Psychiatric disorders in Ecstasy (MDMA) users: a literature review focusing on personal predisposition and drug history

Soar, Kirstie; Turner, John; Parrott, Andrew C.

doi:10.1002/hup.350

Cited by 70 publications

(45 citation statements)

References 26 publications

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“…Several months later she remained very anxious, emotionally labile and tearful, with frequent panic attacks. Other clinical case studies can be seen in the various reviews (McCann and Ricaurte, 1991;McCann et al, 1996;McGuire, 2000;Schifano et al, 1998;Schifano, 2000;Schifano and Magni, 1994;Soar et al, 2001). The main limitation of using individual abreactions as evidence is that they may be seen as idiosyncratic or atypical.…”

Section: Psychiatric Aspectsmentioning

confidence: 95%

Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research

Parrott

2001

Human Psychopharmacology

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MDMA (3,4-methylenedioxymethamphetamine) or 'Ecstasy' was scheduled as an illegal drug in 1986, but since then its recreational use has increased dramatically. This review covers 15 years of research into patterns of use, its acute psychological and physiological effects, and the long-term consequences of repeated use. MDMA is an indirect monoaminergic agonist, stimulating the release and inhibiting the reuptake of serotonin (5-HT) and, to a lesser extent, other neurotransmitters. Single doses of MDMA have been administered to human volunteers in double-blind placebo-controlled trials, although most findings are based upon recreational MDMA users. The 'massive' boost in neurotransmitter activity can generate intense feelings of elation and pleasure, also hyperactivity and hyperthermia. This psychophysiological arousal may be exacerbated by high ambient temperatures, overcrowding, prolonged dancing and other stimulant drugs. Occasionally the 'serotonin syndrome' reactions may prove fatal. In the days after Ecstasy use, around 80% of users report rebound depression and lethargy, due probably to monoaminergic depletion. Dosage escalation and chronic pharmacodynamic tolerance typically occur in regular users. Repeated doses of MDMA cause serotonergic neurotoxicity in laboratory animals, and there is extensive evidence for long-term neuropsychopharmacological damage in humans. Abstinent regular Ecstasy users often display reduced levels of 5-HT, 5-HIAA, tryptophan hydroxylase and serotonin transporter density; functional deficits in learning/memory, higher cognitive processing, sleep, appetite and psychiatric well-being, and, most paradoxically, 'loss of sexual interest/pleasure'. These psychobiological deficits are greatest in heavy Ecstasy users and may reflect serotonergic axonal loss in the higher brain regions, especially the frontal lobes, temporal lobes and hippocampus. These problems seem to remain long after the recreational use of Ecstasy has ceased, suggesting that the neuropharmacological damage may be permament. Copyright 2001 John Wiley& Sons, Ltd.

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Section: Psychiatric Aspectsmentioning

confidence: 95%

Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research

Parrott

2001

Human Psychopharmacology

Self Cite

315

287

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“…A Dutch study reported that MDMA use was proceeded by childhood symptoms of anxiety and depression to a significant degree, and suggested that the euphoric and relaxing effects of MDMA may be particularly seductive in patients thus afflicted [99]. A review of 18 published case reports found that 24% of MDMAexposed mentally ill patients had a psychiatric condition prior to MDMA exposure and that 34% had a significant family history, suggestive of a causative role for MDMA in the remaining individuals [100].…”

Section: Psychiatric Long-term Effectsmentioning

confidence: 99%

The Dark Side of Ecstasy: Neuropsychiatric Symptoms after Exposure to 3,4‐Methylenedioxymethamphetamine

Karlsen

Spigset

Slørdal

2007

Basic Clin Pharma Tox

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3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) is a known neurotoxin in animals. This review discusses the history, pattern of use, pharmacology, acute and long-term effects of MDMA. Emphasis is given to the concern that MDMA may induce long-term cognitive and psychiatric effects. MDMA is an illegal substance, and investigations of the effects of exposure in human beings have limitations and weaknesses. There are numerous studies suggesting a correlation between MDMA exposure and psychopathology, and that the psychotropic effects may be long-lasting or permanent. However, it is not possible to conclude that there is a causal relationship between exposure and the increased psychopathology observed in MDMA users. Longitudinal studies are needed to assess whether MDMA causes persistent cognitive impairment and/or psychiatric symptoms in human beings.In animal models, the illegal substance of abuse 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) has been shown to confer serotonergic neurotoxicity. Whether this also applies to human beings is a subject of controversy. If applicable, MDMA exposure should be expected to induce symptoms of serotonergic hypofunction, such as depression, psychoses, anxiety states and impaired cognition.This review attempts to summarize the current knowledge regarding the effects of MDMA in human beings, with emphasis on long-term neuropsychiatric effects. Relevant literature was obtained through searches in the database PubMed and reference lists in seminal articles published prior to 2007. The following search terms were used: MDMA + human + psychiatry, MDMA + human + depression, and MDMA + human + review. The searches identified approximately 1500 articles that were subjected to screening.

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“…MacInnes et al [36] debated their finding of heightened depression in some ecstasy users applying a vulnerability model, where prior predisposition made some individuals more susceptible to drug abreactions. Soar et al [47] noted that prior predisposition factors and intensive ecstasy usage patterns could both influence the clinical outcome. Butler and Montgomery [97] suggested that impulsivity was a personality factor of those predisposed to taking illicit drugs, but that regular MDMA usage then intensified this characteristic, possibly via serotonergic neurotoxicity.…”

Section: Nevertheless the Literature Is Clear: Across A Wide Range Ofmentioning

confidence: 99%

Cortisol and 3,4-Methylenedioxymethamphetamine: Neurohormonal Aspects of Bioenergetic Stress in Ecstasy Users

Parrott¹

2009

Neuropsychobiology

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Aims: 3,4-Methylenedioxymethamphetamine (MDMA) can affect both neurotransmitter and neurohormonal activity. This review will debate the role of the metabolic activation hormone cortisol for the psychobiological effects of ecstasy/MDMA. Methods: The empirical literature on cortisol release following acute MDMA administration and cortisol functioning in drug-free recreational ecstasy/MDMA users will be reviewed. This will be followed by an overview of cortisol as a bioenergetic stress neurohormone, and a debate on how it could be modulating the acute and chronic psychobiological effects of MDMA. Results: Cortisol release is increased by stimulatory factors, including physical activity, thermal stress and stimulant drugs. In laboratory studies MDMA leads to an acute cortisol increase of around 150% in sedentary humans. In MDMA-using dance clubbers, the cortisol levels are increased by around 800%, possibly due to the combined factors of stimulant drug, physical exertion and psychosocial stimulation. Regular ecstasy/MDMA users also demonstrate changes in baseline cortisol levels and cortisol reactivity, with compromised hypothalamic-pituitary-adrenal activity. Nonpharmacological research has shown how cortisol is important for psychological aspects such as memory, cognition, sleep, impulsivity, depression and neuronal damage. These same functions are often impaired in recreational ecstasy/MDMA users, and cortisol may be an important modulatory co-factor. Conclusions: The energizing hormone cortisol is involved in the psychobiology of MDMA, probably via its effects on energy metabolism. Acute cortisol release may potentiate the stimulating effects of MDMA in dance clubbers. Chronically, cortisol may contribute to the variance in functional and structural consequences of repeated ecstasy usage.

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Psychiatric disorders in Ecstasy (MDMA) users: a literature review focusing on personal predisposition and drug history

Cited by 70 publications

References 26 publications

Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research

Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research

The Dark Side of Ecstasy: Neuropsychiatric Symptoms after Exposure to 3,4‐Methylenedioxymethamphetamine

Cortisol and 3,4-Methylenedioxymethamphetamine: Neurohormonal Aspects of Bioenergetic Stress in Ecstasy Users

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