Clinical and toxicologic aspects of the use of Ecstasy

Methylenedioxymethamphetamine (MDMA, the active compound of ecstacy (XTC) tablets) is a psychoactive amphetamine congener which in humans has a stimulatory effect and enhances feelings of openness and solidarity. MDMA is neurotoxic in animals. It depletes axonal serotonin stores, it inhibits serotonin synthesis by inhibiting tryptophan hydroxylase, and it inhibits the reuptake of serotonin into the neuron. These events lead to destruction of serotonergic axon terminals in animal brain. Selective serotonin reuptake inhibitors protect against the neurotoxic effects of MDMA. Binding of (+)[11C]McN-5652, a selective neuroligand for the serotonin transporter, is decreased in the brains of XTC-users. This indicates that XTC damages serotonergic axon terminals in human brain, also. We strongly advise against the use of XTC as the long-term clinical consequences are not known. In man, somatic life-threatening complications after XTC use include hyperthermia, hyponatraemia and liver failure. Psychiatric complications include psychosis, depression, panic disorder, and impulsive behaviour. The chronic psychosis responds poorly to therapy.