MDMA Boosts Social Bonding, Improves Cooperation

Michael Vlessides

December 06, 2018

MDMA (3,4-methylenedioxymethamphetamine), the active ingredient in the recreational drug ecstasy, may help individuals regain trust in others, results from a small study in healthy men suggest.

The British research team behind the double-blind, placebo-controlled crossover trial found that those who received 100 mg of MDMA — which is known to affect interpersonal interactions — were more likely to cooperate with a trustworthy opponent in a simulated game than their counterparts who received placebo. Investigators also found altered activity in brain regions linked to social cognition.

"What we found really interesting about our results is that using a game-theory paradigm, we were able to see that MDMA increased how much people wanted to cooperate with interacting partners," principal investigator Anthony S. Gabay, PhD, a postdoctoral fellow at the University of Oxford, United Kingdom, told Medscape Medical News.

"But what was surprising was that this was only the case when they were interacting with someone who was already trustworthy," Gabay added. "It means that when people were interacting with an untrustworthy person, MDMA didn't change their behavior at all. It didn't make people want to naively cooperate with those who were uncooperative."

The study was published online November 19 in the Journal of Neuroscience.

Marked Social, Emotional Effects

Social decision making is an integral part of successful social functioning but can be negatively affected both by psychiatric illness and serotoninergic modulation. Current medications do not effectively address social cognitive deficits.

New evidence suggests that manipulating the serotoninergic system can positively affect social decision making. MDMA has been shown to produce marked social and emotional effects, particularly with respect to interpersonal interactions.

To test the effect of MDMA on cooperation, investigators turned to a social decision making game called the Prisoner's Dilemma, which has been shown to affect various regions of the brain known to be involved in social processing. These include the superior temporal sulcus, the temporal parietal junction, and the posterior cingulate gyrus.

The researchers also tested other components of social cognition by including emotion-recognition and empathy tasks in the trial.

A total of 21 male participants were recruited. All of the participants had had at least one previous experience with MDMA; 20 patients (mean age, 24.8 ± 3.7 years) completed the study. The participants had no history of psychiatric illness or other neurologic disorders.

While undergoing neuroimaging, the volunteers each played repeated rounds of the game with opponents of differing cooperation levels. In each round, participants chose to compete or cooperate and were asked to rate their trust in the other player.

At the conclusion of each experimental session, participants completed the 11-dimension Altered States of Consciousness questionnaire, considered to be the gold standard when investigating compounds with psychedeliclike properties.

The study showed that after taking MDMA, cooperation was enhanced with trustworthy opponents (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.42 - 2.84; P < .001) but not an untrustworthy player (OR, 1.37; 95% CI, 0.78 - 2.30 [nonsignificant]). Specifically, the drug was found to enhance recovery from, but not the impact of, breaches in cooperation.

With respect to neuroimaging, MDMA was found to increase activation of four brain regions — the precentral and supramarginal gyri, the superior temporal cortex, the central operculum/posterior insula, and the supplementary motor area.

"The brain imaging allowed us to look at various phases of social interactions, including the decision phase, feedback phase, and trust phase," said Gabay. "We found MDMA had an effect only when people were receiving feedback about the other person's behavior.

"That means that somehow, the drug is affecting the brain processes underlying the processing of that feedback. But when it came to actually making their own decisions, MDMA didn't have an effect," he added.

Gabay believes the study offers meaningful insights into how MDMA — and perhaps similar agents — may ultimately prove beneficial in people suffering from psychiatric disorders that negatively affect social interactions.

"There are a lot of conditions which are known to have impairments in social interactions, such as depression and schizophrenia," he explained. "And so by showing that different aspects of the social interaction can be modulated with MDMA, it gets us thinking that perhaps we can modulate these sorts of things."

New Treatment for Mental Illness?

Commenting on the findings for Medscape Medical News, Matthew W. Johnson, PhD, associate professor of medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland, who was not involved in the study, said that although the findings are consistent with anecdotal evidence that MDMA can increase social bonding and rapport between people, the effect is not absolute.

"It was only seen with other people who at least treated them fairly most of the time, and MDMA allowed people to recover to cooperation quicker rather than completely leaving the participants completely gullible," he noted.

"This is very consistent with the notion that MDMA increases rapport and trust between a patient and a compassionate therapist during therapy for posttraumatic stress disorder [PTSD], a disorder for which MDMA is showing promising results.

"That's important, because we know that such rapport is critical to maximize success of psychotherapy, and we know that rapport and trust are difficult, understandably, for patients dealing with PTSD," he added.

Recently, as reported by Medscape Medical News, MDMA has been shown to benefit patients with PTSD.

Given the study's findings, the researchers were confident that MDMA may one day play a role in the treatment of psychiatric disorders.

"With all the clinical trials that are going on at the moment, I think there could well be a day when — in the context of psychotherapy at least — people could be given MDMA to help with psychiatric disorders," said Gabay.

Dr Gabay and Dr Johnson have disclosed no relevant financial relationships.

J Neurosci. Published online November 19, 2018. Abstract

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