Ecstasy, not ECT

Depression is a big problem. There are effective medicines to treat depression, called selective serotonin reuptake inhibitors (SSRI); prozac and paxil are examples of this drug class. They work by increasing the amount of serotonin available to serotonergic axons in the brain. For reasons which are unclear to me, the SSRI drugs do not immediately alleviate depression - often they take 4-6 weeks to work - and if they aren't going to work for a certain individual, he or she must endure 4-6 weeks of depression before this fact is clear. A person who takes a tablet of prozac in fact usually feels nothing - there are almost no acute effects.

For depressed people who are at suicide risk or who are too depressed to take their medicines, the only fast acting treatment is electroconvulsive therapy (ECT). Although ECT works, and is "safe", it is distasteful to most and clearly another comparably active method would be welcome.

Ecstasy (MDMA) is an abused and maligned drug which also works by augmenting serotonergic release in the brain. Unlike the serotonergic drugs mentioned above, ecstasy does cause acute and usually pleasant effects.

Ecstasy is, pharmacologically, essentially fast acting prozac. I propose a study of severely depressed individuals who are candidates for ECT in which these individuals are instead treated with one or several doses of ecstasy in a controlled hospital environment. If it does not help, they could then go on to receive ECT anyway. If some do benefit, the next step would be a larger randomized trial comparing ECT to X.