Meta-analysis · 2026
MDMA-assisted therapy for PTSD: pooled trial results show symptom drops but very low certainty
- Original title
- Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for posttraumatic stress disorder: A systematic review and meta-analysis of clinical and functional outcomes.
- Authors
- Fares-Otero NE, Furukawa Y, Sijbrandij M, et al.
- Journal
- European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2026
- Molecules
- MDMA
- Conditions
- PTSD
- Participants
- 298
- Evidence grade
- Low
- Source
- Read the original paper
The question
How well does MDMA-assisted therapy work for post-traumatic stress disorder (PTSD), compared with control conditions, on symptoms and day-to-day functioning?
What they did
Researchers searched nine databases plus manual sources up to August 14, 2025, for randomized controlled trials of MDMA-assisted therapy in PTSD. From 1,035 records, 14 studies were included in the written review and 8 trials had enough data to be combined statistically (24 separate comparisons). They assessed study quality with the Cochrane risk-of-bias tool and rated the certainty of the evidence using the GRADE system.
What they found
Pooled results showed MDMA-assisted therapy was associated with lower PTSD symptom severity (298 people across 9 comparisons, standardized mean difference -1.19, 95% confidence interval -1.95 to -0.42), lower dissociative symptoms (148 people, 5 comparisons, SMD -0.37, CI -0.70 to -0.04), and possibly better functioning (227 people, 4 comparisons, SMD -0.83, CI -1.47 to -0.19). There was no clear evidence of benefit for depressive symptoms. Results varied a lot between studies for PTSD symptoms and functioning (I² = 68.8% and 61.2%). Overall certainty of the evidence was rated very low.
The fine print
Few trials, small samples, and wide variation between studies limit confidence. Most trials used inactive placebos, so participants and raters could often guess who received MDMA, and most studies had high risk of bias in how outcomes were measured. Long-term follow-up data were lacking, and this summary is based on the abstract only.
What it means
Pooled trial data point toward reduced PTSD symptoms with MDMA-assisted therapy, but the evidence is weak enough that larger, better-controlled trials are needed before firm conclusions can be drawn.
Evidence grade: Low. Although it pools randomized trials, the trials were few and small, heterogeneity was high, most lacked active placebo controls, and the authors themselves rated the overall certainty of evidence as very low.
This summary is based on the study’s published abstract.