Mental disorders in current and former heavy ecstasy (MDMA) users

Current and former ecstasy users show no higher rates of most mental disorders than non-users, except for substance-related disorders. Substance-induced cognitive, affective, and anxiety disorders were more common among ecstasy users than polydrug controls. Lifetime ecstasy dependence occurred in 73% of users. Over half of former users and nearly half of current users met criteria for substance-induced cognitive disorders at testing. Higher lifetime doses of ecstasy predicted cognitive disorders. Pre-existing depression or anxiety did not explain ecstasy use, as these disorders were not more frequent in users. Cognitive problems persisting after more than five months of abstinence may result from MDMA's serotonergic neurotoxicity.

Study at a glance

Abstract

ABSTRACT Background Ecstasy use has often been found to be associated with psychopathology, yet this research has so far been based largely on subjective symptom ratings. Aims To investigate whether ecstasy users suffered from long‐term psychopathological consequences. Measurements We compared the prevalence of Diagnostic and Statistical Manual version IV (DSM‐IV) mental disorders in 30 current and 29 former ecstasy users, 29 polydrug and 30 drug‐naive controls. Groups were approximately matched by age, gender and level of education. The current ecstasy users reported a life‐time dose of an average of 821 and the former ecstasy users of 768 ecstasy tablets. Findings Ecstasy users did not significantly differ from controls in the prevalence of mental disorders, except those related to substance use. Substance‐induced affective, anxiety and cognitive disorders occurred more frequently among ecstasy users than polydrug controls. The life‐time prevalence of ecstasy dependence amounted to 73% in the ecstasy user groups. More than half of the former ecstasy users and nearly half of the current ecstasy users met the criteria of substance‐induced cognitive disorders at the time of testing. Logistic regression analyses showed the estimated life‐time doses of ecstasy to be predictive of cognitive disorders, both current and life‐time. Conclusions The motivation for ecstasy use is not likely to be self‐medication of pre‐existing depressive or anxiety disorders as these did not occur more frequently in the ecstasy users than in control groups or in the general population. Cognitive disorders still present after over 5 months of ecstasy abstinence may well be functional consequences of serotonergic neurotoxicity of 3,4‐methylenedioxymethamphetamine (MDMA).