Long term psychiatric and cognitive effects of MDMA use
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
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