FDA Approves Study of Ecstasy In Some Terminally Ill Patients

Bender, Eve

doi:10.1176/pn.40.2.00400046a

Cited by 4 publications

(4 citation statements)

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“…This would be in concordance with findings that depression (Parrott et al, 2002), impulsivity (Halpern et al, 2004), and especially memory problems in ecstasy users are dose related (Bolla et al, 1998;Morgan, 2000;Gouzoulis-Mayfrank et al, 2000;Reneman et al, 2001a), although it was shown that even novice ecstasy users who used ecstasy less than ten times reported a diversity of problems which they attributed to their ecstasy use (Parrott et al, 2002). Especially because there is growing interest in the possible medical benefits of low dose ecstasy as an adjuvant to psychotherapy (Check, 2004;Bender, 2005), it is an important finding that low doses of ecstasy use do not seem to cause increased depression or impulsivity.…”

Section: Discussionsupporting

confidence: 81%

Ecstasy use and self-reported depression, impulsivity, and sensation seeking: a prospective cohort study

et al. 2006

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Although there are indications that ecstasy users have higher levels of depression, impulsivity, and sensation seeking, it is unknown whether these are consequences of ecstasy use or predisposing factors for starting ecstasy use. We prospectively assessed the predictive value of depression, impulsivity, and sensation seeking on future first time ecstasy use. We also assessed whether depression, impulsivity, and sensation seeking had changed after first ecstasy use. Depression, impulsivity, and sensation seeking were assessed using self-report questionnaires in 188 ecstasy-naive volunteers with high probability for future ecstasy use. After a mean follow-up of 17 months, measurements were repeated in 59 incident ecstasy users (mean 6.0 tablets) and 61 matched persistent ecstasy-naive volunteers. Only experience seeking (subscale of the sensation seeking scale) predicted future ecstasy use (OR -- 1.05, 95% CI 1.00 to 1.10), but after adjustment for potential confounders this was not significant anymore. At follow-up, significant effects of ecstasy use on the general and the disinhibition subscale of the sensation seeking scale were observed (after adjustment for potential confounders: regression coefficient B 0.51, 95% CI 0.20 to 0.83 and B -- 3.25, 95% CI 1.74 to 4.76, respectively). These data indicate that depression, impulsivity, and sensation seeking do not predict first time ecstasy use in a population of young adults with the intention to start using ecstasy and that low level ecstasy use does not seem to cause depression or impulsivity. However, low level ecstasy use may increase (certain aspects of) sensation seeking.

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Section: Discussionsupporting

confidence: 81%

Ecstasy use and self-reported depression, impulsivity, and sensation seeking: a prospective cohort study

et al. 2006

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“…As pointed out above, it is possible that some abnormalities represent preselection or biological vulnerability markers that predate actual drug taking. Because MDMA is occasionally administered to human beings in research studies, and has been used therapeutically as a psychotherapy adjunct in disorders characterized by anxiety, 86–88 including post‐traumatic stress disorder and terminal cancer, 89 it is also important for ethical decision making to determine the possible negative consequences, if any, of low doses of MDMA.…”

Section: Structural Brain Abnormalities and Mdmamentioning

confidence: 99%

Abuse of Amphetamines and Structural Abnormalities in the Brain

Berman

O’Neill²,

Fears³

et al. 2008

Annals of the New York Academy of Sciences

230

242

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We review evidence that structural brain abnormalities are associated with abuse of amphetamines. A brief history of amphetamine use/abuse, and evidence for toxicity is followed by a summary of findings from structural magnetic resonance imaging (MRI) studies of human subjects who had abused amphetamines and children who were exposed to amphetamines in utero. Evidence comes from studies that used a variety of techniques that include manual tracing, pattern matching, voxel-based, tensor-based, or cortical thickness mapping, quantification of white matter signal hyperintensities, and diffusion tensor imaging. Ten studies compared controls to individuals who were exposed to methamphetamine. Three studies assessed individuals exposed to 3-4-methylenedioxymethamphetamine (MDMA). Brain structural abnormalities were consistently reported in amphetamine abusers, as compared to control subjects. These included lower cortical gray matter volume and higher striatal volume than control subjects. These differences might reflect brain features that could predispose to substance dependence. High striatal volumes might also reflect compensation for toxicity in the dopamine-rich basal ganglia. Prenatal exposure was associated with striatal volume that was below control values, suggesting that such compensation might not occur in utero. Several forms of white matter abnormality are also common, and may involve gliosis. Many of the limitations and inconsistencies in the literature relate to techniques and cross-sectional designs, which cannot infer causality. Potential confounding influences include effects of pre-existing risk/protective factors, development, gender, severity of amphetamine abuse, abuse of other drugs, abstinence, and differences in lifestyle. Longitudinal designs in which multimodal datasets are acquired and are subjected to multivariate analyses would enhance our ability to provide general conclusions regarding the associations between amphetamine abuse and brain structure.

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“…Second, it is debated whether MDMA should become available for medical use, because MDMA may be useful as an adjunct in psychotherapy, or whether this would lead to neuronal damage (Check, 2004). This discussion is of interest, since pilots have been approved that will study therapeutic effects of MDMA on anxiety in patients with post-traumatic stress disorder (Check, 2004) and in terminally ill cancer patients (Bender, 2005). When considering ecstasy as adjunct in psychotherapy, it is important that estimations of risk are available to decide whether potential risks outweigh potential benefits.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Cohort Study on Sustained Effects of Low-Dose Ecstasy Use on the Brain in New Ecstasy Users

Win

Reneman

Jager

et al. 2006

Neuropsychopharmacol

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It is debated whether ecstasy use has neurotoxic effects on the human brain and what the effects are of a low dose of ecstasy use. We prospectively studied sustained effects (42 weeks abstinence) of a low dose of ecstasy on the brain in ecstasy-naive volunteers using a combination of advanced MR techniques and self-report questionnaires on psychopathology as part of the NeXT (Netherlands XTC Toxicity) study. Outcomes of proton magnetic resonance spectroscopy ( 1 H-MRS), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), and questionnaires on depression, impulsivity, and sensation seeking were compared in 30 subjects (12M, 21.873.1 years) in two sessions before and after first ecstasy use (1.871.3 tablets). Interval between baseline and follow-up was on average 8.176.5 months and time between last ecstasy use and follow-up was 7.774.4 weeks. Using 1 H-MRS, no significant changes were observed in metabolite concentrations of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and creatine (Cr), nor in ratios of NAA, Cho, and mI relative to Cr. However, ecstasy use was followed by a sustained 0.9% increase in fractional anisotropy (FA) in frontoparietal white matter, a 3.4% decrease in apparent diffusion (ADC) in the thalamus and a sustained decrease in relative regional cerebral blood volume (rrCBV) in the thalamus (À6.2%), dorsolateral frontal cortex (À4.0%), and superior parietal cortex (À3.0%) (all significant at po0.05, paired t-tests). After correction for multiple comparisons, only the rrCBV decrease in the dorsolateral frontal cortex remained significant. We also observed increased impulsivity ( + 3.7% on the Barratt Impulsiveness Scale) and decreased depression (À28.0% on the Beck Depression Inventory) in novel ecstasy users, although effect sizes were limited and clinical relevance questionable. As no indications were found for structural neuronal damage with the currently used techniques, our data do not support the concern that incidental ecstasy use leads to extensive axonal damage. However, sustained decreases in rrCBV and ADC values may indicate that even low ecstasy doses can induce prolonged vasoconstriction in some brain areas, although it is not known whether this effect is permanent. Additional studies are needed to replicate these findings.

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FDA Approves Study of Ecstasy In Some Terminally Ill Patients

Cited by 4 publications

References 0 publications

Ecstasy use and self-reported depression, impulsivity, and sensation seeking: a prospective cohort study

Ecstasy use and self-reported depression, impulsivity, and sensation seeking: a prospective cohort study

Abuse of Amphetamines and Structural Abnormalities in the Brain

A Prospective Cohort Study on Sustained Effects of Low-Dose Ecstasy Use on the Brain in New Ecstasy Users

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