Human psychobiology of MDMA or ‘Ecstasy’: an overview of 25 years of empirical research

MDMA, initially considered a novel psychoactive substance with low abuse potential due to loss of efficacy, is now understood to cause widespread neuropsychobiological damage. Recreational users show a pattern of increasing doses and deteriorating cost-benefit ratios. MDMA elevates body temperature and thermal stress, and can increase cortisol levels by 800% in dance clubbers. It can be extremely euphoric but also intensifies negative moods. The drug causes apoptosis and has been investigated for cancer therapy due to anti-lymphoma properties. Users exhibit deficits in memory, higher cognition, problem solving, and social intelligence, while basic cognitive skills remain intact.

Study at a glance

Abstract

AIMS: This paper aimed to review how scientific knowledge about the human psychobiology of MDMA has developed over time. METHODS: In this paper, the empirical findings from earlier and later studies will be reviewed. RESULTS: When MDMA was a 'novel psychoactive substance', it was not seen as a drug of abuse, as it displayed loss of efficacy. However, recreational users display a unique pattern of increasing doses, deteriorating cost-benefit ratios, and voluntary cessation. MDMA increases body temperature and thermal stress, with cortisol levels increased by 800% in dance clubbers. It can be extremely euphoric, although negative moods are also intensified. MDMA causes apoptosis (programmed cell death) and has been investigated for cancer therapy because of its anti-lymphoma properties. Recreational users show deficits in retrospective memory, prospective memory, higher cognition, problem solving, and social intelligence. Basic cognitive skills remain intact. Neuroimaging studies show reduced serotonin transporter levels across the cerebral cortex, which are associated with neurocognitive impairments. Deficits also occur in sleep architecture, sleep apnoea, complex vision, pain, neurohormones, and psychiatric status. Ecstasy/MDMA use during pregnancy leads to psychomotor impairments in the children. CONCLUSIONS: The damaging effects of Ecstasy/MDMA are far more widespread than was realized a few years ago, with new neuropsychobiological deficits still emerging.