\u201cIt felt like a huge gap between what everyone else around me was experiencing and myself. Everyone else was living, whereas I was just trying to survive.\u201d<\/p>\n
But after the Melbourne lawyer discovered a New Zealand trial into the use of MDMA therapy, she leapt at the opportunity to take part.<\/p>\n
In Australia, the Therapeutic Goods Administration (TGA) has permitted the use of MDMA, also known as the party drug ecstasy, for the treatment of post-traumatic stress disorder. But the cost of receiving this treatment is high, at about $20,000.<\/p>\n
Academic psychiatrist David Menkes, who has cared for seriously ill patients for several decades, says MDMA treatment is now viewed in a different light when it comes to depression, anxiety and other psychological challenges.<\/p>\n
Those facing the prospect of death, Menkes says, often experience existential distress and concern about life\u2019s meaning and purpose.<\/p>\n
Psychedelic therapy was not something Gleeson had considered before receiving her cancer diagnosis, but after researching studies online, she was convinced it was something that could help.<\/p>\n
To avoid the prohibitive cost, she made the jump across the ditch to join a landmark study seeking participants.<\/p>\n
\u201cI still struggle to put into words what it actually has done for me,” Gleeson says.<\/p>\n
Menkes, who studied medicine and has a PhD in pharmacology from Ivy League university Yale, says conventional palliative care is usually successful in managing pain, anxiety and depression. However, patients facing a life-limiting diagnosis often also experience existential distress.<\/p>\n
\u201cPeople approaching the end of life can often feel dissatisfied and have a sense of a lack of completion.<\/p>\n
\u201cThey might have regrets about the past, concern about problematic family relationships, and uncertainty about what lies ahead. Such existential concerns are highly individual and more challenging to treat than symptoms of anxiety and depression,\u201d Menkes, who also trained in psychiatry in Dunedin, says.<\/p>\n
\u201cThat\u2019s one of the things where conventional psychiatry and indeed conventional palliative care don\u2019t really have a great track record.\u201d<\/p>\n
The trial of which Gleeson is part is taking place at two study sites, Dunedin and Auckland, with another planned in Hamilton. Overall, the study aims to recruit 32 cancer patients experiencing depression and anxiety. Participants will be randomly assigned to receive 120mg of MDMA or an active placebo with similar stimulant effects. To reduce possible bias, neither participants nor researchers will know which they received until the end of the trial.<\/p>\n
After the randomised trial, each participant is given the opportunity to experience a further treatment session with MDMA in case they missed out during the formal, blinded study.<\/p>\n
Gleeson chose this option. After flying to New Zealand for the trial, she found herself in an Auckland clinic lying under a blanket and wearing a large pair of headphones before receiving a dose of MDMA.<\/p>\n
Vivid memories and images emerged in her mind as she found herself reliving a collection of different events from her life.<\/p>\n
\u201cThe following day, my close friend was looking at me when I was eating breakfast, and her words were: I just can\u2019t believe how different you are,\u201d Gleeson says.<\/p>\n
\u201cI still struggle to put into words what it has actually done for me. There\u2019s a lightness to me, a calmness and an acceptance.\u201d<\/p>\n
Since receiving MDMA therapy, Shannon Gleeson has been travelling the world.<\/p>\n
Since the therapy, Gleeson has travelled and now has plans to start a business, and she feels the therapy has given her the ability to live fully despite her diagnosis. However, she also views regular therapy sessions, eating well and exercising as contributing to maintaining her sense of wellbeing.<\/p>\n
She views the professionalism of the clinicians and the way they kept her well-informed throughout the entire process as being integral to the success of the therapy, rather than the isolated effects of the substance itself.<\/p>\n
\u201cI don\u2019t want to make it seem like this is a silver bullet,\u201d she says.<\/p>\n
The trial involves more than just taking a dose of MDMA during a seven-hour treatment session. There are 90-minute preparation and integration sessions before and after the experience, as well as phone calls and questionnaires to check in on patients in the months following.<\/p>\n
Much of the cost of MDMA therapy overseas, outside of research trials, comes from the lengthy amount of clinician time needed. Two therapists are required to sit with the patient during the lengthy treatment session.<\/p>\n
Menkes says early evidence suggests MDMA therapy appears to work by shutting down the amygdala, a section of the brain that is activated in fearful situations. As a result, people can find it easier to talk about things that would otherwise be suppressed because they are too fear-inducing. The drug then facilitates feelings of connectedness, even love, towards oneself, other people, and the environment.<\/p>\n
Elizabeth, who also has advanced cancer, chose to have an MDMA therapy session at a Dunedin clinic after her trial. After six months, she found she was finally able to rewrite her will and scatter her husband\u2019s ashes after 15 years. The heavy feeling she was carrying inside had shifted.<\/p>\n
The 77-year-old witnessed substance abuse in her own family that led to her living a sober life from a young age. She never contemplated taking hard drugs.<\/p>\n
She works three days a week as a counsellor, and her decision to take part in the MDMA trial was motivated by her desire to be able to continue helping her patients after depressive thoughts were affecting her mental and emotional state.<\/p>\n
\u201cI think that the whole MDMA experience has lifted this low mood, that I wasn\u2019t even fully aware of,\u201d she says.<\/p>\n
\u201cYou know, when you hear your illness is progressive, it\u2019s incurable. It stuffs up your head, because what decisions can you possibly make?\u201d<\/p>\n
In the days following her MDMA session, Elizabeth experienced a comedown and \u201ccried for a week\u201d, but she says the long-term effect of the drug was overwhelmingly positive.<\/p>\n
Menkes says he isn\u2019t aware of any significant adverse effects from taking MDMA so far in the trial, but there were potential side effects of the drug, such as increased blood pressure and heart rate. One of the exclusion criteria for the trial is if someone is too frail from their illness to withstand the cardiovascular effects of the drug.<\/p>\n
Leona at Bastion Point where she went to watch the sunrise before receiving MDMA therapy for the first time. Photo \/ Michael Craig<\/p>\n
There is also a societal stigma around taking psychedelics, which Menkes says could be part of what is slowing down investigations into MDMA\u2019s possible therapeutic use. For Leona*, her workplace and job as a prominent board member means she is not permitted to reveal her identity for this story.<\/p>\n
After receiving the news of an advanced cancer diagnosis, Leona began taking anti-depressants and fantasising about jumping off buildings. Suicide did not feel like an option because of her children, but she felt herself slipping out of reality and into a dark place.<\/p>\n
In an Auckland clinic in February, Leona received her first dose of MDMA. The sensations that followed were intense and made her feel she was \u201cutterly connected\u201d to her surroundings and that \u201cevery cell in my body was vibrating\u201d.<\/p>\n
Leona, who is M\u0101ori, says her MDMA experience also involved connecting with te ao M\u0101ori, her spirituality, and during the session she saw visions of herself on a waka travelling home to her ancestors, being guided by the stars.<\/p>\n
\u201cIt has just completely dissolved my fear of death,\u201d she says.<\/p>\n
Among the nearly 200 patients who have taken part in early use of MDMA therapy in Australia, there have been no serious adverse events recorded, but access to treatment is progressing slowly as only authorised psychiatrists can prescribe the drug.<\/p>\n
Before the trial, Leona perceived MDMA as a party drug that was \u201cillegal for a good reason\u201d and had tried it only once recreationally in her university years. By contrast, she says a therapeutic MDMA session was \u201cthe most profound experience of my life\u201d and changed her view of the drug.<\/p>\n
After receiving MDMA therapy, Elizabeth completed two paintings that symbolise the before and after of her mental state.<\/p>\n
Menkes believes it is unlikely MDMA will become a front-line conventional treatment, but he sees a case for it becoming more available for people with treatment-resistant PTSD and, as suggested by the current trial, cancer patients struggling with unresolved existential issues.<\/p>\n
\u201cI would always suggest to people, for example with PTSD, that they try a generic intervention first,\u201d he says.<\/p>\n
He says psychiatrists are excited about the potential of MDMA therapy because usual treatment for severe PTSD often includes daily medication and weekly psychotherapy sessions for months or years. A potentially one-off experience and could radically alter the treatment paradigm, Menkes believes.<\/p>\n
In New Zealand, psychedelic therapy is slowly progressing in other areas too, as the use of psilocybin<\/a>, the active constituent in magic mushrooms, has been permitted for a psychiatrist and doctor working in palliative care, who can prescribe it for treatment-resistant depression and end-of-life distress, respectively.<\/p>\n When asked if the treatment should be publicly funded, Menkes says it could be a cost-effective option for the Government, if it enables functional recovery and a return to work in cases of severe PTSD.<\/p>\n \u201cParticularly if they\u2019re young and have a lot of years left, an expensive treatment may be worth the investment if it helps to restore function and return them to society.\u201d<\/p>\n Gleeson says she is surprised New Zealand is lagging behind Australia in terms of its use of psychedelic therapy because she views the country as being more open and progressive in terms of social justice issues.<\/p>\n \u201cI have a lot of hope that maybe New Zealand can find a different model for this that isn\u2019t so prohibitive in terms of cost.\u201d<\/p>\n Menkes says the future availability of psychedelic medicines could offer valuable alternatives to patients who might otherwise choose to pursue the End-of-Life Choice Act and assisted dying.<\/p>\n An unanticipated result emerging from the trial is also an improvement in the cancer of some participants. Scan results Elizabeth received in February show her cancer has not progressed, which her oncologist described as \u201camazing\u201d.<\/p>\n Gleeson has a remarkable story to tell now. She recently recorded clear scans, and there is currently no evidence of cancer in her body as she continues to undergo maintenance therapy.<\/p>\n \u201cI believe the mind was a critical component in this healing journey that I\u2019ve been on,\u201d she says.<\/p>\n For now, Leona\u2019s blood test results show her tumour markers are normal and there is currently no active cancer. However, she warns this could easily change.<\/p>\n Menkes says it is tempting to speculate that an improved sense of emotional wellbeing may contribute to positive outcomes for cancer patients, as stress is known to compromise the immune system. On the other hand, he explains, the study was designed to assess psychological wellbeing and quality of life, not cancer outcomes, and it is impossible to reach a conclusion at this early stage of the research.<\/p>\n *Name withheld for privacy reasons.<\/p>\n The trial has been conducted by a dedicated research team of 24 members and has been co-sponsored by Auckland University and Otago University with support from Mana Health.<\/p>\n To take part in the trial, people have to be over the age of 18, living with a confirmed cancer diagnosis, and experiencing depression. Interested individuals and health professionals can find out about the study and make enquiries on the EMMAC Study website<\/a>. The study is supported by charitable funding; further donations<\/a> will continue this work.<\/p>\n\u201cIt has just completely dissolved my fear of death,\u201d Leona says. Photo \/ Michael Craig<\/p>\n