3,4-Methylenedioxymethamphetamine (MDMA), commonly called “Ecstasy”, is a drug used for recreation in many countries (mainly in the developed world). It was first patented in 1912 by German pharmaceutical giants Merck, who named it “Methylsafrylamin”. [1] It appeared as a street drug in the late 1960s in the US, where it garnered the name ‘love drug’ due to it’s emotional effects. It was not until the 1980s, however, when use became widespread over North America and Europe. In the UK, it was especially popular in on the rave scene of the late ’80s/early ’90s with students. [6]
MDMA is usually found in the form of a compressed powder tablet or a capsule and is usually taken orally, sometimes smoked and almost never injected (see Figure 1). Its chemical structure is similar to methamphetamine (see Figure 2), and has hallucinogenic effects like drugs such as LSD, however these effects are not as pronounced. [6] Even though it is less potent than drugs such as LSD, it is still a class A drug (UK), most likely due to the fact that the long-term effects are still largely undefined and highly disputed in the scientific community. [5]
Despite its classification, the use of the drug has risen dramatically over the past 15-20 years. Between 1991 and 1997 the percentage of college students (US) who had taken MDMA rose from 0.9% to 2.4%. During the same period, use among young adults rose from 0.8% to 2.1%. [6] A more recent study in the US has shown that 2.3% of college students and 4.3% of young adults between the ages of 19-28 years had taken the drug at least once during the last year. [3]
MDMA works by stimulating neurones which release serotonin, a neurotransmitter which affects mood, producing a euphoric effect in which the user feels empathetic and ‘loving’ of everyone around them. However, users are also prone to dehydration as they are able to dance and exert themselves for long periods of time. This is a well known fact and some users gorge themselves with water thinking they are counteracting the dehydration, but in fact they are drinking too much water. This has caused some well publicised deaths in the past, to highlight the dangers of MDMA. [6][7]
Reported adverse effects of taking MDMA include anxiety, depression and sleep disorders such as insomnia. These however are disputed due to the fact that there is no conclusive evidence that MDMA itself actually causes these problems. [6] It is also known, from previous physiological tests, that MDMA damaged serotonin neurons in animals, some of which were non-human primates. [2][3] This is why it is thought that MDMA may cause the same problems in humans. Other studies carried out have shown that long-term ecstasy use causes impairment to verbal and visual memory. The aim of this report is to examine expert studies in this field and determine whether MDMA does in fact cause any damage to the human brain.
Results.
MDMA is known to cause damage to serotonin transporters in the brains of animals, including non-human primates such as baboons. [2]-[4] Therefore, there has obviously been speculation that it causes the same problems in the human brain. Some studies, including the ones being discussed have concluded that MDMA causes damage and reduces the number of serotonin transporters in the human brain after long-term use.
The first study was investigating serotonin neurones in MDMA users. Twenty-nine test subjects were gathered, 14 of whom had previously used ecstasy heavily and 15 who had never used the drug (controls). The 14 users had been abstaining from using the drug for 3 weeks and were drug tested before the experiments commenced using urine and blood samples. The test subjects were also paid after the drug test to ensure they hadn’t actually taken anything. A technique called positron emission tomography (PET) was used along with a carbon-11, which is a radioligand which labels serotonin transporters within the brain, so they become visible to the scan. [2] The scans were taken between one hour and an hour and a half after a tracer was injected to track the binding of the [11C]McN-5652 (the ligand which binds to the serotonin transporters).
Above are the brain scans from one control subject and an MDMA user. It clearly shows that the non-user has much higher binding activity and therefore more serotonin transporters within the brain. This contrast was shown throughout the test subjects and it is consistent with previous studies done on the action of MDMA on serotonin transporters in animals. These results, however, did not show differences in users who had been off the drug for different periods of time. [2] This graph highlights the difference in binding of [11C] McN-5652 to serotonin between non users and progressively higher users. It clearly shows a correlation between the level of MDMA use and the binding activity on the serotonin transporters. This suggests that MDMA users on average have a lower concentration of serotonin transporters. Age and sex had no noticeable effect on the results. [2]
As the test subjects had to abstain from taking drugs for 3 weeks before the scans, the global deficits in serotonin transporters observed in the MDMA users was were not because of physiological effects of MDMA or other drugs. [2] This study concluded that MDMA users are at risk of affecting their brain in that it diminishes the concentration of serotonin transporters. It is known that serotonin is important in humans’ emotional development and in functions such as memory etc.
By affecting these concentrations, users are at risk of developing memory problems and mental conditions such as depression. [2] There have been several accounts that long term use causes psychological problems including one instance, when a 26 year old male who had used ecstasy over 4 years and experiences psychological problems. He stopped using MDMA, however, after seven years abstinence, his mental condition hadn’t improved. [8] Psychological damage in baboons has also been recorded, well over a year after they had been given MDMA. [2]