Ecstasy users should note extended effects

Twitchell is a research psychologist at the Integrated Substance
Abuse Programs.

By Geoff R. Twitchell, Ph.D.

Although initially thought of as a “safe” drug, you
may have heard rumors about how using ecstasy will drain your
spinal fluid, melt your brain or take away your personality.

Of course, to make good decisions about whether or not to use
ecstasy, people need accurate information about both the costs and
benefits of using this popular drug.

People use drugs because they’re fun, and ecstasy, as its
name implies, is no exception. Ecstasy acts as both a stimulant and
a hallucinogen. Recently, college students have rediscovered the
increased energy, sense of pleasure and connection with others that
ecstasy produces. Not surprisingly, its use has quickly spread.

To understand both the positive effects and the potential damage
ecstasy can cause, it’s necessary to know how ecstasy works.
Ecstasy exerts many of its effects through the release of the
important neurotransmitter serotonin, whose primary role is to
modulate and affect behavior. Due to wide projections throughout
the brain, serotonin impacts many behaviors including mood and
cognition. Consequently, if ecstasy use causes damage to the
serotonin system, changes in behaviors that are regulated by
serotonin should be observable.

For example, since serotonin regulates mood, it’s
reasonable to expect that mild serotonin damage might cause mild
sadness and fatigue. On the other end of the spectrum, serious
damage could be expected to cause profound depression that
interferes with everyday functioning.

Research on ecstasy’s effects on brain function, mood and
thought is relatively new. In addition, problems in early studies
limit what we can say for sure. For example, ecstasy users almost
always use other drugs, which can make results hard to interpret.
However, only recent studies have controlled for the effects of
other drug use. In fact, marijuana use is so prevalent in ecstasy
users that most studies that take this into account have to compare
ecstasy users with pot smokers who don’t use ecstasy. Early
studies that failed to take marijuana use in ecstasy users into
account may have falsely concluded that brain damage, mood
problems, or memory deficits were related to ecstasy use when
marijuana may have been causing the problems.

Still, well controlled recent studies that take snapshots of the
brain (neuroimaging) do detect serotonin problems when comparing
ecstasy users to controls with similar drug use histories.
Interestingly, one researcher reports that women are more
susceptible than men to the neurotoxic effects of ecstasy. However,
her interpretation may be problematic due to the presence of
depression in some of the women and the small number of
subjects.

Although the rumor of ecstasy burning holes in the brain may be
an exaggeration, current research is consistent with brain
alterations in areas served by serotonin. Ecstasy users describe
the positive spike in mood that occurs an hour after taking ecstasy
as one of its most powerful effects. Unfortunately, this is
followed by a decrease in mood that can last two to three days.
Although the depressive phase following ecstasy use has been
documented, researchers are just now studying the possibility that
ecstasy use may cause depressive symptoms that are long standing
and may not resolve over time.

To examine this possibility, a meta-analysis of the current
studies was performed. This statistical procedure allows us to
combine studies and calculate the magnitude of relationships.
Results indicated large relationships between ecstasy use and
depressive symptoms that were unremitting. Unfortunately, these
findings suggest that ecstasy abuse today may cause persistent mood
alterations and result in long-standing depressive symptoms that
last well into the future. However, it’s still unclear
whether serotonin damage associated with ecstasy use is
long-lasting or resolves over time.

The possibility that ecstasy affects the ability to think is of
interest to both researchers and ecstasy users. However, research
results have been inconsistent. Results of meta-analytic review
indicated a relationship between heavy ecstasy use and problems in
cognition. The largest deficits were in verbal memory and executive
functioning (the ability to plan and use abstract thought). Medium
sized deficits were found in non-verbal memory.

In summary, recent research indicates that moderate to heavy
ecstasy use is associated with damage to the serotonin system,
depressive symptoms, and problems with memory and thinking.
However, many questions remain. For example, it is essential to
determine whether serotonergic, mood or cognitive alterations are a
consequence of ecstasy use or whether they predate it. Although we
expect ecstasy use causes these problems, it could be the other way
around. Although less likely, it’s possible that mood and
cognitive problems may occur prior to ecstasy use and may actually
predispose people to use the drug.

Another question of obvious importance is whether or not the
effects of ecstasy are reversible. We also need to determine what
role drug use patterns play in ecstasy users’ deficits and
whether women are more susceptible to ecstasy’s neurotoxic
effects.

At UCLA, we are studying genetic and family history variables
that may be vulnerability factors placing people at risk to use
ecstasy and/or to be more negatively impacted by ecstasy use.

Having accurate data on the effects of a drug is helpful in
making a cost-benefit analysis regarding whether to use a rewarding
drug like ecstasy. Ecstasy undeniably has many positive effects.
However, ecstasy use may also be associated with long-term
problems. Hopefully, knowledge of current data will help people
make informed decisions.

If you are an ecstasy user or a non-ecstasy user interested in
participating in Dr. Twitchell’s research, or if you’re
interested in learning more about ecstasy’s effects, you can
reach him at (310) 794-4809. If you are interested in treatment for
drug addiction, please contact the UCLA Substance Abuse Services at
(310) 825-9989.