How an unconventional new treatment helped an Iraq veteran conquer Post-Traumatic Stress Disorder and start a new life
"There's no way I'm going to sustain living like this."
Those are the words of Tony Macie, a 29-year-old Iraq veteran, describing his outlook at the peak of his struggle with Post-Traumatic Stress Disorder. Macie was barely functioning. He drank and relied heavily on antidepressants and painkillers to manage his PTSD and a back injury.
The 15 months he spent fighting as a Sergeant of the U.S. Army in Iraq left him in a state of constant vigilance—he couldn’t shake the feeling that he might come under attack at any moment. Macie saw several friends die in the line of duty. He was the first responder when a truck bomb struck his platoon near Baghdad, a gruesome scene he has relived countless times since returning to the states.
Re-experiencing the trauma has been one of the keys to his recovery, but traditional drugs and therapy were not what ultimately triggered healing. As a participant in a Phase 2 clinical trial of MDMA-assisted psychotherapy, Macie attributes his breakthrough to taking the psychedelic drug, popularly known as Ecstasy, just once in a controlled setting.
Selective serotonin reuptake inhibitors, or SSRIs, are the class of antidepressant drug most commonly prescribed for PTSD. The drugs block reabsorption of the neurotransmitter serotonin, allowing it to bind more frequently to receptors in the brain. The goal is to improve mood balance, but research suggests SSRIs only lead to complete remission in less than one-third of PTSD patients.
Preliminary trials of MDMA-assisted psychotherapy, on the other hand, boast remission rates of up to 66 percent, with lasting improvements more than 12 months after therapy.
Press coverage of the new research often equates MDMA with the popular party drug, but Ecstasy can contain dangerous additives unknown to users. The PTSD trials test only pure MDMA administered in small doses of 40 to 125 mg.
Brad Burge is the director of communications at the Multidisciplinary Association for Psychedelic Studies, which sponsored the trials. He says that MDMA, like traditional antidepressants, acts on the brain’s serotonin system.
“It also releases hormones in the body, specifically oxytocin and prolactin,” he explains. Oxytocin, which plays a role in mother-child bonding during lactation, “produces this intense sense of bonding and intimacy, not just with oneself but also with the people around you.”
These feelings of connectedness and wellbeing lay the foundation for experiencing trauma in a safe space. And that’s just what Macie did: when memories of combat surfaced, he embraced them instead of pulling away. The drug ensured that he continued feeling secure and relaxed, in situations where he’d ordinarily feel anxious.
Before taking MDMA, Macie underwent three preparatory sessions over the course of 16 weeks. He got to know the study’s investigators and learned what to expect when taking the drug. He also weaned off the other medications he was taking to avoid any adverse interactions or confounding effects.
Macie arrived at the treatment center in Charleston, South Carolina at nine o’clock sharp on the morning of his procedure. An hour later, he took one 75 mg dose of MDMA, then stretched out on a comfortable futon to wait. He donned eye shades and headphones, which played relaxing music selected by the experimenters (click here to check out the playlist).
Two therapists were present to monitor and support him, but their instructions were to let him speak first and guide the conversations. The drug kicked in after about an hour, and with it came deep feelings of euphoria, though Macie says his mind remained clear and alert. Some of the work he did was voiced aloud, with the therapists providing validation. Other times, he kept quiet and processed his insights internally.
“I attribute the MDMA to giving me that lightbulb and being like come on, you know you’re killing yourself with these meds,” he says, referring to the antidepressants and painkillers he was prescribed for years, “So stop doing it.”
MDMA provided Macie with a breakthrough that allowed him to avoid months, years or even a lifetime on antidepressants. But he’s careful to warn others that it’s not a cure all, and it’s not something patients can replicate at home.
“People want to take a pill and feel better rather than actually do the work,” says Dr. Mark Ingram, an L.A.-based psychologist who treats PTSD patients. “And drug companies are more than happy to provide you with that, whether it works or not.”
Ingram uses Cognitive Behavioral Therapy in his work with PTSD patients, about half of whom also see a psychiatrist for prescription drugs. He says the treatments currently available, for example Cognitive Processing Therapy, which involves re-envisioning a traumatic memory with a different outcome, are very effective.
He also worries about the risks of administering MDMA to trauma patients in light of a doctor’s Hippocratic Oath to “do no harm.” “You have to be careful with [MDMA]. It can trigger depression, sleep problems, anxiety—and actually increase the symptoms brought on by the trauma,” Ingram says.
The MAPS studies were able to effectively prescreen participants to avoid such harm. But the studies were small—130 veterans, police, firefighters and sexual assault victims participated in two published Phase 2 trials. The 66 percent remission statistic is based on just 65 subjects.
But the results were promising enough for MAPS to obtain approval for Phase 3 trials, in which researchers will test varied doses of MDMA on 230 participants.
Burge says the nonprofit is also studying the drug’s effectiveness in Cognitive Behavioral Conjoint Therapy for PTSD—where couples take MDMA together to connect and heal. One member of the pair has PTSD, and the couples are not restricted to romantic relationships: friends and family members are eligible to participate. With the guidance of a therapist, patients explore how trauma has affected the relationship, and practice healthy ways to communicate.
Though it’s tough to relive his experiences for interviews, Macie says it’s important to spread awareness about the therapy to others suffering from PTSD.
He now owns and operates a nonprofit called Expert Exchange; he recruits fellow veterans to “deploy for a cause” to Cambodia. The organization provides resources and support to schoolchildren and helps rebuild the country’s infrastructure following a destructive genocide.
“I want all combat veterans to take their tours of duty with pride and not have to feel any disconnect when we come home,” Macie wrote in a Reddit post earlier this year. “Now I seek to fight a different war, to stand up for all my brothers and sisters who are lost.”