Welcome to Back from the Abyss. I'm Dr. Craig Hecock.

Today's episode is called What I'm Thinking About Now.

It's looking like FDA approval for MDMA is coming this year, and I'm both thrilled

at this prospect and also a little worried.

On the positive side, I think medicalized MDMA is going to revolutionize how we treat

complex and developmental trauma, arguably one of the most difficult to treat syndromes

in all of psychiatry and psychology.

MDMA will help so many people regain their lives, begin to trust, and to feel, and to love

again, and I think it's also going to cause some harm if we

aren't very careful. Psychiatrically, the sweet spot of MDMA-assisted therapy is patients with

pure trauma, where their anxiety and depression and despair all come out of trauma. And millions of people,

in fact, have trauma as their core and primary

issue. However, there are also millions of people with trauma and with an endogenous mood or

psychotic or anxiety disorder, such as bipolar disorder, or OCD, or schizophrenic disorder. Many of these

folks are going to want to try MDMA therapy,

but will face the hurdle of being on various psychiatric meds that interact in potentially

dangerous ways with MDMA, or will simply render MDMA ineffective.

What I'm seeing in my practice is that patients with significant mental illness, with serious mood and anxiety

and psychotic disorders, they cannot and should not go off all their meds in an attempt to do

MDMA assisted therapy. The safer middle ground might look like tapering some psychiatric

meds prior to the MDMA session, but not going off the meds completely. But there's still

so much we really don't know here.

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