Ecstasy (MDMA) Information
What Is Ecstasy?
The chemical abbreviation for the so-called "designer" drug
Ecstasy is "MDMA."
Users of MDMA (Ecstasy) may encounter problems similar to those
experienced by amphetamine and cocaine users, including addiction.
In addition to its rewarding effects, MDMA's psychological effects
can include confusion, depression, sleep problems, anxiety, and paranoia
during, and sometimes weeks after, taking the drug. Physical effects can
include muscle tension, involuntary teeth clenching, nausea, blurred
vision, faintness, and chills or sweating. Increases in heart rate and
blood pressure are a special risk for people with circulatory or heart
disease.
MDMA-related fatalities at "raves" (large, all-night dance
parties) have been reported. NIDA's epidemiologic studies indicate that
MDMA (Ecstasy) use has escalated in recent years among college students
and young adults who attend these social gatherings. The stimulant
effects of Ecstasy, which enable the user to dance for extended periods,
combined with the hot, crowded conditions usually found at raves can
lead to dehydration, hyperthermia, and heart or kidney failure.
MDMA (3,4-methylenedioxymethamphetamine) damages brain serotonin
neurons. Serotonin is thought to play a role in regulating mood, memory,
sleep, and appetite. Recent research indicates heavy MDMA use causes
persistent memory problems in humans.
Long-term brain injury from use of MDMA (Ecstasy)
MDMA (Ecstasy) causes long-lasting damage to brain areas that are
critical for thought and memory, according to new research findings in
The Journal of Neuroscience.
In an experiment with red squirrel monkeys, researchers at The Johns
Hopkins University demonstrated that four days of exposure to the drug
caused damage that persisted six to seven years later. These findings
help to validate previous research by the Hopkins team in humans,
showing that people who had taken MDMA scored lower on memory tests.
"The serotonin system, which is compromised by MDMA, is
fundamental to the brain's integration of information and emotion,"
says Dr. Alan I. Leshner, director of the National Institute on Drug
Abuse (NIDA), National Institutes of Health, which funded the research.
"At the very least, people who take MDMA, even just a few times,
are risking long-term, perhaps permanent, problems with learning and
memory."
The researchers found that the nerve cells (neurons) damaged by MDMA
are those that use the chemical serotonin to communicate with other
neurons. The Hopkins team had also previously conducted brain imaging
research in human MDMA users, in collaboration with the National
Institute of Mental Health, which showed extensive damage to serotonin
neurons.
MDMA (Ecstasy) tests reveal brain damage
MDMA (Ecstasy) has a stimulant effect, causing similar euphoria and
increased alertness as cocaine and amphetamine. It also causes
mescaline-like psychedelic effects. First used in the 1980s, it has
become the drug of choice of young people attending raves.
In this new study, the Hopkins researchers administered either MDMA
or salt water to the monkeys twice a day for four days. After two weeks,
the scientists examined the brains of half of the monkeys. Then, after
six to seven years, the brains of the remaining monkeys were examined,
along with age-matched controls.
In the brains of the monkeys examined soon after the two-week period,
Dr. George Ricaurte and his colleagues found that MDMA caused more
damage to serotonin neurons in some parts of the brain than in others.
Areas particularly affected were the neocortex (the outer part of the
brain where conscious thought occurs) and the hippocampus (which plays a
key role in forming long-term memories).
This damage was also apparent, although to a lesser extent, in the
brains of monkeys who had received MDMA during the same two-week period
but who had received no MDMA for six to seven years. In contrast, no
damage was noticeable in the brains of those who had received salt
water.
"Some recovery of serotonin neurons was apparent in the brains
of the monkeys given MDMA six to seven years previously," says Dr.
Ricaurte, "but this recovery occurred only in certain regions, and
was not always complete. Other brain regions showed no evidence of
recovery whatsoever."
MDMA (Ecstasy) brain damage apparent in humans
Further studies have revealed the first direct evidence that chronic
use of MDMA causes brain damage in people. Using advanced brain imaging
techniques, the NIDA study found that MDMA harms neurons that release
serotonin, a brain chemical thought to play an important role in
regulating memory and other functions.
In a related study, researchers found that heavy MDMA users have
memory problems that persist for at least two weeks after they have
stopped using the drug. Both studies suggest that the extent of damage
is directly correlated with the amount of MDMA use.
"The message from these studies is that MDMA does change the
brain and it looks like there are functional consequences to these
changes," says Dr. Joseph Frascella of NIDA's Division of Treatment
Research and Development.
That message is particularly significant for young people who
participate in raves where the drug is often passed around, and which
continue to be popular in many cities around the nation.
In the brain imaging study, researchers used positron emission
tomography (PET) to take brain scans of 14 MDMA users who had not used
any psychoactive drug, including MDMA, for at least three weeks. Brain
images also were taken of 15 people who had never used MDMA. Both groups
were similar in age and level of education and had comparable numbers of
men and women.
In people who had used MDMA, the PET images showed significant
reductions in the number of serotonin transporters, the sites on neuron
surfaces that reabsorb serotonin from the space between cells after it
has completed its work. The lasting reduction of serotonin transporters
occurred throughout the brain, and people who had used MDMA more often
lost more serotonin transporters than those who had used the drug less.
Previous PET studies with baboons also produced images indicating
MDMA had induced long-term reductions in the number of serotonin
transporters. Examinations of brain tissue from the animals provided
further confirmation that the decrease in serotonin transporters seen in
the PET images corresponded to actual loss of serotonin nerve endings
containing transporters in the baboons' brains.
"Based on what we found with our animal studies, we maintain
that the changes revealed by PET imaging are probably related to damage
of serotonin nerve endings in humans who had used MDMA," says Dr.
George Ricaurte of The Johns Hopkins Medical Institutions in Baltimore.
Dr. Ricaurte is the principal investigator for both studies, which are
part of a clinical research project that is assessing the long-term
effects of MDMA.
"The real question in all imaging studies is what these changes
mean when it comes to functional consequences," says NIDA's Dr.
Frascella.
MDMA (Ecstasy) study shows memory impairment
To help answer that question, a team of researchers, which included
scientists from Johns Hopkins and the National Institute of Mental
Health who had worked on the imaging study, attempted to assess the
effects of chronic MDMA use on memory. In this study, researchers
administered several standardized memory tests to 24 MDMA users who had
not used the drug for at least two weeks and 24 people who had never
used the drug. Both groups were matched for age, gender, education, and
vocabulary scores.
The study found that, compared to the nonusers, heavy Ecstasy users
had significant impairments in visual and verbal memory. As had been
found in the brain imaging study, MDMA's harmful effects were
dose-related and the more MDMA people used, the greater difficulty they
had in recalling what they had seen and heard during testing.
MDMA tests in U.K. support findings
The memory impairments found in MDMA users are among the first
functional consequences of MDMA-induced damage of serotonin neurons to
emerge. Recent studies conducted in the United Kingdom also have
reported memory problems in MDMA users assessed within a few days of
their last drug use. "Our study extends the MDMA-induced memory
impairment to at least 2 weeks since last drug use and thus shows that
MDMA's effects on memory cannot be attributed to withdrawal or residual
drug effects," says Dr. Karen Bolla of Johns Hopkins, who helped
conduct the study.
The Johns Hopkins/NIMH researchers also were able to link poorer
memory performance by MDMA users to loss of brain serotonin function by
measuring the levels of a serotonin metabolite in study participants'
spinal fluid. These measurements showed that MDMA users had lower levels
of the metabolite than people who had not used the drug; that the more
MDMA they reported using, the lower the level of the metabolite; and
that the people with the lowest levels of the metabolite had the poorest
memory performance. Taken together, these findings support the
conclusion that MDMA-induced brain serotonin neurotoxicity may account
for the persistent memory impairment found in MDMA users, Dr. Bolla
says.
Research on the functional consequences of MDMA-induced damage of
serotonin-producing neurons in humans is at an early stage, and the
scientists who conducted the studies cannot say definitively that the
harm to brain serotonin neurons shown in the imaging study accounts for
the memory impairments found among chronic users of the drug. However,
"that's the concern, and it's certainly the most obvious basis for
the memory problems that some MDMA users have developed," Dr.
Ricaurte says.
MDMA-caused cognitive dysfunction appears to be permanent
Findings from another Johns Hopkins/NIMH study now suggest that
Ecstasy / MDMA use may lead to impairments in other cognitive functions
besides memory, such as the ability to reason verbally or sustain
attention. Researchers are continuing to examine the effects of chronic
MDMA use on memory and other functions in which serotonin has been
implicated, such as mood, impulse control, and sleep cycles. How long
MDMA-induced brain damage persists and the long-term consequences of
that damage are other questions researchers are trying to answer. Animal
studies, which first documented the neurotoxic effects of the drug,
suggest that the loss of serotonin neurons in humans may last for many
years and possibly be permanent.
"We now know that brain damage is still present in monkeys seven
years after discontinuing the drug," Dr. Ricaurte says. "We
don't know just yet if we're dealing with such a long-lasting effect in
people."
Information on this page courtesy of National
Institute on Drug Abuse.
NOTE: See additional Ecstasy information page links in the Related
Links column at the right.
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