A balm for psyches scarred by war
By Rachel Nuwer
Nigel McCourry removed his shoes and settled back on the daybed in the office of Dr. Michael Mithoefer, a psychiatrist in Charleston, South Carolina.
“I hadn’t been really anxious about this at all, but I think this morning it started to make me a little bit anxious,” McCourry said as Annie Mithoefer, a registered nurse and Michael Mithoefer’s colleague and spouse, wrapped a blood pressure cuff around his arm. “Just kind of wondering what I’m getting into.”
McCourry, a former U.S. Marine, had been crippled by post-traumatic stress disorder ever since returning from Iraq in 2004. He could not sleep, pushed away friends and family and developed a drinking problem. The numbness he felt was broken only by bouts of rage and paranoia. He was contemplating suicide when his sister heard about a novel clinical trial using the psychedelic drug MDMA, paired with therapy, to treat PTSD. Desperate, he enrolled in 2012. “I was willing to do anything,” he recalled recently.
PTSD is a major public health problem worldwide and is particularly associated with war. In the United States, an estimated 13% of combat veterans and up to 20% to 25% of those deployed to Iraq and Afghanistan are diagnosed with PTSD at some point in their lives, compared with 7% of the general population.
Although PTSD became an official diagnosis in 1980, doctors still have not found a surefire cure. “Some treatments are not helpful to some veterans and soldiers at all,” said Dr. Stephen Xenakis, a psychiatrist and retired U.S. Army brigadier general. As many as half of veterans who seek help do not experience a meaningful decline in symptoms, and two-thirds retain their diagnosis after treatment.
But there is growing evidence that MDMA — the illegal drug known as Ecstasy or Molly — can significantly lessen or even eliminate symptoms of PTSD when the treatment is paired with talk therapy.
Last year, scientists reported in Nature Medicine the most encouraging results to date, from the first of two Phase 3 clinical trials. The 90 participants in the study had all suffered from severe PTSD for more than 14 years on average. Each received three therapy sessions with either MDMA or a placebo, spaced one month apart and overseen by a two-person therapist team. Two months after treatment, 67% of those who received MDMA no longer qualified for a PTSD diagnosis, compared with 32% who received the placebo. As in previous trials, MDMA caused no serious side effects.
McCourry was among the 107 participants in earlier, Phase 2 trials of MDMA-assisted therapy; these were conducted between 2004 and 2017 and sponsored by the Multidisciplinary Association for Psychedelic Studies, or MAPS, a research group that has led such studies in the United States and abroad. Fifty-six percent of Phase 2 participants no longer met the criteria for PTSD after undergoing several therapeutic sessions with MDMA. At least one year after participation, that figure increased to 67%.
A decade later, McCourry still counts himself among the successes. He had his first MDMA session in 2012 under the guidance of the Mithoefers, who have worked with MAPS to develop the treatment since 2000. He shared the video of that session with The New York Times. “I was suffering so badly and had so little hope, it was inconceivable to me that doing MDMA with therapists could actually turn all of this around,” he said.
The second Phase 3 trial should be completed by October; FDA approval could follow in the second half of 2023.
“We currently deal with PTSD as something that needs to be managed in an ongoing way, but this approach represents real hope for long-term healing,” said Rachel Yehuda, a professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai in New York.
“What makes this moment different from 20 years ago is the widespread recognition that we should leave no stone unturned in identifying new treatments for PTSD,” said Dr. John Krystal, the chair of psychiatry at Yale School of Medicine, who was not involved in the research. Although data from the second Phase 3 trial are needed, he says, the results so far are “very encouraging.”
McCourry, 40, lives in Portland, Oregon, and comes from a military family. He joined the Marines in 2003 because he wanted to make a positive difference, he said: “When I went over to Iraq, I felt like we were there because it was for the overall good.”
But he soon became disillusioned. Rather than fighting for freedom, he guarded convoys of oil. He regularly saw civilians killed. He survived an explosion that knocked him unconscious, and he suspected it may have caused lasting traumatic brain injury. He never received a diagnosis because the symptoms of traumatic brain injury — problems with thinking, sleeping and mood — overlap with those of PTSD, and the Army lacks tests that can objectively distinguish between the two conditions, Xenakis said.
“I just felt like I put my life in harm’s way really for nothing,” McCourry said. “I watched friends die really for nothing.”
Two months into his deployment, McCourry was caught in a firefight. Amid a hail of bullets and mortar rounds, he spotted a white truck approaching from the opposite direction. Despite signaling the truck to stop and firing a warning shot, it kept approaching.
McCourry began shooting at it. Later, he learned that the people in the truck were a father and his two daughters. The father survived, but the girls did not. “The death of those girls, it haunted me,” McCourry said.
In 2005, between tours of duty, McCourry sought help from a battalion medical officer for his sleep and anxiety issues. When the doctor dismissed his concerns, “I kind of lost my mind and started yelling at him,” McCourry said. Shortly after, he was honorably discharged on the basis of a personality disorder — a diagnosis that was not legitimate grounds for discharge and that McCourry vehemently disputed.
McCourry tried therapy, but it “didn’t help at all,” he said. The medications he was prescribed only complicated his symptoms by causing serious side effects, including disorientation and drowsiness — a common experience.
When McCourry first heard about MDMA-assisted therapy, he doubted it would make a difference. He met with the Mithoefers for three 90-minute preparatory sessions designed to establish trust and provide guidance on how to respond to difficult memories and feelings that might arise during treatment.
Scientists still do not fully understand how MDMA catalyzes healing. Evidence in mice indicates that the drug opens what neuroscientists refer to as a “critical period,” a window that typically occurs during childhood in which the brain is more malleable and better able to learn.
“This critical-period explanation really offers a different way of thinking about it,” said Dr. Gül Dölen, a neuroscientist at Johns Hopkins University and senior author of the findings, which were published in Nature in 2019. “MDMA is allowing you to do a cognitive reappraisal and reformulate all of the personal narrative you’ve written around the trauma.”
McCourry emerged from his first session of MDMA-assisted therapy with what he described as an aerial map of his mind. “It’s just been so tangled up, I didn’t even know where to start,” he told the Mithoefers.
He slept soundly that night, and his sleep problems never returned.
In one of his later sessions with MDMA, he revisited the memory of the two girls he had accidentally killed and saw that he had been harboring a tremendous amount of self-loathing for the person he had become in Iraq. He was able to replace the contempt he felt toward “Nigel the Marine,” as he put it, with compassion.
McCourry recently became a father and — after a nearly 10-year long bureaucratic struggle — successfully convinced the Navy to correct his reason for discharge to combat-related PTSD, instead of passive-aggressive personality disorder.
He still sometimes becomes overwhelmed in stressful situations and “just starts to mentally shut down,” he said. But he is now able to recognize when this is happening and to better manage his feelings.
“It’s really important for me that these experiences I’m sharing are used to show people that there is hope,” McCourry said. “I’ll keep doing what I can to support this therapy until it’s legalized.”