More Evidence MDMA May Boost Empathy

Wendy Wolfson

March 14, 2019

Repeat use of MDMA (3,4-methylenedioxymethamphetamine), otherwise known as ecstasy, may increase self-reported "emotional empathy" over time, new research suggests.

In a cross-sectional study of the drug, researchers at the University of Exeter in the United Kingdom used computerized tasks and self reports to measure cognitive empathy, which is the ability to understand the perspective of another person; emotional empathy, which involves putting oneself in the emotional state of another; and pain from social exclusion.

Results showed that those using MDMA scored higher in self-reported emotional empathy and in cognitive empathy in computerized tasks compared with the participants who used multiple drugs but not MDMA.

Contrary to findings from previous studies, long-term use of MDMA did not increase feelings of social distress in users. In addition, there were no differences between these groups and those who only used alcohol in how they reacted to social exclusion.

"We were surprised that empathy was improved long term, but only compared to other drug users — not alcohol users alone, although it looked like it was going that way," co-investigator Celia Morgan, PhD, professor at the Psychopharmacology and Addiction Research Centre, University of Exeter, told Medscape Medical News.

The findings provide further evidence "that MDMA may be a safe drug to use alongside psychological therapy, and might actually be able to enhance prosocial processes longer term,” she added.

The study was published online February 5 in the Journal of Psychopharmacology.  

Effective for PTSD?

MDMA is currently being assessed in two phase 3 trials as a treatment for posttraumatic stress disorder (PTSD) and other trauma because it seems to help process painful memories. The drug works by eliciting release of the neurotransmitters serotonin, dopamine, and noradrenaline.

Previous research on MDMA has also shown "that under the influence, empathy is improved," Morgan said.

"No one knew if there were long-term effects, and some had suggested that as MDMA improved empathy when intoxicated, it might have a detrimental effect in the long term," she noted. 

The current 67-person cross-sectional study focused on empathy, as well as responses to socially painful events — in part because prior studies have suggested that long-term MDMA use can lessen the ability to deal with social pain by depleting the brain's serotonin levels.

The investigators compared the effect of MDMA on relative levels of empathy in three groups: one that used MDMA and other drugs (n = 25); one that used other drugs but not MDMA (n = 19); and one that consumed alcohol only (n = 23).

All groups used the substances at least once per month for the past 10 months and/or more than 10 times in a lifetime. The participants were between the ages of 18 and 43 years (mean age, 21.4 years) and 45 were women. Not all participants were students, Morgan noted.

Individuals with severe mental illness, aside from generalized depression or anxiety, were excluded from the study. One participant was removed from the study because he was found to have Asperger Syndrome.

Increased Empathy

After 24 hours of no drugs or alcohol, participants filled out the Interpersonal Reactivity Index (IRI), which measures trait empathy. They also completed the Multifaceted Empathy Test (MET), a computerized series of tasks which measures cognitive and emotional empathy, and the computerized Cyberball Game, which measures social pain from exclusion.

In addition, they recorded their feelings on the Post-Ostracism Cyberball Questionnaire (POCQ) and provided an assessment of their drug and alcohol use.

Measured by the IRI, MDMA users rated higher than non-MDMA users in cognitive and emotional empathy (P < .01).

In the MET test, cognitive empathy was again significantly greater for MDMA users compared with non-MDMA users, but there were no significant differences in emotional empathy ratings.

There were no significant differences between the groups in social pain, contradicting previous research showing that previous MDMA use over time could increase this outcome.

Study limitations included that users self-reported their drug use and that biomarkers were not used.

"In summary, the current study suggests that mild, repeated use of MDMA is not associated with any impairment to interpersonal functioning," the investigators write.

"Future work could investigate whether there are any protective effects of mild MDMA use in clinical populations, for example in those with affective disorders, or autism spectrum disorders," they add.

"A repeated MDMA trial would be interesting, to address whether these are preexisting differences. But clearly that would be tricky to run in the current legal framework," Morgan said.

Limited Applicability?

Commenting on the study for Medscape Medical News, Boris Heifets, MD, PhD, professor of anesthesiology at Stanford University, Stanford, California, said the findings were helpful as another step in setting up objective measures to spur more evaluation of MDMA's powerful therapeutic potential.

Prior studies have shown that just one to two doses of MDMA had "big effects" on patients with PTSD, he noted. However, "it is also a drug of abuse. Can you separate out the abuse potential from its societal uses?"

Heifets, who was not involved with the current research, also noted that the study used standard self-reported measures to assess empathy.

"The thing that I really liked about the study is their use of a task," he said. "It didn't work, unfortunately. They didn't see any group differences."

Still, he liked "that they were trying to create an operational definition — an understanding of what MDMA does. What we need to do is to come up with a better concrete definition of what specific psychological processes are being affected."

Heifets was also concerned about the "broader applicability" of the findings.

"The average age is 21. I am not sure what [targeting a group of light MDMA users] means exactly for patients who are going to get multiple rounds of MDMA," he concluded.

The study authors and Heifets have disclosed no relevant financial relationships.

J. Psychopharmacol. Published online February 5, 2019. Abstract

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