Pharmacology, Toxicology, Usage Patterns, and Neurological Effects in Humans

3,4-Methylenedioxymethamphetamine (MDMA) is a ring-substituted amphetamine with a potential for abuse. Although originally developed by Merck, MDMA is an illegal drug that is popular recreationally, and is more recently being touted as a therapeutic agent. Unlike some other drugs in the amphetamine class, the mechanism(s) by which MDMA produces its subjective effects are not well understood. MDMA is a selective serotonin (5-HT) neurotoxin. Exposure to MDMA can lead to lasting reductions in brain 5-HT and 5-HT axonal markers. Somewhat paradoxically, its acute pharmacological effects involve a dramatic acute increase in serotonin (and other monoamine) levels in the brain and the periphery. MDMA is also a direct agonist at several different monoaminergic receptors. Although these pharmacological properties of MDMA are known, they don’t appear to fully explain the subjective of effects of MDMA, which include feelings of well-being and euphoria. One unfortunate notion held by many MDMA users is that the drug is safe, or at least safer than many other illegal drugs. This is a notion that is strengthened by MDMA’s current and past use as a psychotherapeutic agent, although definitive safety/efficacy reports have yet to appear in the literature. In recent years, there has been a renewed push to acknowledge the potential utility of MDMA in the treatment of conditions such as post-traumatic stress disorder.