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Correspondence to Dr Scott Hoener, Department of Psychiatry, Naval Medical Center San Diego, San Diego, CA 92134, USA; [email protected]
Introduction
Post-traumatic stress disorder (PTSD) is estimated to affect between 5% and 20% of US service members who deployed to Iraq and Afghanistan since 2001 and has estimated costs of 42.7 billion dollars annually.1 2 Moreover, current therapies for PTSD have inadequate efficacy and high treatment drop-out rates.3–5 In active-duty military populations, these conditions may lead to limitations on duty status or medical separation from the service. The development of newer therapies to address trauma-related disorders more effectively and rapidly, as well as other comorbid psychiatric conditions such as depression, anxiety or substance use disorders, could provide substantial benefit to service members who have not responded to current treatments. A potential breakthrough in this search may be found in psychedelics.
In clinical trials, 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin are being investigated as adjuncts to therapy for PTSD and depression, respectively. The first phase 3 trial for MDMA-assisted therapy (MDMA-AT) showed large and sustained reductions in symptoms of PTSD.6 Current first-line therapies for PTSD include cognitive processing therapy and prolonged exposure with rates of 28%–40% of those with military-related trauma no longer being diagnosable with PTSD.1 7 Of individuals who received MDMA-AT, two-thirds were deemed in remission from PTSD after a course of treatment.6 Results were promising enough for MDMA-AT receive breakthrough therapy designation by the Food and Drug Administration (FDA) in 2017.7–9 Similarly, several phase 2 trials for psilocybin-AT showed highly encouraging results for treatment resistant depression.10–12 Psilocybin also recently demonstrated promising preliminary evidence of antiaddictive potential for treating alcohol and tobacco use disorders,13 14 though larger phase 3 trials are required. Neither MDMA or psilocybin has been studied specifically in active-duty service member populations.
MDMA and psilocybin appear to be largely safe when administered in controlled environments, with the most commonly reported side effects reported as transient anxiety, headaches, increased blood pressure and fatigue immediately following treatment.8 15 Transient anxiety, which may arise during treatment sessions with MDMA or psilocybin, appears to respond well to psychotherapeutic support.7 15 No changes in neurocognition have been reported after a course of treatment with either MDMA or psilocybin.6...