Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-25T04:24:13.761Z Has data issue: false hasContentIssue false
  • English
  • Français

Agony and ecstasy: a review of MDMA effects and toxicity

Published online by Cambridge University Press:  16 April 2020

C. Burgess ,
A. O’Donohoe  and
M. Gill
C. Burgess*
Affiliation:
Department of Psychiatry, The Trinity Health Sciences Centre, St. James's Hospital,Dublin 8, Ireland
A. O’Donohoe
Affiliation:
Department of Psychiatry, The Trinity Health Sciences Centre, St. James's Hospital,Dublin 8, Ireland
M. Gill
Affiliation:
Department of Psychiatry, The Trinity Health Sciences Centre, St. James's Hospital,Dublin 8, Ireland
*
*Correspondence and reprints: Dr. Ciara Burgess, Specialist Registrar in Psychiatry, The Postgraduate Medical Education Centre, Box 342, Fulbourn Hospital, Cambridge, Cambridgeshire, CB1 5EF, UK
Get access

Summary

Background

Background – Ecstasy is a recreational drug with an anecdotal reputation for safety. However, reports of adverse effects and fatalities have increased in the medical and popular press.

Methods

Method – Literature search and review.

Results

Results – Acute Ecstasy toxicity does not appear to be due to overdose and cannot be solely attributed to the nature of the usual ambient environment. Adverse effects include hyperthermia, seizures, cardiac arrhythmias, hepatotoxicity, hyponatraemia and many psychiatric disorders. Ecstasy causes serotonergic neurotoxicity in the brains of animals at doses close to those used by humans, but its long-term effect on the human brain is unknown.

Conclusions

Conclusion – Ecstasy toxicity should be considered in the differential diagnosis of a variety of medical and psychiatric conditions. Given its popularity, both the acute and the potential long-term effects are a cause for concern.

Keywords

ecstasygeneticMDMAserotonintoxicity
Type
Review
Information
European Psychiatry , Volume 15 , Issue 5 , August 2000 , pp. 287 - 294
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allen, R.PMcCann, U.DRicaurte, G.APersistent effects of (+/-) 3,4-methylenedioxymethamphetamine on sleep Sleep 16 1993 560–564CrossRefGoogle Scholar
Brosen, KRecent developments in hepatic drug oxidation. Implications for clinical pharmacokinetics Clin Pharmacokinet 18 1990 220–239CrossRefGoogle ScholarPubMed
Brown, COsterloch, JMultiple severe complications from recreational ingestion of MDMA, (“Ecstasy”) JAMA 258 1987 780–781CrossRefGoogle Scholar
Brown, E.RJarvie, D.DSimpson, DUse of drugs at ‘raves’ Scott Med J 40 1995 168–171CrossRefGoogle Scholar
Colado, M.IWilliams, J.LGreen, A.RThe hyperthermic and neurotoxic effects of “Ecstasy”, (MDMA) and 3,4-methylenedioxyamphetamine, (MDA), in the Dark Agouti rat, a model of the CYP2D6 poor metaboliser phenotype Br J Pharmacol 115 1995 1281–1289CrossRefGoogle Scholar
Colado, M.IO’Shea, EGranados, RMurray, T.KGreen, A.RIn vivo evidence for free radical involvement in the degeneration of rat brain 5HT following administration of MDMA (‘ecstasy’) and p-chloroamphetamine but not the degeneration following fenfluramine Br J Pharmacol 121 1997 889–900CrossRefGoogle Scholar
Concar, DDeadly combination. Should pharmaceutical companies warn patients about the dangers of mixing prescribed medications with illicit drugs? New Scientist 155 1997 20–21Google Scholar
Curran, H.VTravill, R.AMood and cognitive effects of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy): weekend high followed by mid-week low Addiction 92 1997 821–831Google ScholarPubMed
De la Torre, ROrtuno, JMas, MFarre, MSegura, JFatal MDMA intoxication Lancet 353 1999 593593CrossRefGoogle ScholarPubMed
Dowling, G.PMcDonagh, E.TBost, R.O“Eve” and “Ecstasy.” A report of five deaths associated with the use of MDEA and MDMA JAMA 257 1987 1615–1617CrossRefGoogle ScholarPubMed
Downing, JThe psychological and physiological effects of MDMA on normal volunteers J Psychoactive Drugs 18 1986 335–340CrossRefGoogle ScholarPubMed
Ellis, A.IWendon, J.APortmann, BWilliams, RAcute liver damage and Ecstasy ingestion Gut 38 1996 454–458CrossRefGoogle ScholarPubMed
Fischer, CHatzidimitriou, GWros, J et al. Reorganisation of 5HT axon projections in animals previously exposed to the recreational drug (+/–) 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”) J Neurosci 15 1995 5476–5485CrossRefGoogle Scholar
Frischer, MTaylor, AGoldberg, D.JMcKeganey, NBloor, MIncreasing Ecstasy use among Glasgow drug injectors Addiction Res 3 1995 73–76Google Scholar
Gerra, GZaimovic, AGiucastro, GMaestri, DMonica, CSartori, R et al. Serotonergic function after (+/-) 3,4 Methylenedioxymethamphetamine in humans Int Clin Psychopharmacol 13 1998 1–9CrossRefGoogle ScholarPubMed
Ghodse, A.HKreek, M.JA rave at Ecstasy Current Opin Psychiatry 10 1997 191–193CrossRefGoogle Scholar
Gonzalez, F.JMeyer, U.AMolecular genetics of the Debrisoquine-Sparteine polymorphism J Clin Pharm Ther 50 1991 233–238CrossRefGoogle Scholar
Green, A.RCross, A.JGoodwin, GReview of the pharmacology and clinical pharmacology of 3,4-methylenedioxymethamphetamine, (MDMA or “Ecstasy”) Psychopharmacology 119 1995 247–260CrossRefGoogle Scholar
Green, A.RGoodwin, G.MEcstasy and neurodegeneration. Ecstasy’s long-term effects are potentially more damaging than its acute toxicity BMJ 312 1996 14931493CrossRefGoogle Scholar
Hatzidimitriou, GMcCann, U.DRicaurte, G.AAltered serotonin innervation patterns in the forebrain of monkeys treated with (+/-) 3,4 Methylenedioxymethamphetamine seven years previously; factors influencing abnormal recovery J Neurosci 19 1999 5096–5107CrossRefGoogle ScholarPubMed
Henry, J.AJeffreys, K.JDawling, SToxicity and deaths from 3,4-methylenedioxymethamphetamine, (“Ecstasy”) Lancet 340 1992 384–387CrossRefGoogle Scholar
Henry, J.AHill, I.RFatal interaction between ritonavir and MDMA Lancet 52 1998 1751–1752CrossRefGoogle Scholar
Hiramatsu, MKumagai, YUnger, S.ECho, A.KMetabolism of Methylenedioxymethamphetamine: formation of dihydroxyamphetamine and a quinone identified as its glutathione adduct J Pharmacol Exp Ther 254 1990 521–527Google Scholar
Hughes, J.CMcCabe, MEvans, R.JIntracranial hemorrage associated with ingestion of “Ecstasy” Arch Emerg M 10 1993 372–374CrossRefGoogle Scholar
Jansen, K.LForrest, A.RToxic effect of MDMA on brain serotonin neurons Lancet 353 1999 1270–1271CrossRefGoogle ScholarPubMed
Jones, A.JSimpson, K.JReview article: mechanisms and management of hepatotoxicity in ecstasy (MDMA) and amphetamine intoxications Aliment Pharmacol Ther 13 1999 129–133CrossRefGoogle ScholarPubMed
Klugman, AHardy, SBaldeweg, TGruzelier, JToxic effect of MDMA on brain serotonin neurons Lancet 353 1999 1269–1270CrossRefGoogle ScholarPubMed
Lim, H.KFoltz, R.LIn vivo and in vitro metabolism of 3,4-(methylenedioxy)-methamphetamine in the rat: identification of metabolites using an ion trap detector Chem Res Toxicol 1 1988 370–378CrossRefGoogle ScholarPubMed
Lin, L.YKumagi, L.YCho, A.KEnzymatic and chemical demethylenation of (methylenedioxyamphetamine, (MDA) and (methylenedioxymethamphetamine, (MDMA), by rat microsomes Chem Res Toxicol 5 1992 401–406CrossRefGoogle Scholar
Marsh, J.C.WAbboudi, Z.HGibson, F.MScopes, JDaly, SO’Shaughnessy, D.F et al. Aplastic anemia following exposure to 3,4-methylenedioxymethamphetamine (“Ecstasy”) Br J Haematol 88 1994 281–285CrossRefGoogle Scholar
Mas, MFarre, Mde la Torre, RRoset, P.NOrtuno, JSegura, J et al. Cardiovascular and neuroendocrine effects and pharmacokinetics of 3,4 methylenedioxymethamphetamine in humans J Pharmacol Exp Ther 290 1999 136–145Google ScholarPubMed
Maxwell, D.LPolkey, M.IHenry, J.AHyponatremia and catatonic stupor after taking “Ecstasy” BMJ 307 1993 13991399CrossRefGoogle ScholarPubMed
McCann, U.DRidenour, AShaham, YRicaurte, G.ASerotonin neurotoxicity after (+/-) 3, 4-methylenedioxymethamphetamine (MDMA; Ecstasy): a controlled study in humans Neuropsychopharmacology 10 1994 129–138CrossRefGoogle ScholarPubMed
McCann, U.DRicaurte, G.AMDMA and panic disorder: induction by a single dose Biol Psychiatry 32 1992 950–953CrossRefGoogle ScholarPubMed
McCann, U.DSzabo, ZScheffel, UDannals, R.FRicaurte, G.APositron emission tomographic evidence of MDMA (“Ecstasy”) on brain serotonin neurons in human beings Lancet 352 1998 1433–1437CrossRefGoogle ScholarPubMed
McGuire, PFahy, TChronic paranoid psychosis after misuse of MDMA (“Ecstasy”) BMJ 302 1991 697697CrossRefGoogle Scholar
McGuire, P.KCope, HFahy, T.ADiversity of psychopathology associated with the use of 3,4-methylenedioxymethamphetamine (“Ecstasy”) Br J Psychiatry 165 1994 391–395CrossRefGoogle Scholar
Milroy, C.MClark, J.CForrest, A.RPathology of deaths associated with “Ecstasy” and “Eve” misuse J Clin Pathol 49 1996 149–153CrossRefGoogle ScholarPubMed
Morgan, J.FToxic effect of MDMA on brain serotonin neurons Lancet 353 1999 1268–1269CrossRefGoogle ScholarPubMed
Morgan, M.JRecreational use of “Ecstasy” (MDMA) is associated with elevated impulsivity Neuropsychopharmacology 19 1998 252–264CrossRefGoogle ScholarPubMed
Morgan, M.JMemory deficits associated with recreational use of “Ecstasy” (MDMA) Psychopharmacology 141 1999 30–36CrossRefGoogle Scholar
Obrocki, JBuchert, RVaterlein, OThomasius, WBeyer, WSchiemann, TEcstasy: long-term effects on the human central nervous system revealed by positron emission tomography Br J Psychiatry 175 1999 184–188CrossRefGoogle ScholarPubMed
Paris, J.MCunningham, K.ALack of serotonin neurotoxicity after intraraphe microinjection of (+/-)3,4-methylenedioxymethamphetamine (MDMA) Brain Res Bull 28 1992 115–119CrossRefGoogle Scholar
Peroutka, S.JIncidence of recreational use of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) on an undergraduate campus N Eng J M 317 1987 1542–1543Google Scholar
Reed, L.JWinstock, ACleare, A.JMcGuire, PToxic effect of MDMA on brain serotonin neurons Lancet 353 1999 12681268CrossRefGoogle ScholarPubMed
Ricaurte, G.AMartello, A.LKatz, J.LMartello, M.BLasting effects of (+/-) 3,4-methylenedioxymethamphetamine (MDMA) on central serotonergic neurons in non-human primates: neurochemical observations J Pharmacol Exp Ther 261 1992 616–621Google Scholar
Ricaurte, G.ADelanney, L.EIrwin, ILangston, J.WToxic effects of MDMA on central serotonergic neurons in the primate: importance of route and frequency of administration Brain Res 446 1988 165–168CrossRefGoogle Scholar
Ricaurte, G.AForno, L.SWilson, M.ADelanney, L.EIrwin, IMolliver, M.E et al. (+/-) 3,4-methylenedioxymethamphetamine selectively damages central serotonergic neurons in non-human primates JAMA 26 1988 51–55CrossRefGoogle Scholar
Scanzello, C.RHatzidimitriou, GMartello, A.LSerotonergic recovery after (+/-) 3,4-methylenedioxymethamphetamine injury: observations in rats J Pharmacol Exp Ther 264 1993 1484–1491Google ScholarPubMed
Scheffel, USzabo, KYuan, JRicaurte, G.AIn vivo detection of short and longterm MDMA neurotoxicity-a positron emission tomography study in the living baboon brain Synapse 29 1998 183–1923.0.CO;2-3>CrossRefGoogle Scholar
Schmidt, C.JNeurotoxicity of the psychedelic amphetamine methylenedioxymethamphetamine J Pharmacol Exp Ther 240 1987 1–7Google ScholarPubMed
Schmidt, C.JBlack, C.KTaylor, V.LAntagonism of the neurotoxicity due to a single administration of methylenedioxymethamphetamine Eur J Pharmacol 181 1990 59–70CrossRefGoogle ScholarPubMed
Semple, D.MEbmeier, K.PGlabus, M.FO’Carroll, R.EJohnstone, E.CReduced in vivo binding to the serotonin transporter in the cerebral cortex of MDMA (“Ecstasy”) users Br J Psychiatry 175 1999 63–69CrossRefGoogle ScholarPubMed
Shankaran, NYamamoto, B.KGudelsky, G.AInvolvement of the serotonin transporter in the formation of hydroxyl radicals induced by 3,4-methylenedioxymethamphetamine Eur J Pharmacol 385 1999 103–110CrossRefGoogle ScholarPubMed
Siegel, R.KMDMA: non-medical use and intoxication J Psychoactive Drugs 18 1986 349–354CrossRefGoogle Scholar
Simantov, RTauber, MThe abused drug MDMA (Ecstasy) induces programmed death of human serotonergic cells FASEB 11 1997 141–146CrossRefGoogle ScholarPubMed
Sprague, J.EHuang, XKanthasamy, ANichols, D.EAttenuation of 3,4-methylenedioxymethamphetamine, (MDMA), induced neurotoxicity with the serotonin precursors tryptophan and 5-hyroxytryptophan Life Sci 55 1994 1193–1198CrossRefGoogle Scholar
Steele, T.DMcCann, U.DRicaurte, G.A3,4-Methylenedioxymethamphetamine (MDMA, “Ecstasy”): pharmacology and toxicology in animals and humans Addiction 89 1994 539–551CrossRefGoogle ScholarPubMed
Sternbach, HThe serotonin syndrome Am J Psychiatry 148 1991 705–713Google ScholarPubMed
Tucker, G.TLennard, M.SEllis, S.W et al. The demethylenation of methylenedioxymethamphetamine (“Ecstasy”) by Debrisoquine hydroxylase, (CYP2D6) Biochem Pharmacol 47 1994 1151–1156CrossRefGoogle Scholar
Wolff, KHay, A.W.MSherlock, K et al. Contents of “Ecstasy” Lancet 346 1995 1100–1101CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.