MDMA for PTSD. A vision of treating war trauma in Ukraine with psychedelic-assisted therapy

For millions of people in Ukraine, the war has caused severe mental health problems. One Ukrainian organization is proposing a new solution to this problem: a psychedelic-assisted therapy.

While scrolling on Instagram, it‘s no longer a surprise to me to see a video of somebody having a birthday party or a piano session somewhere in Ukraine while the air raid system is warning the area about another attack from Russian forces. I keep wondering – are the people in Ukraine already used to the war? Somehow, I highly doubt that war can pass by a person without leaving any trace, even if one eventually can get used to all the horror and pain.

In 2023 it was estimated that around 25 million people in Ukraine were at risk of developing a chronic mental health disorder, while up to 4 million lived with Post-Traumatic Stress Disorder, or PTSD. If people with PTSD seek medical help, they will be treated with psychotherapy and antidepressants. Apparently, the effectiveness of this kind of treatment hovers around 40 percent. So even if every person with PTSD seeked medical help, what would happen to the roughly 2,4 million people (if not more, as the war is not over yet) who woldn’t get over panic attacks, suicidal thoughts, flashbacks, anxiety, and sleeping disorders?

There are people who started offering innovative solutions as soon as Russia began its full-scale war in Ukraine. These people are now part of a non-profit organization called the Ukrainian Psychedelic Research Association, or UPRA. It started working in October 2019 as an informal community aiming to promote public discussion about psychedelic research and now unites more than 300 people, including mental health practitioners, scientists, healthcare and charity professionals, public advocates, IT specialists, project managers and others. They are trying to bring a new solution to the problem of PTSD treatment, a psychedelic-assisted therapy, by advocating for scientific research and training mental health professionals concerning psychedelics as medical drugs in Ukraine.

Scrolling through UPRA’s website, I stumbled upon a story of Stanislav Gibadulin who lost a foot and also his best friend in the war. He states that after receiving a PTSD diagnosis and thus a conventional treatment, he still struggled with panic attacks and suicidal thoughts. This continued until he tried psychedelic mushrooms and had a vision of meeting his late best friend during his psychedelic session, as he had thought about him throughout the whole treatment process. After trying magic mushrooms, he finally stopped blaming himself for his friend’s death and felt the will to live again.

Advocates of psychedelic-assisted therapy believe that these substances can help people with PTSD process traumatic memories. ©Berta Tilmantė
Advocates of psychedelic-assisted therapy believe that these substances can help people with PTSD process traumatic memories. ©Berta Tilmantė

Psilocybin mushrooms, known for their psychedelic effect, are currently legal or decriminalized in Jamaica, Bahamas, British Virgin Islands, Nepal, Samoa, Czech Republic and the states of Oregon and Colorado in the USA. Meanwhile, in the Netherlands the “magic truffles” are legal, and Canada permits taking psilocybin in palliative care and to battle severe depression. A lesser-known psychedelic substance ibogaine can be legally used in Gabon, South Africa, New Zealand and Germany. Spain, Portugal and Switzerland have decriminalised the use of various drugs. Ayahuasca ceremonies are legal in Peru and MDMA can be prescribed for medical purposes in Israel. From July 2023, approved psychiatrists in Australia can prescribe MDMA for PTSD and psilocybin for depression that has resisted other treatments, making Australia the first country in the world to regulate these drugs as medication. In some other countries, the traditional use of particular psychedelic substances is also legal.

Psilocybin and MDMA affect the human brain differently. Psilocybin creates a “psychedelic” state which means higher neuroplasticity, creative thinking, higher ability to learn new things and come to new conclusions, which helps to find new meanings. Meanwhile MDMA, which is an empathogen with psychedelic properties, creates a state of calmness, openness, and trust. A person reacts more positively to positive “thoughts” (in this case “thoughts” meaning psychic content) and less negatively to the negative ones. The activists for psychedelic-assisted therapy see these qualities as helping patients with PTSD to process traumatic memories.

Psychedelics can also have side effects. Although the risk of overdose or developing dependence from psychedelics is very low compared to other recreational drugs, some studies show that around 22 percentof mentally healthy people have experienced symptoms of anxiety and panic during a psychedelic session. Meanwhile, around 38 percent of those who experienced negative emotions during a psychedelic session were diagnosed with new mental disorders after the psychedelic experience. People who have been diagnosed with bipolar disorder or schizophrenia, or who have a family history of these disorders, are also advised by some health professionals not to use psychedelics. However, research on psychedelics is growing in popularity, as is the belief that psychedelics can benefit many people suffering from PTSD and depression.

But how exactly does psychedelic-assisted therapy work when it comes to healing the trauma of war? Would it really be a panacea to the traumatized part of Ukrainian society just like it was to Stanislav? I got answers to these and some other questions from one of UPRA’s co-founders, Viktoriya Wolotko, who holds a degree as a medical doctor from the Belarusian State Medical University, and who is currently based in Vilnius, Lithuania.

The interview has been edited and condensed.

“Ukraine needs to legally reclassify psychedelics,” says Viktoriya Wolotko. This way, doctors and researchers can provide patients with access to these substances in a “controlled and safe environment.” ©Berta Tilmantė
“Ukraine needs to legally reclassify psychedelics,” says Viktoriya Wolotko. This way, doctors and researchers can provide patients with access to these substances in a “controlled and safe environment.” ©Berta Tilmantė

How did you end up working for UPRA?

I lived in Belarus and worked at a pharmaceutical company as a business development manager. I dealt a lot with bringing new oncology drugs to the market. Trying to fit new medical drugs into the local regulatory environment was my daily job challenge. I would routinely participate in planning interactions with key stakeholders, the Ministry of Health, doctors, opinion leaders, scientists, patients and caregivers.

By then, in 2020, I was already familiar with psychedelic compounds from my own experience. I take spiritual retreats in the Netherlands to reconsider my own journey from time to time. I know them as something with great potential for changing people's lives. That's why I followed some psychedelic drug startups in pharmaceutical world news. Some developers were running commercial clinical trials of psychedelics for patients with Major Depressive Disorder and PTSD. And they had really promising results. It was obvious that psychedelic compounds are coming to the drug market.

Around that time, I met Ukrainian psychedelic activist Sasha Astron, who wanted to introduce psychedelics to the public. Ukrainian society was already much freer than Belarusian society in this regard. The Belarusian government has built a part of its political power on anti-drug discourse.

In 2022, because of the scope of the damage of the Russian aggression we saw unfolding, we believed it was the right time to try to introduce psychedelics as a solution to the trauma. We estimate that the people that witnessed the atrocities and traumatically experienced the pain of their loved ones can be counted in the millions. PTSD patients are not only those who directly got injured by the war as first responders. People forcefully displaced from their homes are at great risk of developing PTSD as well.

“In 2022, because of the scope of the damage of the Russian aggression we saw unfolding, we believed it was the right time to try to introduce psychedelics as a solution to the trauma.”

The conventional course of PTSD treatment includes psychotherapy, antidepressants, sleeping pills, anti-anxiety drugs and painkillers. According to different sources, 30 to 70 percent of people exit the course with no result. They have a higher risk of suicide, substance abuse and co-existing depressive disorder.

In 2023, we registered UPRA as a legal entity in Ukraine, as UPRA’s community has become more condensed by that time. The very name of the association includes the word “psychedelic” and our application wasn’t censored or denied.

We formulate our nearest aim as “rescheduling”. Ukraine needs to legally reclassify psychedelics, in particular MDMA and psilocybin, from being on the list of “very dangerous compounds with no medical use” to “controlled substances with medical use” list so doctors and researchers can provide patients with access to these substances in a controlled and safe environment. We believe that rescheduling MDMA and psilocybin can help mitigate the mental health crisis in Ukraine.


You've mentioned the traditional, conventional methods of PTSD therapy. Could you elaborate on why psychedelics can be more efficient than conventional treatment in this case?

What psychedelics bring to the table is a different neurophysiological approach. They pharmacologically target different receptors in the brain than conventional antidepressants do. And it causes a consciousness impact that science struggles to reliably measure. We know that in clinical practice, some patients sustainably benefit from such therapy. We see from clinical trials that 67 percent of the patients with severe chronic PTSD no longer qualified for the diagnosis after three MDMA-assisted therapy sessions.

It is not exactly known how it works. Psychedelics might have the ability to decrease the integrity of the default mode network in the human brain. The default mode network is a collection of regions in the brain that provides us with the feeling of self perception and memory. When we think about ourselves, when we judge ourselves, when we compare ourselves - that's where the Default Mode Network is in action. Psychedelics diminish the electrical activity of this network. Meanwhile, the electrical activity is redistributed to other functional zones of the brain.

Trauma survivors may experience intense emotional moments when revisiting the traumatic event. MDMA cushions the emotional overload. This way, the unspoken inner guilt and related pain become accessible for observation and processing. In some patients psychedelic experience has initiated an alteration of cyclical thinking patterns and enhanced social openness, as observed by family members. We don’t know how to measure such life quality improvements by brain scans.

At the moment, we can’t state that psychedelics are more efficient than conventional treatments, because there were no head-to-head comparison clinical trials yet. But what we can say for sure is that some patients, who do not experience clinical improvement from conventional therapy, may benefit from this new approach. And it makes it worth trying to challenge their current regulatory status.

As I understand, a psychedelic trip is something that each person experiences very differently. And the trauma of war can also be very different, as one can be traumatized from being on the frontline, another from shellings, being raped, or having seen somebody die. These traumas can also overlap. Does this kind of therapeutic, highly controlled approach let a therapist guide the patient’s trip and thus in a sense control what happens in a person’s mind?

It is impossible to predict what kind of experience will occur to the patient during a psychedelic session. Professional and compassionate therapeutic help is required to go through a consciousness-altering experience. Underground psychedelic sessions with no trauma-informed guidance can indeed be very challenging and even retraumatizing. The proposed clinical system guides the patient through preparation sessions with a therapist, where they carefully discuss the nature of the trauma. A therapist prepares the patient to deal with fear, and teaches them to use breathing techniques during the session. It is quite common to use cognitive-behavioral therapy approaches which help to set a task or a goal for the session.

An important part of any psychedelic experience is mindset and setting. The mindset is prepared by the patients themselves with the help of a psychotherapist. The setting is provided by a clinic which is organized much more as a comfy hotel room, so it does not resemble a hospital. The patient receives a psychedelic drug (MDMA or psilocybin) in the form of a pill right there at the clinic. It is also possible to track the patient's blood pressure, cardiovascular parameters and many other parameters. This brings a sense of calmness and risk management for patients because they know that if something happens, they are in a hospital. During the psychedelic session, two therapists may be present with the patient. The patient faces intense challenges during the session that might be overwhelming to them, so the therapist might support them by conversation, playing some music, holding their hand, or even providing a hug.

After the psychedelic session, integrative psychotherapy sessions occur, where patients work with the same therapist. It is important to discuss what they saw, what was revealed to them during the psychedelic experience, how they interpret it themselves, and what can be done to foster a better life for themselves.

So is the training for such therapists taking place in Ukraine right now, or is it a step to be taken only after the legalization of psychedelic-assisted therapy?

UPRA has received more than 500 applications from mental health practitioners to join a training program. Together with our partner Fluence providing training for psychedelic-assisted psychotherapy, we translated an educational program for psychologists and medical doctors into Ukrainian. It is now under consideration to become an officially recognised continuous education training program for medical practitioners. We received support from MAPS (Multidisciplinary Association for Psychedelic Studies, which is located in the US) in providing psychedelic-assisted therapy trainings as well. Fifteen Ukrainian therapists who have sufficient medical qualifications received educational programs provided by a MAPS / MAPS Israel / Phoenix Ukraine / Healing Balkans joint program last year. HUT (Heal Ukraine Trauma, a US-based nonprofit organization) is also working on group ketamine assisted therapy training for Ukrainian doctors.

It is recommended for therapists to undergo a psychedelic experience themselves. Because people who support patients undergoing such an immense alteration of consciousness cannot be skeptical of it.

©Berta Tilmantė
©Berta Tilmantė
©Berta Tilmantė
©Berta Tilmantė

I've read the story of Stanislav on your website, and it really gives one an impression that psychedelics are almost miraculous: a person is highly traumatized, then takes a pill, and suddenly is healed. But if psychedelics really do work in therapy, does it happen so fast? Shouldn't a person at least continue psychotherapy afterwards?

It really depends on the person and on the availability of the therapy. In the ideal clinical setting, of course, standard clinical protocol implies weeks of integration sessions. Stanislav had his session in an underground guided retreat. And for him that worked from the first experience. As he said, he woke up after the trip and he already knew that he had healed. His problem, the most painful issue, was the loss of his friend, and as he said, he met him and had a conversation during the psychedelic session. And that freed him, provided a sense of relief instantly. However, sustainable healing is a process that requires time. Of course, it is desirable for people to at least have integration sessions with their guide or informed therapist.

As the scale of patients with PTSD in Ukraine apparently is and will be huge, who would be the first people to have access to this kind of therapy?

Well, first of all, it will be the patients with severe PTSD who have already exhausted other therapeutic options. The current approach doesn't differentiate between causes of trauma, and mostly focuses on treatment that has already been conducted earlier and its effectiveness.

It will also depend on what resources Ukraine will have, which includes the number of clinics eligible to provide the therapy, therapists with necessary training, and the number of drugs available. People with no documented PTSD treatment history will probably not be the patients first in line.

Growing up, many of us heard statements about all drugs being very harmful. Psychedelics weren’t differentiated from others. Before and even after the legalization of psychedelic-assisted therapy, it is probably very important to make society understand the nature of psychedelics, build trust, and raise awareness on ways psychedelics can help and be used as a form of treatment. Is war triggering a change in Ukrainian society’s view of psychedelics?

It's difficult to say, we don't have data on this. But here the example of Stanislav really helps. Before he received the diagnosis, he was very much radical about drugs and drug users, and he himself was prejudiced against receiving psychedelics as a form of treatment. But PTSD is already such a huge problem in Ukraine, and it is already obvious to society that state medicine doesn't have solutions for it. People have come to the point where they're desperate and that can trigger a change. Stanislav tried psychedelics despite his former prejudice. People like him set a positive example for other patients. It's one thing to hear about psychedelics from a smart-looking person in a white robe and another from an ex-soldier who went through the therapy himself. He is speaking from his heart and has no other reasons to share this information, other than a willingness to help people around him. So the opinion is changing, because people seek solutions and eventually they find out that psychedelics work.

“It's one thing to hear about psychedelics from a smart-looking person in a white robe and another from an ex-soldier who went through the therapy himself.”

Also, Ukrainian veterans read stories of US military veterans who go to Mexico to participate in mescaline, Ayahuasca or MDMA sessions and then share their experiences on the internet. So even if Ukrainian soldiers do not believe in what UPRA does, there is some third-party evidence that psychedelics work. This also causes a risk of seeking underground therapy. There are people who offer the veterans underground therapy which is not medically controlled and may expose patients to higher risks. We see so many new psychologists who emerged as being ready to help veterans without having the proper education and proper training to work with trauma.

MAPS started its activity in the US way back in 1986 and psychedelic-assisted therapy is only legalized in a few cities and two states so far. UPRA just started operation. You’ve mentioned the international support UPRA gets, but is there political will in the Ukrainian government to help UPRA and thus make the process of legalization happen quicker than in MAPS’ case? In how much time would you see psychedelic-assisted therapy legalized in Ukraine?

Political will is something at the very top of the pyramid of any will in society. We have support from the Ukrainian mental health professional community and it comes all the way up to the level of the Ministry of Health. The Ministry of Health didn’t object to hosting our conference on psychedelic therapy at the leading public mental health hospital for veterans in Kyiv in May 2023. And there is an interest from the military community, as the representatives of institutions under the ministries of Defense and Veteran Affairs, as well as Ukrainian politicians, attended the conference and provided positive feedback on it.

When the Ministry of Health engages in support of this topic, when we can see results of international research, the willingness of partners to help and to finance many of the initiatives, and the war veterans engaging in the discussion, there is no clear reason for the government to resist the legalization. We try to speak with the government in their language. That's why we registered UPRA as a legal entity, that's why we're very cautious about how we convey our messages to society. And it is clear that the Ukrainian government is open to exploring the opportunities that are out there. The law on the legalization of medical cannabis, which comes into effect in August, will introduce some minor changes that allow for the research of scheduled substances.

“Are there prospects for [psychedelic-assisted therapy in] Belarus? I don't want to be pessimistic, but I don't see that for now, unfortunately,” says Viktoriya Wolotko. “But there is always hope.” ©Berta Tilmantė
“Are there prospects for [psychedelic-assisted therapy in] Belarus? I don't want to be pessimistic, but I don't see that for now, unfortunately,” says Viktoriya Wolotko. “But there is always hope.” ©Berta Tilmantė

This year, the US Food and Drug Administration (FDA) has accepted a New Drug Application (NDA) for MDMA intended for use in combination with psychological intervention for individuals with PTSD. We expect that this will help us to accelerate regulatory changes in Ukraine. We are optimistic to hope that the medical use of psychedelics will be legal in Ukraine in 2025. I believe that the Ukrainian spirit is so entrepreneurial that they will make the therapy very accessible. And once it becomes legal and the system is established, there will be no shortage of therapy providers.

You’ve mentioned that UPRA is important not only to Ukraine but the whole region. I thought about Belarus and, of course, the anti-government protests in 2020 after the falsified presidential election. The state apparatus traumatized thousands of people and, as repressions continue, the traumatization of Belarusian people is still ongoing. As a Belarusian, do you see a perspective of introducing psychedelic-assisted therapy to Belarusians as well?

Well, UPRA currently works for Ukraine, but it is very significant for the whole post-Soviet block and post-Soviet mentality. Are there prospects for Belarus? I don't want to be pessimistic, but I don't see that for now, unfortunately. I haven't heard much of a discussion inside the professional community in Belarus, but I am also not deeply involved in the Belarusian medical community anymore. It’s difficult to imagine fast changes in Belarus, because most of the progressive young and educated people have left the country. But there is always hope.

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Dr Linas Tamošaitis, a Field Application Strategist at Atrandi Biosciences, and Dr Oleh Orlov, a chairman and CEO of UPRA, contributed reviewing the article.