Elsevier

Toxicology Letters

Volumes 112–113, 15 March 2000, Pages 153-156
Toxicology Letters

Long term psychiatric and cognitive effects of MDMA use

https://doi.org/10.1016/S0378-4274(99)00219-2Get rights and content

Abstract

Clinical case reports suggest that regular MDMA use can be associated with chronic psychiatric symptoms which persist after the cessation of drug use. Neuropsychological comparisons of regular MDMA users and controls also suggest that MDMA use may lead to memory deficits, with other cognitive processes relatively unaffected. This paper reviews these studies and discusses a number of methodological issues that impact on the interpretation of the findings. Methods for examining the biological effects of MDMA use in man are also outlined. Future research should clarify whether MDMA use has long term psychological effects, and if these are related to changes in central serotonergic function.

Introduction

The other presentations have covered the epidemiology, toxicology and acute effects of 3,4-methylenedioxymethamphetamine (MDMA). In this paper I will focus on the long term psychiatric and cognitive effects of MDMA use.

Section snippets

Psychiatric cases

The first data that indicated that MDMA use might lead to chronic psychiatric symptoms came from descriptive reports of patients who presented to clinicians. These patients had psychiatric complaints which appeared to have developed in the context of MDMA use, and which persisted after they stopped taking the drug. In the UK, ‘ecstasy’ (MDMA) use became widespread in the late 1980s in conjunction with a dramatic growth in the popularity of new forms of dance music. Young adults attending dance

Comparisons of users and non-users

An alternative to studying subjects who present with frank psychopathology is to survey MDMA users in the community and compare them with non-users. This approach has the advantage that it is likely to sample subjects who are a more representative group of the total population of MDMA users. Studies of this type have usually incorporated a neuropsychological assessment which permits the identification of cognitive deficits which the subject may be unaware of. Most have found few differences in

Biological investigations

The main measure of brain dysfunction that has been used in MDMA users is the neuroendocrine response to serotonergic probes. Some studies have reported a blunting of prolactin release in response to l-tryptophan (Price et al., 1988) or d-fenfluramine (Gerra et al., 1998) in MDMA users relative to controls, but others have not (McCann et al., 1994). Functional neuroimaging offers a more direct means of investigating central serotonergic processing. One approach is to use single photon or

Conclusions

Clinical case reports suggest that regular MDMA use can be associated with chronic psychiatric symptoms which persist after the cessation of drug use. However, it is difficult to determine whether MDMA use is directly responsible, triggers symptoms in subjects predisposed to mental illness, or is incidental. In any event, severe long term psychiatric disturbances following MDMA use seem uncommon relative to the large numbers of people who use MDMA. Neuropsychological comparisons of regular MDMA

References (24)

  • H. Curran et al.

    Mood and cognitive effects of week-end ‘high’ followed by mid-week ‘low’

    Addiction

    (1997)
  • G. Gerra et al.

    Serotonergic function after 3,4-methylenedioxymethamphetamine (‘ecstasy’) in humans

    Int. Clin. Psychopharmacol.

    (1998)
  • Cited by (67)

    • ‘Never drop without your significant other, cause that way lies ruin’: The boundary work of couples who use MDMA together

      2019, International Journal of Drug Policy
      Citation Excerpt :

      In fact, the presumption of relational harm is sometimes built into studies, which set out to measure drug-related problems including intimate partner violence (Topp et al., 1999). However, more common, is the total omission of relationships from studies of MDMA use, even those examining long-term consequences (see McGuire, 2000; Parrott, 2001; Verheyden, Maidment, & Curran, 2003). There is an assumption within these studies that the effects of drug use can be contained to the individual.

    • Interactions between specific parameters of MDMA use and cognitive and psychopathological measures

      2015, Progress in Neuro-Psychopharmacology and Biological Psychiatry
      Citation Excerpt :

      Changes in the serotonergic system can have diverse effects on the CNS, including disturbances in mental health and cognition. Several studies have found an association between MDMA use and psychiatric and cognitive syndromes (Gouzoulis-Mayfrank and Daumann, 2009; McGuire, 2000). Cognitive symptoms found in ecstasy users mostly concern learning and memory processes (Gouzoulis-Mayfrank and Daumann, 2009).

    • The Neuropathology of Drug Abuse

      2013, The Effects of Drug Abuse on the Human Nervous System
    • Reduced efficacy of fluoxetine following MDMA ("Ecstasy")-induced serotonin loss in rats

      2008, Progress in Neuro-Psychopharmacology and Biological Psychiatry
    View all citing articles on Scopus
    View full text