In the Lancet for May 20, three doctors from Sydney, Australia, paint a sombre picture of the evil effects of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy"). This drug, abused by young adults on a wide scale, is an amphetamine analogue which induces euphoria, stimulation and a sense of closeness to others.
MDMA is typically regarded as a safe drug by many of its users, and is often taken fortnightly or less frequently because of the tolerance that develops to it. Larger doses are necessary if the drug is taken more often, and this increases the prevalence of undesirable side effects. Injecting it increases the risk of serotonin neurotoxicity, and multiple or repeated doses by mouth have a similar ill effect. To make matters worse, MDMA is often used in hot and crowded environments with limited access to drinking water and increased risk of hyperthermia.
Effects on the brains of users have included depletion of serotonin uptake sites, reduction of glucose metabolism in the left hippocampus and alterations of electroencephalogram patterns resembling those of ageing and dementia. Following MDMA use there may be depression for up to a week, and more persistent depressive symptoms have been observed. Repeated use of MDMA or taking other drugs to mitigate its effects may result in irritability, depression and sleep disturbances. Short-term memory may be disrupted, and memory and cognition may be impaired for a longer term. After long-term abuse, cardiac dysfunction, eating disorders, thermoregulation defects and sleeping abnormalities may occur, while exposure of infants in utero may be associated with congenital defects.
It is considered that the risk of clinical depression and suicide in users should be assessed urgently, and that individuals with memory dysfunction should be studied to determine the effects of abstinence and ageing. Some serious hazard might be associated with the recourse to selective serotonin reuptake inhibitors such as fluoxetine to overcome the dysphoria experienced after MDMA use. Fluoxetine might potentiate some toxic effects of MDMA.