White C Michael
University of Connecticut School of Pharmacy, Hartford, CT, USA
Ann Pharmacother. 2014 Jul;48(7):908-915. doi: 10.1177/1060028014532236. Epub 2014 Apr 16.
Review the current literature assessing the role of 3,4-methylenedioxymethamphetamine (MDMA) on posttraumatic stress disorder (PTSD).
OVID MEDLINE search (1960-February 2014) using the terms MDMA, 3,4-methylenedioxymethamphetamine, Molly, and Ecstasy crossed with posttraumatic stress disorder with backwards citation tracking using references from procured articles.
English language studies assessing MDMA in patients with PTSD.
Three randomized controlled trials (RCTs) were conducted along with follow-up open-label and extension evaluations. In the 3 RCTs, therapy with MDMA-assisted psychotherapy is promising, with reductions in PTSD rating scale scores (Clinician-Administered PTSD Scale, Severity of Symptoms Scale for PTSD Scale), although 2 of 3 trials did not show significant results, and all three had methodological limitations. The direction of effect for all trials was toward benefit in patients who were refractory to other PTSD therapies; the percentage reductions on rating scores ranged from 23% to 68%; and in 1 trial, the effect was sustained over a long period of time. MDMA ingestion without sustained psychotherapy over a 6- to 8-hour period is unlikely to be beneficial; trying to prolong the duration of effect with supplemental dosing is unlikely to provide additional benefits; and there are adverse effects on blood pressure and heart rate that should be appreciated. These studies used unadulterated MDMA with known and reproducible potency, which may not happen with street purchase of the product.
MDMA-assisted psychotherapy may be an effective therapy in refractory PTSD but needs further evaluation to determine its place in contemporary therapy.
回顾当前评估3,4-亚甲基二氧甲基苯丙胺（MDMA）对创伤后应激障碍（PTSD）作用的文献。
通过OVID MEDLINE检索（1960年至2014年2月），使用MDMA、3,4-亚甲基二氧甲基苯丙胺、摇头丸和迷幻药等术语，并与创伤后应激障碍交叉检索，同时利用所获文章的参考文献进行反向引文追踪。
评估PTSD患者中MDMA的英文研究。
进行了三项随机对照试验（RCT）以及随访开放标签和扩展评估。在这三项RCT中，MDMA辅助心理治疗颇具前景，创伤后应激障碍评定量表评分（临床医生评定的创伤后应激障碍量表、创伤后应激障碍症状严重程度量表）有所降低，尽管三项试验中有两项未显示出显著结果，且所有三项试验都存在方法学局限性。所有试验的效果方向均有利于对其他创伤后应激障碍治疗无效的患者；评分降低的百分比范围为23%至68%；在一项试验中，效果在很长一段时间内持续存在。在6至8小时内无持续心理治疗的MDMA摄入不太可能有益；试图通过补充给药延长效果持续时间不太可能带来额外益处；并且对血压和心率存在不良影响，应予以重视。这些研究使用了纯度已知且可重现效力的未掺假MDMA，而街头购买的产品可能并非如此。
MDMA辅助心理治疗可能是难治性创伤后应激障碍的一种有效治疗方法，但需要进一步评估以确定其在当代治疗中的地位。
