Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK.
University College London Medical School, London, UK.
J Psychopharmacol. 2021 May;35(5):501-511. doi: 10.1177/0269881120965915. Epub 2020 Dec 20.
Novel, evidence-based treatments are required for treatment-resistant post-traumatic stress disorder (PTSD). 3,4-Methylenedioxymethamphetamine (MDMA) has beneficially augmented psychotherapy in several small clinical trials.
To review the use of MDMA-assisted psychotherapy in treatment-resistant PTSD.
Systematic searches of four databases were conducted from inception to February 2020. A meta-analysis was performed on trials which were double-blinded, randomised, and compared MDMA-assisted psychotherapy to psychotherapy and placebo. The primary outcomes were the differences in Clinician Administered PTSD Scale (CAPS-IV) score and Beck's Depression Inventory (BDI). Secondary outcome measures included neurocognitive and physical adverse effects, at the time, and within 7 days of intervention.
Four randomised controlled trials (RCTs) met inclusion criteria. When compared to active placebo, intervention groups taking 75 mg (MD -46.90; 95% (confidence intervals) CI -58.78, -35.02), 125 mg (MD -20.98; 95% CI -34.35, -7.61) but not 100 mg (MD -12.90; 95% CI -36.09, 10.29) of MDMA with psychotherapy, had significant decreases in CAPS-IV scores, as did the inactive placebo arm (MD -33.20; 95% CI -40.53, -25.87). A significant decrease in BDI when compared to active placebo (MD -10.80; 95% CI -20.39, -1.21) was only observed at 75 mg. Compared to placebo, participants reported significantly more episodes of low mood, nausea and jaw-clenching during sessions and lack of appetite after 7 days.
These results demonstrate potential therapeutic benefit with minimal physical and neurocognitive risk for the use of MDMA-assisted psychotherapy in TR-PTSD, despite little effect on Beck's Depression Inventory. Better powered RCTs are required to investigate further.
CRD42019109132 available online at www.crd.york.ac.uk/prospero.
对于治疗抵抗性创伤后应激障碍（PTSD），需要新的、基于证据的治疗方法。3,4-亚甲二氧基甲基苯丙胺（MDMA）在几项小型临床试验中已被证明可有效增强心理治疗。
综述 MDMA 辅助心理治疗在治疗抵抗性 PTSD 中的应用。
从开始到 2020 年 2 月，对四个数据库进行了系统检索。对双盲、随机、将 MDMA 辅助心理治疗与心理治疗和安慰剂进行比较的试验进行了荟萃分析。主要结局指标为临床医生管理的 PTSD 量表（CAPS-IV）评分和贝克抑郁量表（BDI）的差异。次要结局指标包括神经认知和身体不良事件，干预时和干预后 7 天内。
四项随机对照试验（RCT）符合纳入标准。与活性安慰剂相比，接受 75mg（MD-46.90；95%置信区间[CI]为-58.78，-35.02）、125mg（MD-20.98；95%CI 为-34.35，-7.61）但不是 100mg（MD-12.90；95%CI 为-36.09，10.29）MDMA 联合心理治疗的干预组，CAPS-IV 评分显著降低，无活性安慰剂组（MD-33.20；95%CI 为-40.53，-25.87）也是如此。与活性安慰剂相比，BDI 显著降低（MD-10.80；95%CI 为-20.39，-1.21）仅在 75mg 时观察到。与安慰剂相比，参与者在治疗过程中报告了更多的情绪低落、恶心和下巴紧咬发作，以及 7 天后食欲不振。
尽管 MDMA 辅助心理治疗对贝克抑郁量表的影响较小，但在治疗抵抗性 PTSD 中使用 MDMA 辅助心理治疗具有潜在的治疗益处，且对身体和神经认知的风险最小。需要更好的、更有力的 RCT 来进一步研究。
CRD42019109132 可在 www.crd.york.ac.uk/prospero 在线获得。
