotonin, dopamine, noradrenaline, and others. This general neurochemical activation means that MDMA can induce a wide range of mood changes."

--Saidmann (talk) 15:31, 31 December 2021 (UTC)

The source isn't connecting it to clinical use. This may be a WP:SYNTH problem. WhatamIdoing (talk) 21:44, 3 January 2022 (UTC)

The 1st source (pmid 18047478) does refer to clinical use. More importantly, neurochemistry of the drug is independent of type of usage. --Saidmann (talk) 12:19, 4 January 2022 (UTC)

Does the first source (which I haven't read) not merely refer to clinical use, but actually contain a statement that directly says the unpredictable effects are the source of the controversy? A sentence e.g., that says "This is controversial because you never know what will come up in therapy" or "This really wouldn't be controversial except for the problem that you don't know what to expect the client to be feeling"? Mentioning clinical use in one paragraph and unpredictable moods in another paragraph isn't good enough for this statement. The source has to draw a direct line between the two. WhatamIdoing (talk) 16:31, 4 January 2022 (UTC)

It does - several times:

A) "In a medical setting, Liechti et al. (2001) found significant mood increases in every positive mood state being assessed, including emotional excitation and sensitivity. However, negative moods were also boosted by MDMA, including apprehensiveness anxiety, and fear-of-loss of thought control."

B) "This mixture of positive and negative mood changes is also evident in the psychotherapeutic situation. Greer and Tolbert (1986) reported that in their overall group of 29 volunteers, 18 reported positive mood such as euphoria, while 16 reported less-desirable negative moods such as anxiety."

--Saidmann (talk) 21:55, 4 January 2022 (UTC)

Where is the part that says it's controversial because of the significant mood increases? I've no doubt whatsoever that this drug causes this effect. What we need is a statement that directly connects the mood increases to the controversy. What if it turns out that mood changes are a non-controversial or even considered desirable aspect of the drug's effects? We need the source to make a direct connection between this effect and any controversy. WhatamIdoing (talk) 02:30, 5 January 2022 (UTC)

Here is a "direct connection": "There may also be potential legal issues if a powerful and unpredictable CNS stimulant such as MDMA were to be used for medical purposes." (PMID 24830184) --Saidmann (talk) 12:15, 5 January 2022 (UTC)

"Potential legal issues" is not "controversy". A "powerful and unpredictable CNS stimulant" is not "mood increases". This doesn't directly support the claim. WhatamIdoing (talk) 02:46, 7 January 2022 (UTC)

"Neither I nor any of the referenced sources used the expression "mood increases". "unpredictable CNS stimulant" is the term in the source that is refered to in the article. --Saidmann (talk) 11:54, 7 January 2022 (UTC)

Also, my impression from these sources is that they can predict the neurochemical effects pretty well. It predictably depletes serotonin. WhatamIdoing (talk) 21:45, 3 January 2022 (UTC)

"can induce a wide range of mood changes" means that the mood changes happening under the therapy seession are unpredictable. Some therapists might like this, but others don't. One reason for the controversy. --Saidmann (talk) 12:13, 4 January 2022 (UTC)

Neurochemical effects are not the same as moods, even to someone who holds to an absolute philosophy of materialism. If you mean that it produces unpredictable moods, then you need to say "unpredictable moods", not "unpredictable neurochemical effects". WhatamIdoing (talk) 16:27, 4 January 2022 (UTC)

"Neurochemical effects are not the same as moods". Of course not. But the mood changes are caused by neurochemical effects. --Saidmann (talk) 21:34, 4 January 2022 (UTC)

Phrasing "unpredictable moods" as "unpredictable neurochemical effects" sounds like a Dihydrogen monoxide problem. We should not make this sound more mysterious than it really is. In plain English, if you take this drug, you will experience bigger feelings, which you might or might not enjoy. That's not nearly as scary-sounding as "unpredictable neurochemical effects". WhatamIdoing (talk) 02:36, 5 January 2022 (UTC)

Moods are always unpredictable, irrespective of drug intake. Here, however, we are dealing with specific neurochemical effects that are unpredictable: "the emergent material can be susceptible to environmental influences and this also makes the MDMA-induced experiences difficult to control. Hence, there may be clinical reactions to this powerful and unpredictable drug (Greer & Tolbert 1986; Parrott 2007). There is also the issue of neurochemical recovery afterwards, when negative moods tend to predominate." (PMID 24830184) --Saidmann (talk) 12:29, 5 January 2022 (UTC)

The bit about "the issue of neurochemical recovery afterwards, when negative moods tend to predominate" is exactly the opposite of "unpredictable neurochemical effects".

If I've understood this accurately, the sources are saying:

• There are legal risks here (which are completely separate from questions about how or whether it works).
• People taking this experience bigger moods (including unpleasant, inconvenient, and/or surprising moods).
• No matter how useful it might/might not be overall, most people feel bad the next day/week, due to serotonin depletion.

Is that the plain meaning? WhatamIdoing (talk) 02:55, 7 January 2022 (UTC)

The plain meaning is that it is a "powerful and unpredictable drug", and that this applies both to the acute effects and the "neurochemical recovery afterwards". The source says "when negative moods tend to predominate". There is no predictability here either. --Saidmann (talk) 12:02, 7 January 2022 (UTC)

"Powerful" sounds like a value judgment. I might say that chlorinating water is a "powerful" treatment, because it saves so many lives, but obviously the sources mean something different when they use that word. It would be good to figure out what they mean by that word, and say that clearly.

I do not think we can make the leap from "unpredictable drug" to "unpredictable neurochemical effects". Those are not equivalent phrases.

If it is true that there is a time when "negative moods tend to predominate", then it is predictable that "negative moods tend to predominate" at that time. Predictable does not mean "guaranteed". Predictable means "behaving in a way that is expected". The authors clearly expect negative moods to predominate. Therefore, it is predictable (and, indeed, predicted by these authors). WhatamIdoing (talk) 05:00, 11 January 2022 (UTC)

Since the word unpredictable has in the meantime been erased from the article, this thread has become obsolete.--Saidmann (talk) 18:27, 11 January 2022 (UTC)

Wiki Education assignment: 2023-24 WikiMed Directed Studies

This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 October 2023 and 18 November 2023. Further details are available on the course page. Student editor(s): Skippy0206 (article contribs). Peer reviewers: SDlren.

— Assignment last updated by Ewingdo 15:22, 8 November 2023 (UTC)

Peer Review

Lead

- Lead reflects contents of the article.

Content

- The content of the original has been expanded and I think that this gives a great descriptive overview on MDMA-assisted psychotherapy. Many other psychotherapy associated wikipedia links have also been added. The article discusses controversy and legality in a neutral manner.

- I broke up a few longer sentences for flow and corrected some grammatical errors.

Sources and References

- Sources have been included appropriately and no information in uncited. All links and references are functioning.

Images

- Images on the page are appropriate.

Overall impressions

- There have been some great additions to the development of MDMA-assisted psychotherapy. This includes a lot of relevant current research findings. Information is unbiased and presented neutrally.

- My only suggestion would be to expand on the concerns about "drug-dependent learning".

- Great job overall! SDlren (talk) 23:13, 14 November 2023 (UTC)