Are There Long-Term Consequences to Using Ecstasy
This article was originally published on WebMD Connect to Care.
Ecstasy is an illegal, lab-made drug that can have dangerous effects on your body and mind. It’s also called MDMA (3,4-methylenedioxymethamphetamine). It is a popular recreational drug, which is usually taken by tablet or capsule, and can affect your mood and distort how you perceive people and things around you, according to the National Institute on Drug Abuse (NIDA).
Using ecstasy can have damaging long-term consequences, too.
Symptoms of an Ecstacy High
The National Institute on Drug Abuse says that about 45 minutes after you take a dose, you may feel:
A greater sense of well-being
More energy
Heightened physical senses
More warmth and empathy toward other people
Willing to talk about emotional memories
You could also have bad side effects, including:
Overheating
Jaw clenching
Feeling disconnected from your body or thoughts
Nausea
Hot flashes or chills
Stiff muscles or joints
Short-Term Effects of Ecstacy
Ecstasy is a stimulant that affects the nervous system. According to a 2021 review published in Critical Reviews in Toxicology, it increases the concentration of monoamines in the brain, like serotonin, norepinephrine, and dopamine. It does this in a few ways:
Prevents monoamines from being reabsorbed by neurons, which allows them to continue to pass messages to other neurons
Decreases storage capacity of monoamines, so the concentration is increased outside of neurons
Reverses the direction of monoamine transporters, causing more monoamines to be released than normal
Because it increases the activity of serotonin, norepinephrine, and dopamine it causes effects like increased alertness, euphoria, loving feelings, and feeling more connected to others. Changing the chemistry of the brain in these ways has negative effects too including increased heart rate, blood pressure, and body temperature.
According to a 2021 review published in Neurotoxicity Research, the most common adverse side effects of short-term recreational ecstasy use are heatstroke, dehydration, and hyponatremia (low sodium in the blood). Overheating can lead to severe dehydration, rhabdomyolysis (the release of proteins and electrolytes into the blood from muscle damage), multi-organ failure, abnormal blood clotting throughout the body.
Body temperature is maintained by a balance between heat generation and heat loss. Because of the way ecstasy affects the central nervous system and several different neurotransmitters, it causes an increase in heat generation and a decrease in heat loss. Ecstasy also constricts blood vessels and inhibits an antidiuretic hormone called arginine vasopressin, leading to excessive urination and sweating. This increases the risk of dehydration and cerebral edema, or an accumulation of fluid in the brain. Combining this drug with alcohol increases the risk of negative side effects like dehydration.
Ecstasy's Long-Term Effects
According to The National Institute on Drug Abuse, some of the long-term problems from chronic ecstasy use may not be due to ecstasy alone. Rather, they might be connected to using ecstasy along with other drugs, like cocaine, alcohol, or marijuana. They may also be linked to risky ingredients in ecstasy tablets called adulterants.
A 2021 review published in Critical Reviews in Toxicology found that combining alcohol with ecstasy increased the negative effects of ecstasy on the brain, cardiovascular system, liver, and endocrine system. This increases the toxicity of ecstasy.
“The drug itself is challenging to study in the real world, as adulterated forms of MDMA, or completely different forms of amphetamine, are used under the umbrella term of ‘ecstasy,’” says Harshal Kirane, MD, the medical director of Wellbridge Addiction Treatment and Research. Because of this, the long-term effects may vary from one particular ecstasy drug to another.
Additionally, if you keep using ecstasy, you may develop problems including the following:
Memory and Cognitive Problems
“Long-term effects of ecstasy use include damage to several parts of the brain.” explains Dr. Staci Holweger, Founder and Dr of Regenerative Medicine Website Life Patches. “Ecstasy can cause damage to the hippocampus, which is the part of the brain that controls memory, learning, and the ability to form new memories.”
According to a 2020 review published in Basic Clinical Neuroscience, clinical studies have found that ecstasy users had declarative memory impairments up to 6 months after drug use and significantly lower working memory. Declarative memories are facts or memories of your past. Deficits in short-term memory, executive control, and learning have been observed as well as increased impulsivity. Some studies have found that it is possible for these issues to persist in abstinence, even up to 18 months.
“Ecstasy has also been known to damage the frontal lobe, which is the area of the brain that controls personality, language, and emotions. The frontal lobe is also responsible for the planning, execution, and organization of our daily activities. Because of these effects, there have been several cases where ecstasy has been a direct cause for mental disorders and psychotic episodes.” continues Dr. Holweger.
Mood and Emotional Issues
“Aside from the obvious physical risks and dangers that people typically associate with taking MDMA, it is important to be aware of the long-term damage that can occur to the way that the brain functions after taking the drug.” explains Martin Preston, founder and Chief Executive at Delamere. “As well as the short-term ‘comedown’ that people experience after taking MDMA, regular consumption can lead to a plethora of long-term cognitive issues and difficulties with regulating emotions.”
According to the NIDA, since ecstasy causes a large release in several neurotransmitters, especially serotonin, it causes the brain to become severely depleted of serotonin afterwards. This can lead to days of depression. Positron emission tomography (PET) imaging studies on people who previously used ecstasy have found a decrease in brain activity at rest in many regions of the brain, including those involved in learning, memory, emotion formation, and emotion processing.
Brain Changes
“Ecstasy has been shown to alter both white and gray matter in the brain.” continues Dr. Boyer. “This can lead to confusion, difficulty thinking and remembering things, mood disorders such as anxiety or depression, and problems with impulse control or attention span.”
According to the NIDA, studies have found that one dose of MDMA decreased cerebral blood flow in several regions of the brain that are responsible for emotions, learning, and sensory and motor function.
Altered Cardiac Function
Experimental and clinical data has found that ecstasy can cause rhythm disturbances. A 2015 study published in Toxicological Sciences found that chronic ecstasy use can cause changes to gene expression in the heart. These changes have been found to be associated with an increase in heart size, which is reversible after drug use stops. This study also found alterations in heart rhythm gene expression.
Permanent Damage to the Brain and Nervous System
Ecstasy can lead to depression, but if the drug continues to be taken it can cause damage to the brain. For chronic users who take high doses of ecstasy, this can cause permanent nerve damage, especially to serotonergic neurons. Serotonergic neurons are responsible for producing serotonin, so permanently damaging them can result in a loss of connection between these neurons and can cause depression and anxiety.
Research in rodents and primates have found that ecstasy damages serotonergic neurons and a study published in The Official Journal of the Society for Neuroscience found that this damage is potentially long-lasting, with MDMA-exposed primates having less serotonergic neurons 7 years after exposure to the drug.
Human studies are still mixed, and there is an ongoing debate about whether ecstasy causes permanent damage to the brain. Brain imaging studies in humans have found altered serotonergic functioning in ecstasy users. A 2019 meta-analysis published in Neuroscience and Biobehavioral Reviews found that heavy ecstasy users had significantly reduced serotonin transporter densities in the brain.
Cite this article:
Tietz, G. Are There Long-Term Consequences to Using Ecstasy. Sober Powered. 2022.
Sources:
Vercoulen, E. et al. Combining ecstasy and ethanol: higher risk for toxicity? A review. Critical Reviews in Toxicology. 2020.
Leichti, M. Effects of MDMA on body temperature in humans. Temperature. 2014
van Amsterdam, J., Brunt, T.M., Pierce, M. et al. Hard Boiled: Alcohol Use as a Risk Factor for MDMA-Induced Hyperthermia: a Systematic Review. Neurotox Res 39, 2120–2133 (2021).
Commins DL, Vosmer G, Virus RM, Woolverton WL, Schuster CR, Seiden LS. Biochemical and histological evidence that methylenedioxymethylamphetamine (MDMA) is toxic to neurons in the rat brain. J Pharmacol Exp Ther. 1987;241(1):338-345.
Hatzidimitriou G, McCann UD, Ricaurte GA. Altered serotonin innervation patterns in the forebrain of monkeys treated with (+/-)3,4-methylenedioxymethamphetamine seven years previously: factors influencing abnormal recovery. J Neurosci Off J Soc Neurosci. 1999;19(12):5096-5107.
O’Hearn E, Battaglia G, De Souza EB, Kuhar MJ, Molliver ME. Methylenedioxyamphetamine (MDA) and methylenedioxymethamphetamine (MDMA) cause selective ablation of serotonergic axon terminals in forebrain: immunocytochemical evidence for neurotoxicity. J Neurosci Off J Soc Neurosci. 1988;8(8):2788-2803.
Mustafa NS, Bakar NHA, Mohamad N, et al. MDMA and the Brain: A Short Review on the Role of Neurotransmitters in Neurotoxicity. Basic Clin Neurosci. 2020;11(4):381-388.
NIDA. MDMA (Ecstasy) Abuse Research Report.
Muller, F. Neuroimaging of chronic MDMA (“ecstasy”) effects: A meta-analysis. Neuroscience & Biobehavioral Reviews. 2019.
Bonsignore, A., Barranco, R., Morando, A. et al. MDMA Induced Cardio-toxicity and Pathological Myocardial Effects: A Systematic Review of Experimental Data and Autopsy Findings. Cardiovasc Toxicol 19, 493–499 (2019)
Christopher A. Koczor, Ivan Ludlow, Robert S. Hight, II, Zhe Jiao, Earl Fields, Tomika Ludaway, Rodney Russ, Rebecca A. Torres, William Lewis, Ecstasy (MDMA) Alters Cardiac Gene Expression and DNA Methylation: Implications for Circadian Rhythm Dysfunction in the Heart, Toxicological Sciences, Volume 148, Issue 1, November 2015, Pages 183–191
