LONDON (Reuters Health) Nov 29 – Heavy use of 3,4-methylenedioxymethamphetamine (MDMA, popularly known as ecstasy) damages serotonin neurons, especially among women, but these effects may be reversible, Dutch researchers report in the December 1st issue of The Lancet.
"There were significant decreases in serotonin transporters of women who were regular users of MDMA, which suggests that females are more susceptible than males," Dr. Liesbeth Reneman, from the Academic Medical Center in Amsterdam, told Reuters Health. "These effects in women are dose-related and may be reversible in most brain regions," she added.
The reason for the apparent gender difference in reaction to MDMA is not known, Dr. Reneman said.
Dr. Reneman and colleagues collected data on 15 moderate MDMA users, 23 heavy MDMA users and 16 ex-MDMA users recruited from "rave" clubs. The researchers also recruited 15 controls who said they had never used MDMA.
Using a radioligand that binds with serotonin transporters, the researchers studied the effects of MDMA on brain serotonin transporters in each subject. They used single-photon-emission computed tomography to calculate the ratio of serotonin receptor density in various parts of the brain compared with the cerebellum.
Among women who were heavy users of MDMA, there was a significant decrease in overall binding ratios (p < 0.01), but the decrease was not significant in men (p = 0.587), the Dutch team found.
Compared with heavy MDMA users, women who were ex-MDMA users had significantly higher densities of serotonin transporters overall (p = 0.004). Moreover, in the parieto-occipital cortex there was a trend toward decreased density in female ex-users compared with controls (p = 0.059). These findings indicate that the neurotoxic effect is reversible after cessation of MDMA use, Dr. Reneman's group maintains.
"Although the study is timely and potentially important, the small sample size and methodological questions limit confidence in the conclusions about differences between sexes or possibility of reversibility of the effects of MDMA in human beings," Dr. George A. Ricaurte and Dr. Una D. McCann from Johns Hopkins University School of Medicine, Baltimore, Maryland, comment in a journal editorial.
"Studies in larger cohorts of both sexes, free of psychiatric illnesses in which serotonin is implicated, are needed," they add.
Lancet 2001;358:1831-1832,1864-1869.
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