Influence of Gamma-Hydroxybutyric Acid-Use and Gamma-Hydroxybutyric Acid-Induced Coma on Affect and the Affective Network

Abstract

Background: Gamma-hydroxybutyric acid (GHB) is a drug of abuse associated with increased emergency room attendances, due to GHB-induced comas. Withdrawal from GHB often increases social anxiety and is linked to alterations in emotion processing. However, little is known about the effects of GHB-use and GHB-induced comas on affect regulation in humans. Objectives: We aimed to assess the effect of GHB-use and GHB-induced comas on the affective network. Method: We recruited 27 GHB users with ≥4 GHB-induced comas (GHB-Coma), 27 GHB users without a GHB-induced coma (GHB-NoComa), and 27 polydrug users who never used GHB (No-GHB). Participants completed self-report questionnaires assessing negative affect (depression, anxiety and stress) and performed an emotional face matching task during functional magnetic resonance imaging to probe activity of the amygdala and the hippocampus. Results: The GHB-Coma group reported higher levels of depression, anxiety, and stress; showed decreased activity of the hippocampus; and increased functional connectivity of the left hippocampus with the left fusiform gyrus and a cluster on the left temporal-parietal-occipital junction, when compared with the 2 other groups. The GHB-NoComa group showed decreased functional connectivity of the left hippocampus with the amygdala in comparison with the No-GHB group. Conclusions: GHB-use but in particular GHB-induced comas, are associated with altered emotion identification and hippocampal functioning. Awareness campaigns are required to raise consciousness about the adverse effects of GHB-induced comas on affect regulation, despite the absence of subjective side effects.

Effects of Recreational GHB Use and Multiple GHB-Induced Comas on Brain Structure and Impulsivity

“…In this report, we will only present data on impulsivity and brain structure. Other findings have been presented elsewhere (9)(10)(11)(12).…”

“…Disruption in their integrity has been linked to deficits in affect dysregulation, associative memory, goal-directed behavior, or impulse control (48)(49)(50). Interestingly, parts of these fasciculi parallel functional connectivity pathways where alterations were previously associated with the GHB-Coma group while performing similar cognitive processes, suggesting that the alterations found might represent a structural correlate to such functional deficits (9)(10)(11)(12). In contrast to these TBSS findings, no alterations in white matter integrity were found with tractography.…”

“…Regardless, the absence of "hangover" after recovery of consciousness contributes to the erroneous idea among recreational users that GHB use is safe and harmless (1,2,4,5). However, we recently showed that heavy GHB use with multiple GHB-induced comas is associated with differences in cognition and affect, which were linked to the abnormal activation of the prefrontal cortex (PFC) and the limbic regions (e.g., the hippocampus), and their functional connectivity with the temporal-parietal lobe regions involved in perception and attention (9)(10)(11). To a smaller extent, GHB use itself was also associated with altered resting state functional connectivity between the executive and the default mode networks (12).…”

Complications Related to Sexualized Drug Use: What Can We Learn From Literature?

“…Methamphetamine has been linked to a lot of cardiac, psychiatric, neuropsychological and dental effects ( Table 3). Gammahydroxybutyrate is a central nervous system depressant that has a double stimulant and sedative effect (Raposo Pereira et al, 2019b). GBL, which is cheaper, is taken orally in liquid form and transformed into GHB (Busardo et al, 2018).…”