Authors of a Dutch study in this week’s issue of THE LANCET conclude that long-term ecstasy use-especially among women-could have serious negative effects on specific cells in the brain. The study also suggests that the adverse effects of ecstasy use can sometimes be reversed among people who stop using the drug.
Ecstasy is a popular recreational drug that has been shown to damage brain serotonin neurons in high doses. Irreversible loss of serotonin neurons can result in the immediate or delayed onset of neuropsychiatric disorders; serotonin imbalance is thought to underlie depression, anxiety, panic disorder, and disorders of impulse control. The effects of moderate ecstasy use on serotonin neurons have not been studied, and sex differences and the long-term effects of ecstasy use on serotonin neurons have not been identified.
Liesbeth Reneman and colleagues from Academic Medical Centre, Amsterdam, Netherlands, investigated the effects of moderate and heavy ecstasy use, sex differences, and long-term effects of ecstasy use on serotonin neurons in different brain regions. Using flyers posted in “rave” venues in Amsterdam, the investigators recruited 15 moderate ecstasy users, 23 heavy users, 16 ex-users who had stopped using ecstasy for more than 1 year, and 15 controls who claimed never to have used the drug. The effects of ecstasy on brain serotonin neurons was assessed by calculating the ratio of serotonin receptor density in different parts of the brain compared with the cerebellum; this was done using single-photon-emission computed tomography (SPECT).
Among heavy ecstasy users, substantial decreases in overall binding ratios were seen in women but not men. In female ex-ecstasy users, overall densities of serotonin transporters were significantly higher than in heavy ecstasy users.
In an accompanying Commentary (p 1831), George Ricaurte and Una McCann from Johns Hopkins UniversitySchool of Medicine, Baltimore, USA, conclude: “Although the study is timely and potentially important, the small sample size and methodological questions limit confidence in conclusions about differences between sexes or possibility of reversibility of the effects of MDMA [ecstasy] in human beings. Studies in larger cohorts of both sexes, free of psychiatric illnesses in which serotonin is implicated, are needed.”
Contact: Dr Liesbeth Reneman, c/o Department of Communications, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; T) +31 20 566 2929; F) +31 20 696 7899; E) reneman@amc.uva.nl
Professor George A Ricaurte, Department of Neurology, John Hopkins Bayview Medical Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224 USA; T) +1 410 550 0993; F) +1 410 550 2005; E) RICAURTE@JHMI.EDU
Journal
The Lancet