( ±)-MDMA and its enantiomers: potential therapeutic advantages of R (−)-MDMA

AbstractThe use of ( ±)-3,4-methylenedioxymethamphetamine ((±)-MDMA) as an adjunct to psychotherapy in the treatment of psychiatric and behavioral disorders dates back over 50 years. Only in recent years have controlled and peer-reviewed preclinical and clinical studies lent support to (±)-MDMA’s hypothesized clin ical utility. However, the clinical utility of (±)-MDMA is potentially mitigated by a range of demonstrated adverse effects. One potential solution could lie in the individualS(+) andR( −) enantiomers that comprise (±)-MDMA. Individual enantiomers of racemic compounds have been employed in psychiatry to improve a drug’s therapeutic index. Although no research has explored the individual effects of eitherS(+)-MDMA orR( −)-MDMA in humans in a controlled manner, preclinical research has examined similarities and differences between the two molecules and the racemic compound. This review addresses information related to the pharmacodynamics, neurotoxicity, physiological effects, and behavioral effects ofS(+)-MDMA andR( −)-MDMA that might guide preclinical and clinical research. The current preclinical evidence suggests thatR( −)-MDMA may provide an improved therapeutic index, maintaining the therapeutic effects of (±)-MDMA with a reduced side effect profile, and that future investigations should investigate the therapeutic potential ofR( −)-MDMA.
Source: Psychopharmacology - Category: Psychiatry Source Type: research