Nathan McGee was only four years old when he experienced the trauma that would eventually lead him to MDMA therapy almost four decades later. It’s still too painful to go into the details.

In the intervening years, he played what he calls “diagnosis bingo.” Doctors variously told Nathan he had attention deficit hyperactivity disorder, anxiety, depression, and dyslexia. In 2019 he was diagnosed with post-traumatic stress disorder. Along the way, he cycled through a vast array of medications—antidepressants, pills for anxiety, and tablets to calm the effects of ADHD. But he didn’t want to pop multiple pills every day just to feel normal. 

“I’d never really felt happy, no matter what was going on in my life,” he says. “I always felt restless, always felt this underlying heaviness. Things just didn’t connect in my head. It was like someone had taken a cable and unplugged it, and I was trying to fit it back in.”

Eventually, Nathan heard about a study that was testing the use of MDMA to treat severe PTSD and managed to get into a phase 3 clinical trial, the final hurdle before US regulators consider whether to approve the therapy.

MDMA is a synthetic psychoactive with a reputation as a party drug popular among clubbers—you may know it as ecstasy, E, or molly. It causes the brain to release large amounts of the chemical serotonin, which causes a euphoric effect, but it’s also been found to reduce activity in the brain’s limbic system, which controls our emotional responses. This seems to help people with PTSD to revisit their traumatic experiences in therapy without being overwhelmed by strong emotions like fear, embarrassment, or sadness.

To test this theory, the Multidisciplinary Association for Psychedelic Studies, a California-based nonprofit, set up a randomized, double-blind trial—the one Nathan took part in. Participants attended three eight-hour sessions, during which they were given either placebos or two doses of MDMA before discussing their problems and receiving counseling from two qualified therapists.

In May 2021, the trial’s results were published in Nature Medicine. They were breathtaking. Of the 90 patients who participated, those who received MDMA reported significantly better outcomes than the rest. Two months after treatment, 67% of participants in the MDMA group no longer had PTSD, compared with 32% in the placebo group. 

I’m seeing life as a thing to be explored and appreciated rather than something to be endured. 

Nathan McGee

Ben Sessa, a UK-based researcher involved in launching the country’s first psychedelic therapy clinic, in Bristol, says the US Food and Drug Administration could approve MDMA-assisted psychotherapy for PTSD by the end of 2023.

There are other trials under way in the US, the UK, and beyond to test whether compounds like psilocybin and ketamine could be similarly used to help treat mental illness. The early signs are positive, and if they’re borne out, they could shake up the world of mental-health treatment.

I spoke to Nathan about what the experience of MDMA-assisted therapy was like. Our conversation has been condensed and edited for clarity. 

Q: How did your mental-health struggles manifest?

A: Before I participated in the trial, things weren’t going well for me. Everything I was trying went horribly. Nothing worked. I tried so many different therapists and different techniques. I lost my job in January 2018. That was depressing, and I’d lost jobs before, but this time it was different. I decided if this is being caused by my mental health, I’m going to fix this. I’m going to do whatever it takes. If my therapist had told me I had to strip naked and walk through a crowded mall and that would help me, I’d have done it. 

Q: How did you come across this study?

A: I was just in a late-night internet rabbit hole. I’d been researching PTSD for a few hours, and I came across this study. I thought I might as well just apply. I didn’t think anything of it. In fact, I forgot about it after. I didn’t even tell my wife. Then, two months later, I got this phone call from them, asking if they could interview me. 

Q: Walk me through the experience of what the sessions were like.

A: When you get there, it really just looks like an office building. From the outside, you’d never know there’s a bunch of people taking MDMA inside. But you go through, and you’re taken to the treatment room, which has a couch, bedding, blankets, and a pillow. There’s music playing, and that’s pretty integral to the whole experience. It’s very calming. It almost feels like a spa. There’s a lot of sunlight coming in, and through the window you can see trees and a canal. It’s very peaceful. Then the two therapists come in. They check your vitals—your temperature, your blood pressure, your heart rate, and so on. They chat to you a bit about what you hope to get from the experience today. And then they do this little ceremony or ritual, where they light a candle to signify that things are starting. It almost feels a bit like a religious or a spiritual experience. So they light the candle, and then one of the therapists goes and comes back with a little dish with a pill on it. They present it to you with a cup of water, you drink the water and swallow the pill, and then you just sit and wait. You chat as you’re waiting. 

At one point I said, “I don’t think this is the MDMA.” I’d never taken anything like that before, and I was a bit nervous, to be honest. They don’t tell you if you have the MDMA or not, but the head therapist told me pretty much everyone knows. Almost as soon as I said I didn’t think I’d taken it, it kicked in. I mean, I knew. 

I remember going to the bathroom and looking in the mirror, and seeing my pupils looking like saucers. I was like, “Wow, okay.” It felt calming. My mind seemed to just open up and be clear. They’d told me beforehand that it would come in waves, and it did. I decided to lie down and put a mask over my eyes to block out the light so I could just listen to the music. I had headphones I could put on if I wanted to block everything out. My mind went into exploring everything. And then, when I was ready, I chatted to the therapists. 

I was able to almost relive the traumatic experience without all the stigma, pressure, and emotion. You could almost just stand back and analyze it, like you would a movie, looking at the sound effects, the lighting, or the makeup. I came to a kind of understanding, a realization, and I was able to let go of some of that heaviness. I would go between introspective and external periods, either talking to the therapists or just relaxing with my mask and headphones on. A bit later on in the day they gave me another dose, of a bit less of the drug, just to lengthen the experience. As I was coming down, they were talking me through the whole process. 

My wife came to pick me up. She said she saw an immediate difference in the aftermath. I just seemed instantly so much calmer. You do three of these sort of day-long sessions, and then you return for a few of what they call “consolidation” sessions, where you fit everything you’ve learned together. 

Q: How do you feel now?

A: I feel amazing. This trial has changed my life dramatically. I feel alive. I understand what joy is now. I’m not floating around on a cloud—I’m not never sad. But when I feel down now, it doesn’t feel like the end, or a state I’m stuck in. I know it is just a crappy day, which we all get. Before, I felt constantly stressed and felt like nothing good ever happened. Now I can appreciate the good. My wife, my two daughters, all my family and my friends—I enjoy their company so much more now that I am less concerned with myself. My relationship with my parents has improved tremendously too.  

I’m 43 now. I was four when this traumatic experience happened to me. It has had a lifelong and deeply profound impact on me, in ways I only now understand. It changed how I saw the world. And what I am starting to learn now is there’s a difference between who I really am and who I am because of the effects of the trauma. There is this core me that always existed. It was hard for me not to confuse the ups and downs of my life with who I actually am. That’s changed now. I’m tapping back into that four-year-old self, and I’m seeing life as a thing to be explored and appreciated rather than something to be endured. 

Q: What would you say to people considering seeking psychedelic therapy?

A: It can’t get legalized fast enough, especially with the state of the world right now. There are a lot of people out there who are suffering and looking for comfort, or just any sort of relief. But it isn’t just a case of taking the drugs. I don’t condone or condemn recreational use, but if you think “I’ll go to Burning Man and heal my depression by scoring some molly,” you might be disappointed. You need to have the right people there to guide you through it, and help you to feel safe and strong. It’s great, but you have to do it the right way.

Charlotte Jee is a reporter at MIT Technology Review.