For 13 years, Scott Ostrom endured horrible dreams: nightmares in which bullets "just dribbled out of the end” of his weapon in a gunfight; situations when he shot people point-blank; messes where he failed his fellow Marines.
That left Ostrom, a former reconnaissance Marine whose battle with post-traumatic stress disorder was documented in a 2012 Pulitzer Prize-winning photo essay, struggling to function during his waking hours. Tormented by his past and lacking quality sleep, he couldn’t hold a steady job, maintain relationships or go out much in public.
But after three sessions of using MDMA, aka Ecstasy, aka Molly, in conjunction with therapy, the nightmares are gone, seemingly forever, he said in an interview with Military.com.
"Now I sleep in because I have these really cool dreams about really fun shit,” Ostrom said from his Colorado home. “It's awesome."
The Iraq war veteran was one of 90 patients with PTSD who volunteered for MDMA-assisted counseling to see if it improved their condition.
And for he and 40 other people in the study, it did: In the first clinical research trial to test effectiveness of the approach, more than two-thirds of the 46 people who received MDMA and therapy no longer met the criteria for PTSD two months after the study, compared with one-third who received a placebo.
Importantly, the MDMA had few side effects other than muscle soreness, nausea and decreased appetite in those who took it.
"We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation," the researchers, led by University of California-San Francisco neuroscientist Jennifer Mitchell, wrote in the study published earlier this month in the journal Nature Medicine.
Nearly 16% of Iraq and Afghanistan war veterans and 30% of Vietnam veterans are estimated to have had PTSD at some point, according to the Department of Veterans Affairs. Scientists have spent decades looking for treatments, in the hopes of giving those with the chronic illness the chance to maintain relationships, hold a steady job or be comfortable in public.
For many, the established therapies don’t work. Antidepressants and anxiety medications, psychotherapy or cognitive behavioral therapies, eye movement desensitization and reprocessing have helped some, but they left others searching for alternatives.
According to at least one study, nearly 40% and more than 55% who took FDA-approved PTSD medications Paxil or Zoloft, respectively, saw no reduction in their symptoms; just 21%-46% of patients who engaged only in psychotherapy saw improvements.
Ostrom was one of those patients, prescribed a fist full of medications at VA after he left the service in 2007 -- the antipsychotic Seroquel to address nightmares, Oxycontin for orthopedic pain, drugs to help him sleep, drugs to treat the side effects of the drugs.
His life spiraled into unemployment, drug abuse and bad relationships.
"I've always tried to work on getting myself to a better place ... but it'd be like one step forward, two steps back," Ostrom said. "When I saw the study mentioned -- I think on Facebook -- I was like, absolutely, I'd definitely like to do MDMA with a professional."
The participants in the study, which was conducted in Canada, Israel and the United States, included combat veterans, first responders and victims of trauma such as sexual assault or domestic violence. All had severe PTSD, on average, for more than 13 years. More than 90% had considered suicide at some point in their lives, and roughly a third went into the study expressing thoughts of suicide.
The patients were randomly placed in one of two groups -- 46 who would receive MDMA and 44 who received a placebo, or sugar pill.
Over the course of three all-day sessions spaced across three months, the patients were administered MDMA or a placebo and told to engage in inward thought, contemplating their traumas while wearing eye shades and headphones to block out the world, and express their thoughts with their therapists during lulls in their inner monologues.
Ostrom described the experience as allowing him to view himself and his traumatic experiences with empathy. The "walls" he had put up to deny his trauma disappeared, he said.
"Once those boundaries dissolved, it exposed truths, these raw truths in such a gentle and loving way,” he said.” “You can sort of see that maybe you weren't involved, or you can forgive yourself, or you realize there were circumstances that you couldn't change.”
Of the 46 patients who received MDMA, "only five people ... were non-responders," Berra Yazar-Klosinski, chief scientific officer for research sponsor Multidisciplinary Association for Psychedelic Studies, said in an interview. "For that reason, it's really exciting, and we have breakthrough therapy designation [a classification the FDA sometimes awards experimental medications for conditions that lack approved, effective treatments] based on historical comparison to Paxil and Zoloft, which are approved to treat PTSD."
The study also showed that those who received MDMA saw a drop in depression and regained “functional improvement,” meaning they were more inclined to work, participate in household activities or see family and friends.
In this and previous safety studies, the MDMA group also saw long-term improvement in their sleep quality, Yazar-Klosinski said. "That's important because most of the available sleep medications actually have a lot of risks associated with taking them long term," she said.
MDMA was synthesized by the German pharmaceutical manufacturer Merck in 1912 as a precursor to a blood-thinning medication. But other than a few animal studies, the drug went largely forgotten until the late 1970s, when Navy veteran and psychopharmacologist Alexander Shulgin synthesized it and shared it with other psychiatrists for use in talk therapy.
As its popularity grew in the early 1980s as a party drug, the Drug Enforcement Agency designated it a Schedule 1 drug, effectively outlawing it for any use, including therapy. But in recent years, the FDA has approved testing MDMA for research on pain and PTSD, although it has not been approved as a treatment for any conditions as of yet.
The U.K.-made, medical-quality MDMA used in research trials is not the same as what can be ordered illicitly on the internet or purchased on the street. The drug popularized at raves is often of questionable origin and can be cut with any number of additives or not even MDMA at all.
In 2013, a rash of deaths at summer concert venues were attributed to Molly or Ecstasy. According to the Drug Abuse Warning Network, the estimated number of emergency department visits involving Ecstasy in patients below 21 increased 128% between 2005 and 2011 -- the year the Substance Abuse and Mental Health Services Administration stopped publishing the data -- from 4,460 visits to 10,176. It’s unclear if the hospital visits were tied to excessive dosages, or tainted supplies.
Well before he enrolled in the study, Ostrom and a friend, another combat veteran, used Ecstasy to see whether it would improve their mental states. Ostrom described the experiment as "a great release and a great way to spend an afternoon with my best friend," but it wasn't the healing experience he had in the study.
"We didn't have the psychotherapy to go with it or the integration the next day. In this case, the whole is bigger than the sum of the two parts -- MDMA, plus psychotherapy, just goes together," Ostrom said.
Scientists aren't 100% sure how MDMA works in the brain and on the nervous system, but Yazar-Klosinski said the drug influences the actions of several neurotransmitters that "make it a really good fit for treating PTSD."
"I always like to say that MDMA turns on all the faucets in the brain," Yazar-Klosinki said. "And it ends up being the effect that a lot of people associate with pro-social feelings," meaning they are more likely to share their thoughts and emotions, as well as bond, with others .
But it's the combination of therapy with this medication that makes it especially effective for PTSD, she added.
"PTSD and depression and other mental health issues arise because of cognitive rigidity -- your brain gets stuck in a certain way,” Yazar-Klosinki said. “MDMA helps loosen that up. MDMA enables a patient to shut off that fight or flight response, and then they can move more into cognition, and thinking about things."
The approach is unlikely to be necessary for everyone. A third of the patients who took the placebo overcame their diagnosis through therapy alone.
But the results are promising enough that after having completed several Phase II trials, which tested the therapy’s safety, a second Phase III clinical trial, designed to study effectiveness, is underway. That research is one of the last steps needed before developers apply for full FDA approval.
If accepted, the treatment could be available as early as next year.
The effort has enrolled 35% of participants needed and is seeking additional volunteers in the U.S., Canada and Israel through MDMAPTSD.org.
Ostrom said that once it becomes available in a clinical setting, he will seek at least one more treatment to address his post-combat trauma.
For now, Ostrom is living a medication-free life in Boulder, Colorado, running his own heating and air conditioning company, gardening, fly-fishing and enjoying life with his girlfriend Jamie and Tim, his cherished golden-Labrador mix.
"I don't want to sell the treatment too hard because it's like telling someone, 'You have to see this movie or go try this restaurant,’" Ostrom said. "But this is something you don't have to take for the rest of your life. You don't have to remember to take it every night. And man, those clinicians are really, really special. They know what they're doing."
-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.