'Ecstasy' drug tied to permanent neurotoxicity: looming public health problem.(Clinical Rounds)

SAN FRANCISCO -- Use of the club drug MDMA, also known as Ecstasy, appears to result in permanent neurotoxicity, the effects of which may not be felt for many years to come, Dr. David M. McDowell said at the annual meeting of the American Psychiatric Association.

This recent finding, alarming in its public health implications, is supported by multiple lines of evidence. Neuropsychologic testing demonstrates subtle long-term deficits in Ecstasy (3, 4-methylenedioxymethamphetamine) users. Metabolic studies show diminished serotonin levels in their cerebrospinal fluid. And animal studies involving a variety of species consistently show the same worrisome neurologic lesion, said Dr. McDowell of Columbia University, New York.

The observed lesion consists of ulceration of the axons of serotonergic cells in the cerebral cortex. This profound axonal destruction has been demonstrated in monkeys shortly after receiving even a single dose of Ecstasy comparable to the dose typically used in the rave clubs--and the structural damage remains evident in these monkeys for up to at least 7 years.

"I think the functional implication is that somebody who does a lot of Ecstasy and who may not have been going to get depression ever in their lives might get depressed at age 40 or 50. And maybe somebody who does have a depressive diathesis is going to need to be treated earlier or more aggressively" the psychiatrist speculated. "I say to patients in my private practice who tell me they're going to do Ecstasy, "Look, you're already on two medications. Do you want to end up on seven?'"

Whether selective serotonin reuptake inhibitors (SSRIs) protect Ecstasy users against this permanent neurotoxicity is a hot debate topic among neuroscientists. There are theoretic advantages to taking an SSRI shortly before or within a couple of hours after using Ecstasy. Some Ecstasy users are now doing so. But the jury is still out as to whether this strategy actually works, Dr. McDowell continued.

There's a popular phrase about Ecstasy among participants in the youthful all-night-dance-party, rave-culture scene: ...