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Ecstasy Users Live More Dangerously

Risk appraisal significantly impaired after long-term consumption

Long-term users of the 'club drug' Ecstasy can assess risks considerably less accurately than people who have never taken Ecstasy, even when the former are not on the drug. Furthermore Ecstasy, whose chemical abbreviation is MDMA, also seems to permanently impair memory to an appreciable extent. This is revealed in a recent study by the University of Bonn's Psychiatric and Psychotherapeutic Clinic (Director: Professor W. Maier). In a recent publication (Neuropsychopharmacology 2004, 29(5):982-90) the authors also suspect that in the long term Ecstasy produces completely different changes in the brain than has hitherto been assumed - and that the medication recommended to combat the long-term effects may therefore be completely ineffective.

Anyone who frequently takes Ecstasy should not go to the casino - or at least they should not take much money with them: 'The ability to assess chances and risks is appreciably reduced in comparison with persons without experiences with Ecstasy,' explains Boris Quednow of the Bonn Clinical Psychopharmacology research team (head: Dr. K.-U. Kühn). In his PhD Mr Quednow studied how MDMA users coped with what is known as the Iowa Gambling Task when compared with cannabis users and people without experience of drugs. This involves taking cards from four packs of cards placed face down. On each card there is an amount won or lost; the aim of the task is to maximise the total winnings. However, the packs of cards vary in their ratios of winning and losing cards, so that the persons taking part in the experiment first have to learn which packs are the most advantageous in the long run. 'Initially the packs of cards with the highest gains and even higher losses were the most popular in all three groups,' Boris Quednow explains. 'Then members of the cannabis group and the drug abstainer group gradually began to realise which of the packs were the most promising in the long run. It was only the Ecstasy users who did not change their strategy, even at the end of the experiment.' Boris Quednow and his supervisor, Dr. Michael Wagner, presume that even in everyday situations the ability to make rational decisions may be impaired in the long term.

Memory loss

However, even the memory suffers perceptibly when MDMA is taken regularly. For example, the test persons were asked to memorise a list with 15 words which were read out to them five times. Whereas the two control groups mastered the task brilliantly - on average those taking part could remember 14 of the 15 words half an hour later - the members of the Ecstasy group only managed an average of 12 words immediately after the test. Half an hour later they could on average only state ten words accurately. 'However, we cannot yet say whether this impairment would abate after a protracted period off the drug,' Boris Quednow adds.

Ecstasy is very popular as a 'club drug', particularly in the techno scene. About four per cent of all German teenagers between 14 and 25 have taken Ecstasy at some time; whereas in 1987 only 635 tablets were confiscated in Germany, by 2001 the figure was around 4.6 million. This amphetamine derivative is a mild stimulant and puts the user in a relaxed, happy mood. 'Put simply, taking the drug results in the serotonin stores in the brain being emptied at one go," Boris Quednow explains. Serotonin is used by many nerve cells as a messenger substance. When an electrical signal is given it is released from the transmitter cell into what is known as the synaptic gap. From there it proceeds to specific receptors of the recipient cell, which in turn react to this by an electrical pulse. Ecstasy temporarily boosts the serotonin concentration in the synaptic gap, probably thereby resulting in a feeling of elation. However, after one or two days the messenger substance has been broken down. 'Because the storage vesicles are initially empty as a result of taking Ecstasy, the serotonin concentration drops below the normal level,' Boris adds. The result is the notorious 'midweek blues' - a temporary feeling of depression which begins several days after taking Ecstasy, usually in the middle of the week, and then gradually recedes.

Wrong treatment?

Animal experiments have shown that Ecstasy can damage nerve cells to such an extent that the nerve cells which produce serotonin can die. It was therefore assumed that in human long-term users, too, the serotonin concentration in specific areas of the brain may be permanently reduced. Many researchers see this as the reason for the reduced performance of the brain which can occur after long-term abuse with MDMA. Boris Quednow has tested this hypothesis by analysing what is termed the 'acoustic startle response'. This involved testing the reaction of test persons to a series of unexpected noises; in this experiment characteristic changes in the startle response take place, depending on the serotonin level in the brain. 'The Ecstasy users reacted more like we would have expected persons to react after stimulation of the serotonin receptors,' Boris says; 'thus the receptors appear to adapt to the lack of serotonin and to compensate for it.' He speculates that the recipient cells develop more or more sensitive serotonin receptors in response.

Should this interpretation be correct, it would be imperative to treat the long-term effects of this drug differently than has previously been the case: some medical experts, despite the lack of clinical studies, had suggested combating the reduced performance by using SSRIs. SSRIs prevent the reabsorption of serotonin from the synaptic gap, with the result that the level there is kept artificially high. Boris Quednow explains: 'If we are right, however, these substances could even exacerbate the effects of regular Ecstasy use. In order to recommend effective therapy we have simply not had enough data to go on up to now - by contrast with acute intoxications with Ecstasy, for which there are tried and tested methods of intervention.'

Contact partner:
Boris B. Quednow
University Psychiatric and Psychotherapeutic Clinic
Tel.: ++49-228-287-5681
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