Ecstasy has been around for a very long time. Chemically it is 3, 4- methylenedioxymethamphetamine- MDMA. As the name suggests, it is a methamphetamine compound. It is taken orally usually in a tablet or capsule form and the effects start within 30- 60 minutes. Pharmacologically, there is a huge efflux of Serotonin in the brain along with effects on the Dopamine and Noradrenaline sytems as well.The acute effects can often lead to Hyperthermia (raised body temperature) which is compounded by its use in warm, humid climates typically found in the dance clubs and this can be life threatening. The euphoria that is often reported after its use seems to be more related to the contexts of the environment i.e. whether being used in isolation or with club goers and club environment. This has been seen in studies as reported in the 1st International Conference of Psychoactive Drugs in Budapest in March 2012.
Intoxication with Ecstasy has been described as occurring in three stages (Koesters et al, 2002; Parrott and Lasky, 1998)- initial stage of disorientation, second stage of ‘spasmodic jerking and tingling’ and the final stage of increased sociability, increased mental clarity, a feeling of emotional warmth and feeling close to others. Given the context dependent effects, higher doses can give rise to frank euphoria. In toxic doses it can lead to dehydration, hyperthermia (both these can be life threatening in club environment), raised pulse, hypertension, liver failure and/or renal failure (Jonas and Graeme- Cook 2001; Lester et al 2000). There may be anxiety, agitation and even confusion.
The post dose recovery time often leads to depressed mood, irritability, anxiety, sleep impairment, asociability. People who are regular users can experience mid week depression and there are reports of aggression as well.
The chronic effects after regular heavy use can be damaging. Several studies have now indicated that the SERT (Sertraline Transporter) is reduced with chronic use which highlights the diminution of Serotonin in various regions of the brain. As the effects of Ecstasy are on the Frontal Cortex (the part of the brain responsible for planning and executive function), cognitive and memory deficits can be significant. Interestingly, for me working as a Consultant Psychiatrist in Addictions in Wales, what I learnt new from the conference is also that heavy regular use can be associated with Sleep Apnea (serotonin being an important chemical in maintaining lung function).
Whilst experimenting with the drug may be tempting but it can lead to long lasting damage if it becomes persistent or heavy or dependent use.