Eficácia da 3,4-metilenedioximetanfetamina como terapêutica adjuvante da perturbação do stress pós-traumático: uma revisão sistemática com meta-análise

Abstract

3,4-methylenedioxymethamphetamine (MDMA) has been used in the context of assisted psychotherapy for post-traumatic stress disorder (PTSD). However, this approach is still poorly structured and has not been formally approved by the drug's regulatory authorities. In this context, the main objectives of the present work are: to evaluate the evidence of efficacy of this form of therapeutic approach in PTSD and to characterize the methodology of the therapeutic protocol. A review and meta-analysis was performed according to the PRISMA (Key Items for Reporting Systematic Reviews and Meta-analyses) recommendations. A search was performed on Pubmed and Google Scholar to select clinical trials using MDMA-assisted psychotherapy. The effect attributed to the use of MDMA was evaluated by differences in the Clinician-Administered PTSD scale (CAPS-IV) compared to the control group in which only psychotherapy was used. The number of participants who no longer met the clinical criteria for PTSD after the experimental protocol was also evaluated. The methodology that gathers the most consensus involves a protocol of 3 sessions lasting 8 hours each, carried out with an interval of one month. The experimental groups received a loading dose at 10:00 am between 75 and 125 mg of MDMA orally with an additional dose 2h after the first dose (using half of the loading dose). MDMA-assisted psychotherapy was shown to be effective, with a statistically significant reduction in the value of the CAPS-IV scale of superior in the set of experimental groups compared to the control groups. (p<0.05), with a high statistical heterogeneity. A statistically significant reduction in the number of patients with clinical PTSD criteria was also observed after the experimental protocol, in the set of experimental groups compared to the control groups.(p<0.05) A statistically significant benefit of efficacy of MDMA-assisted psychotherapy compared to classical psychotherapy was established. However, there is still a high occurrence of side effects and it is important to frame the use and consumption of MDMA for therapeutic purposes.