This Week at Peak Human: MDMA for PTSD, Ketamine for Depression — What the Trials Actually Show

A note from Dr. Goel

This week, two of our most-requested topics got the full evidence-review treatment: MDMA-assisted therapy for PTSD and ketamine for depression — both treatments patients ask me about constantly, and both more nuanced than the headlines suggest. We also added a pair of omega-3 explainers and refreshed our ashwagandha protocol page with the newest data. Here's what's new at Peak Human this week.

— Dr. Sanjeev Goel

This week's deep dive: psychedelic-assisted therapy, by the numbers

Two new physician-reviewed articles went live on the site this week, both on treatments that get discussed with more hype — or more fear — than evidence. Here's the honest read on each.

MDMA-assisted therapy for PTSD: what the trials actually show

The FDA's 2024 rejection of MDMA-assisted therapy is one of the most consequential — and most misunderstood — decisions in recent psychiatry. In two independent phase 3 trials, MDMA paired with structured psychotherapy produced large drops in PTSD severity: in the larger trial, 71% of participants no longer met diagnostic criteria for PTSD versus 48% on placebo-with-therapy (Mitchell et al., Nature Medicine, 2023). Yet an FDA advisory committee voted 9–2 against effectiveness, citing blinding problems, incomplete long-term safety data, and trial-conduct concerns. As of 2026, MDMA remains investigational — not approved or legally available for PTSD outside an authorized clinical trial in the US or Canada.

Ketamine for depression: the evidence that's already cleared the bar

Ketamine's close cousin, esketamine (Spravato), has already done what MDMA hasn't: in 2025 it became the first drug FDA-approved as a stand-alone treatment for treatment-resistant depression. In head-to-head trials, IV ketamine matched electroconvulsive therapy (55% vs. 41% response rate, Anand et al., NEJM, 2023), and esketamine outperformed an active comparator drug, with benefits that largely held through eight months. It is not first-line and not a supplement — it's a supervised medical treatment for people who've failed standard antidepressants.

Also new this week

Krill oil vs. fish oil: does the pricier omega-3 actually absorb better?

Krill oil is marketed as the omega-3 that absorbs better — priced accordingly. The chemistry is real: krill's EPA/DHA rides on phospholipids rather than triglycerides. But the most tightly dose-matched trial found only a small, non-significant edge for krill (118.5 vs. 108 µg/mL plasma EPA+DHA, Yurko-Mauro et al., 2015), and krill is far less concentrated — matching a standard fish-oil dose can take six or more capsules. For most people, a good triglyceride-form fish oil remains the better value.

DPA: the third omega-3 almost nobody talks about

Everyone's heard of EPA and DHA. Almost no one's heard of DPA — the omega-3 that sits between them, and in a pooled analysis of 19 cohort studies (45,637 people), was the only marine omega-3 significantly linked to lower total coronary heart disease risk. It's found in oily fish and, uniquely, in beef and lamb. The evidence is observational, not a green light to supplement — but it's a good reason to ask your clinician about a fuller omega-3 panel.

Ashwagandha (KSM-66): the protocol page, refreshed

We updated our Ashwagandha (KSM-66) database entry with the newest evidence: a 2025 meta-analysis of 15 randomized trials (873 adults) found that roughly 8 weeks of standardized root extract lowered serum cortisol by 2.36 µg/dL and perceived stress by 4.88 points versus placebo. It's one of our highest-evidence adaptogens for stress resilience — the page covers mechanism, dose range, and who should be cautious.

My take: The MDMA story is a lesson in how "the data was positive" and "the FDA said no" can both be true at once. Two independent trials showed large, real effect sizes in a condition that's brutally hard to treat — and the FDA's concerns about blinding, durability, and safety data are legitimate, not bureaucratic foot-dragging. I'd rather my patients hold both halves of that sentence than the one that makes a better headline. If you're dealing with treatment-resistant PTSD today, evidence-based options already exist — talk to your clinician about them.

Curious how these mechanisms — and the evidence behind them — compare to your own protocol? Every Peak Human membership starts with a physician review of your full picture, not just the trendiest compound.

Longevity news worth your minute

Aging as lost coordination, not single pathways. A growing number of researchers now frame aging less as a set of separate broken pathways and more as a breakdown in coordination between metabolism, immunity, mitochondria, and the microbiome — a shift with real implications for how interventions get designed and tested.

Do billionaire biohacking protocols hold up? A new Nature feature examines which parts of tech leaders' widely publicized longevity routines have real evidence behind them — and which don't.

⚕️ Important disclaimer

This newsletter is for educational purposes only and is not medical advice. Compounds discussed may be investigational and not FDA-approved. Nothing here is a recommendation to start, stop, or change any treatment. Peptide and metabolic therapies carry real risks and should only be used under qualified medical supervision. Always consult your physician before making health decisions.