MIND
May 27, 2011

The Agony of Ecstasy?

The club drug Ecstasy produces changes in brain chemistry. But these may not be the type of changes its users are after.

A study from Vanderbilt University has found physical changes in the brains of Ecstasy users that suggest that their brains are not functioning as efficiently as they once did. These changes did not disappear after a year of abstinence from Ecstasy.

Ecstasy use is associated with a loss of serotonin signaling, which leads to hyper-excitability in the brain.

This comes on the heels of another study published in March that found a definite brain drain in ten long-time Ecstasy users: their hippocampus measured, on average, more than 10% smaller than that of non-users. That study was published in the Journal of Neurology, Neurosurgery and Psychiatry.

Ecstasy or MDMA (3-4-methylenedioxymethamphetamine), is a man-made drug. It is used as a recreational drug and known as a club drug because of its amphetamine-like and hallucinogenic properties. It is classified as a stimulant. Ecstasy produces changes in brain chemistry. But these may not be the type of changes its users are after.

The Vanderbilt study found increased brain activation in three brain areas associated with visual processing in subjects with the highest lifetime Ecstasy use. The researchers interpret this as signs of hyper-excitability in these regions of the brain — the need for more brain to be used to perform a task, which means a loss of brain efficiency.

Dr. Ronald Cowan, who headed the Vanderbilt study, is concerned about some recent media coverage of Ecstasy — pieces reporting on possible therapeutic uses of Ecstasy in PTSD sufferers that suggest that some of Ecstasy's negative effects have been overstated.

"There's tension in the fields of psychiatry and psychotherapy between those who think Ecstasy could be a valuable therapeutic that's not being tested because of overblown fears, and those who are concerned about the drug's potentially harmful effects," Cowan said in a university press release.

Dr. Cowan thinks that the most relevant question is whether or not Ecstasy use causes long-term brain damage.

In discussing the Vanderbilt study, Cowan says that its results are what were expected, based on previous animal studies: Ecstasy use is associated with a loss of serotonin signaling, which leads to hyper-excitability in the brain.

The study was of 20 long-term Ecstasy users, all of whom were abstinent for at least two weeks before the study, and 20 non-users. All underwent fMRI (functional magnetic resonance imaging) scans during visual stimulation. The researchers looked at three brain areas: the visual system lateral geniculate nucleus and Brodmann Areas (BA) 17 and 18.

The scans showed a direct, linear relationship between lifetime Ecstasy use and activation in all three brain regions — the more Ecstasy a subject had taken during their life, the greater was the activation seen in all three brain regions. The heaviest Ecstasy users also showed a greater spatial extent of activation (more of the region was active) in BA 17 and BA 18.

Dr. Cowan interprets this increased activation as a sign of a less functional brain.

Cowan points out that this pattern of hyper-excitability is similar to that seen in studies of individuals at risk for or with early Alzheimer's disease. He says this does not mean that Ecstasy users are at risk of dementia, but that there's a loss of brain efficiency in both Ecstasy users and early Alzheimer's patients.

"We think this shift in cortical excitability may be chronic, long-lasting, and even permanent, which is a real worry," Cowan said.

The results of this study appear in the May 2011 issue of Neuropsychopharmacology.

Ronald L. Cowan, M.D., Ph.D. is an assistant professor of psychiatry in the Division of Adult Psychiatry at Vanderbilt University Medical Center.

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