Chronic 3,4-Mothylonodioxymothamphotamino (MDMA) Use: Effects on Mood and Neuropsychological Function?

332 KRYSTAL ET AL. MDMA EFFECTS ON MOOD AND COGNITIVE FUNCTION 333 Charles Opsahl, Ph.D. appetite suppressant [11. MDMA has been reported useful as an adjunct to Psychiatry Service psychotherapy through facilitating interpersonal communication, enhancing inYale-New Haven Hospital sight, increasing self-esteem, and decreasing the abuse of other illicit substances Department of Psychiatry and Psychology _ [2]. MDMA has also been used as a recreational psychoactive agent, and conYale University School of Medicine i cern over its increasing popularity led to its classification as a Schedule I agent New Haven, Connecticut by the Drug Enforcement Agency in July 1985 [3]. Despite legal sanctions, recreational use of MDMA has been increasingly visible: one survey found that 40% George A. Ricaurte, M.D., Ph.D. of the undergraduates polled at a major university had used MDMA at least once Department of Neurology [4]. The increased frequency of MDMA use has, in turn, raised questions about Johns Hopkins Medical Institution medical and psychiatric complications of acute and chronic MDMA use [5]. 4940 Eastern Avenue, Baltimore, Maryland Subjective reports of acute effects indicate that after ingesting MDMA, one generally experiences a 4-to-8 hour period of peak drug effect associated with George R. Heninger, M.D. feelings of increased closeness to people, euphoria, heightened arousal, selfClinical Neuroscience Research Unit confidence, increased sensory sensitivity, a feeling of openness to new ideas, inDepartment of Psychiatry creased depth of emotion, and decreased appetite [6, 7]. MDMA is reported to Yale University School of Medicine both increase the capacity to focus thought and to cause difficulty in concentrating Connecticut Mental Health Center and racing thoughls. 1)owning 161 reported that MDMA, at a mean oral dose 34 Park Street, New Haven, Connecticut 06508 of 0.52 mg/kg, did not acutely affect short-term memory or digit repetition although there was evidence of judgment impairment in 4/10 subjects. Visual blurring, illusions, or infrequently, visual hallucinations may also occur in associaABSTRACT tion with MDMA administration. Other common MDMA effects include symptoms of sympathetic arousal (e.g., tachycardia, tremor, palpitations, dry mouth, 3,4-Methylenedioxymethamphetamine (MDMA; "ecstasy") is a selective serotonin (5-HT) neurotoxin in animals. There is now preliminary evidence in humans of 5-HT deficits associated and diaphoresis), trismus, and bruxism. The acute effects of MDMA can be prowith extensive use of MDMA. I1:order to begin to describe the cognitive mid mc_xt effects of longed by taking an additional dose of the drug or enhanced by coadministration chronic MDMA use, nine indivkluals with extensive MDMA use histories were studied. Despite of the 5-HT precursor, tryptophan (Subject #7, this study). However, if too much the absence of memory deficits on clinical examination, a pattern o fmild-to-moderate impairment was observed on both the Initial and Delayed Paragraph Tests of the Wechsler Memory Scale; additional MDMA is consumed in a single session, individuals report unpleasant eight of the subjects had at least mild impairment on at least one test in the neuropsychological symptoms of autonomic hyperarousal associated with feelings of restlessness and battery. Despite previously reported suggestive evidence of5-HT defic t in this group none reported anxiety. Following the acute subjective effects of MDMA, users report a 24-48 depressed mood or met clinical criteria for an affective disorder at the time of testing. These preliminary findings raise concern about possible detrimental effects of MDMA use on neurophour period characterized by the persistence of acute MDMA effects and the onset sychological function for future systematic study and they highlight important issues regarding of additional symptoms suggestive of the "crash" after psychostimulant adtheeffectsof 5-HTdeficitson cognitive functionandmoodregulation, ministration. Thus, Peroutka and his colleagues [7] found that the most common