A paper entitled "Positron emission tomographic evidence of toxic effect of MDMA ("Ecstasy") on brain serotonin neurons in human beings" was published in the 31st Oct edition of the Lancet medical journal, and has caused a media sensation around the world. Headlines like "Ecstasy fries your brain" are doing the rounds locally.

The full paper can be found at http://www.thelancet.com/newlancet/reg/issues/vol352no9138/early1433.html
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Using the latest neuroimaging techniques such as positron emission tomography (PET), the researchers have shown that "recreational MDMA use can lead to global, dose-related decreases in the brain 5-HT transporter, a structural element of brain 5-HT neurons."

It concludes that "Potential functional consequences of MDMA-induced brain 5-HT neurotoxic lesions are not yet clear, but may include depression, anxiety, memory disturbance, and other neuropsychiatric disorders in which brain 5-HT has been implicated."

What does all of this mean to ravers who love their E ? Well, it's hard to say and a number of questions remain. For instance, how do these findings apply to the average recreational user, most of whom are quite moderate in their usage (not every weekend).

There are a number of different opinions as to the relevance of this 5-HT Damage. Here are a few:

This was posted on the MAPS list:

"An important point to note is that the subjects were tested for psychiatric disorders, such as anxiety and depression, and were all found to be normal.

In other words, these reductions in transporter binding relative to the control group existed without any anxiety and depression, as established by the experimenters themselves. This is in line with animal experiments which show that considerable persistent changes do not result in persistent behavioural changes in these animals. They cannot be distinguished from controls. While E may cause some brain changes, the evidence for depression and anxiety as a long-term time bomb is entirely lacking, especially if the control group are heavy cocaine users.

So far, these changes in the serotonin transporter are without proven effect. The midweek post E dip is due to an acute fall in serotonin, not the same thing at all."

 

Dr Parry of the Medical Research Council in South Africa, commented:

"You are right to ask those questions. The same could be said for alcohol it causes major neurological damage as a result of causing a thiamine (Vitamin B12) deficiency -- but only in very large doses over a long period of time.

As I said, the size of the Lancet study was very small .... I was therefore very surprised that they were able to find statistically significant differences (15 controls and 14 in the experimental group) ==> meaning that the differences must be very big to be detected in such small samples.

While we don't have precise information on the quantity and frequency of E use among participants in the study we can probably assume that they used at least one tablet per week ("participants had generally used MDMA on more than 200 occasions" and over a 4-5 year period").

The researchers have detected that use of Ecstasy has a large impact on 5-HT neurons. This is undisputed. The study also did not find a correlation between length of abstinence and improvement in functioning (decrease in [11-C]McN-5652 binding), though it does not rule out the fact that MDMA-induced changes may be reversible.

What is not clear to me is how serious is the effect of a long-term (eg 1 year) or permanent loss of functioning of 5-HT neurons?

What they say is that it might have broad implications for many neuropsychiatric illnesses in which brain 5-HT neurons have been implicated (eg depression, anxiety and cognitive dysfunction).

One of the things I am puzzled about is if the researchers did undertake a psychiatric evaluation (the SCID-IV) of participants in both the experimental and control groups (see Participants in Methods section) why they did not also undertake a comparison of the mental status of participants in both groups to answer the question of whether there were mental deficits in the experimental group.

The publication of these findings in this prestigious journal is likely to stimulate further research to investigate the impact of a loss of functioning on 5-HT neurons. Perhaps further answers will start to become available in the next 12 months.

The bottom line, at least from my reading of this article. is that 'use of E does affect your brain (structurally) in ways which could be permanent (or at least long lasting) and that this may affect you psychologically and in other ways'."

We have known for a while that heavy use of E changes the wiring of your brain. See the article we put up last year from the Independent in London.

However, many questions remain. RaveSafe will keep you posted on any news in this field.

 

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