Is Ecstasy the Key to Alleviating Autism Anxiety?

Autism resists both definitions and treatment within the medical community. But the strange historical interpretation of autistic behavior and symptoms has led to novel experimental treatments for the disorder. Sometimes a disease that doesn’t fit neatly into the medical paradigm must go outside that paradigm in search of nontraditional treatment options.

Because autism presents itself in such a variety of ways—from individuals who are completely nonverbal to those with more aggressive, disorganized behaviors—it resists a definitive treatment protocol. In fact, there are no pharmacological interventions that “treat” autism.

Instead, psychiatrists are focused on treating co-morbid conditions, often things like depression, anxiety, and social isolation. So, today, someone on the autism spectrum might take an antidepressant or an atypical antipsychotic medication to improve their experience in the world, but these medications aren’t correcting any neurological changes associated with autism itself. Now, there's building interest in testing the clinical use of psychedelics. Last week, the FDA approved a research study protocol in which adults diagnosed with both autism and social anxiety will be given the psychedelic drug MDMA in hopes that they’ll experience a long-term reduction in anxiety.

Alicia Danforth, a Ph.D. candidate in clinical psychology who focuses on psychedelic research, recently completed a research study on adults with autism who have self-administered ecstasy. Because of how difficult it has traditionally been to get research studies through the FDA approval process, many studies investigating the effects of psychedelic compounds are in fact non-controlled, survey studies on individuals who have illegally and independently used psychedelic drugs. The purpose of this self-administration ranged from those who were using it purely recreationally, to individuals curious about the potential therapeutic effects of MDMA trying, at least partially, to "self-medicate."

The results of her survey study were positive and promising, though of course far more rigorous studies are necessary to strengthen the connection between MDMA use and improvement in social anxiety in the autistic. Danforth said that over half of the people she interviewed spontaneously made reports in improvement in social anxiety.

When asked if structured research studies with autistic people and MDMA will be similar in format to the PTSD trials already underway, Danforth said that there’s a “general consensus in the field that conventional psychotherapies don’t work particularly well with autistic individuals. There are some barriers to developing that trust and therapeutic rapport, so we’re really reconsidering what MDMA-assisted therapy will look like.” So perhaps it’s the actual experience of trust enabled by the drug, rather than any specific talk therapy that takes place while under the influence, that is ultimately beneficial.

It’s important to note that those on the autism spectrum do not necessarily want to be “cured” of their autism, to become neurotypical. Many of the manifestations (or symptoms) of autism can be seen as beneficial—for example, increased ability to focus on details and highly specialized interests. However, the difficulty in relating to others can take a psychological toll. New research into psychedelics and autism treatment is focused on this aspect of the disorder: they want to ease co-existing anxiety, not “fix” neurological differences.

Psychedelics operate in a way that is fundamentally different from the most common pharmacological treatments for mental illnesses like depression and anxiety. These drugs—things like SSRIs and atypical antipsychotics—are maintenance therapies, taken over years or decades to suppress symptoms. Psychedelic drugs operate on the principle that a person can alter their perception of the world in a more permanent way via transient, controlled psychedelic experiences. So while a person who undergoes MDMA-assisted therapy might continue to take some supportive therapy (like an antidepressant) after the experience, the hope is that they would have a sustained improvement in their social anxiety as a result of the therapy.

After a relatively brief period of psychedelic experimentation (both formal and recreational) in the 1950s-70s, the tide of public opinion quickly turned against compounds like LSD and psilocybin both because of their association with the counter-culture movement of the time and due to some of the less-than-rigorous experimental protocols being used by researchers like Timothy Leary. In fact, there was even some research into the effects of LSD and psilocybin on autistic children, then referred to as childhood schizophrenics, which would likely find resistance in today’s ethics review boards.

Following this backlash, doing research on these compounds was all but impossible in the United States. MDMA, despite being originally synthesized in the 1910s, was not really utilized by the US psychiatric community until the 70s, when certain doctors began experimenting with MDMA-assisted therapy.

However, the drug was made illegal in 1985 following its increasing prevalence as a recreational nightlife enhancement. All these compounds—LSD, psilocybin, MDMA, even THC—are listed as Schedule I on the DEA’s list of drug compounds. This indicates that they all have high abuse potential and no redeeming medical value. In order to be reclassified, lowered to the level of, say, methamphetamine (Schedule II) or Xanax (Schedule IV), MDMA would need to be demonstrated to have some medical benefit.

MDMA has been used in a variety of psychotherapeutic settings where a reduction of fear and anxiety, and an increase in trust and rapport, would be beneficial. The current MDMA and PTSD trials taking part here in the US under the Mithoefers have garnered substantial publicity. They have had remarkable success in allowing sexual assault survivors and veterans suffering from PTSD to process difficult memories under the influence of the drug. Simply put, their technique operates on the principle that if you are able to process difficult stimulus under the influence of a mood-enhancing drug like MDMA, that it will both be emotionally “easier” to confront the situation and will provide lasting benefits.

Those with PTSD might recall traumatic events—things they might not otherwise feel capable of speaking about—and work through them using talk therapy with trained therapists under the influence of MDMA. So why might MDMA be helpful in treating those with autism? One of the hallmarks of autism spectrum disorder is an inability to connect to other people socially in the same way that neurotypical individuals do. Obviously, this can often be a source of social anxiety; there can often be a real fear of meeting new people or journeying into unfamiliar settings, which can in turn lead to dissatisfaction and depression.

There is [some evidence](http:// http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697059/ ) that traditional anti-anxiety medications are actually less effective in treating anxiety in autistic individuals than in the general population. It has been postulated that the autistic have fewer GABA receptors, receptors that are instrumental in producing the effect of benzodiazepines (Xanax, for example), one of the most common classes of drugs used in treating anxiety. Because of this, researchers must look outside the box for different types of intervention.

Though Danforth emphasizes that we are truly in the infancy of understanding how MDMA may be beneficial therapeutically. “There are some theories about how MDMA attenuates fear responses," she said. "That burst of oxytocin that you get in the brain may aid bonding and connectedness."

"There’s reduction in left amygdule activation, so the fear centers of the brain calm down a bit,” she continued. “To give you a specific example: participants that I interviewed in my research talked about a reduction in the discomfort during eye contact. They had very sudden and novel experiences of actually enjoying looking into people’s eyes.”

Ecstasy also affected the participants’ perception of their ability to interpret nonverbal cues, a notorious deficit in those with Asperger's. The recently approved research study, which Danforth is also involved with, aims to more formally investigate these anecdotal benefits.

12 MDMA-naïve autistic participants will be enrolled in the study; eight of them will be given various doses of MDMA and later assessed for reduction in social anxiety. The actual protocol involves periods of both structured and unstructured periods of time, with the structured time to be "selected based on elements of therapeutic interventions that are currently in use in this population for the treatment of social anxiety" and the unstructured period to be filled with some combination of self-selected activities, things like making art, listening to pre-selected music, or writing in a journal.

Because of the difficulty of psychedelic researchers obtaining research grant money from the National Institute of Health--with an annual budget of approximately $31 billion, the NIH is the most common source of funding for much medical research—MDMA research is funded through private means, either by foundations or individual donations. The autism and MDMA study, while FDA approved, still needs to raise $256,000 before moving forward.

The investigation of MDMA-assisted therapy for social anxiety in autistic individuals is an important extension of this type of therapy. As with treatment in those with PTSD, it's possible that this therapy could have long-term benefits for patients. This departure from other types of pharmaceutical intervention represents a new way of thinking about mental illness.

Perhaps, sometimes the best way to heal the mind and alter old ways of thinking isn't to consistently introduce drugs that slightly alter brain chemistry; perhaps a very real way of healing lies in administering a drug that radically alters thinking for a short period of time. Now that the stigma surrounding psychedelic research begins to slowly recede, it's possible that this generation of scientists will be able to continue research in this important area.

There's a saying in the addiction industry that, in effect, a broken brain can't fix itself, that patterns of thinking are best altered by outside influence. But an extension of this idea is that the brain, when under the influence of certain psychedelic medication in a controlled environment, can itself be the outside influence.

@kellybourdet