background Ecstasy or 3,4-methylenedioxymethamphetamine (MDMA) is a popular party drug with a good reputation in the clubbing and dancing scene. However there is reason to worry. Apart from the sporadic reports about acute, serious and fatal complications, there are clues that ecstasy can cause psychiatric complications over a long period. This could be a consequence of serotonergic neurotoxicity.
aim To review the psychiatric complications associated with the use of MDMA.
methods Articles considering the adverse reactions with ecstasy and its neurotoxicity were selected by means of a search in Medline (1980 - 2001) and Psychlit (1998 - 2001).
results Apart from the well-known acute complications, we found many studies that describe long term psychiatric complications in functions which are considered to be modulated by serotonin. MDMA is known to cause serotonergic neurotoxicity in animals. Studies with XTC users suggest that serotonergic neurotoxicity is a real risk for humans as well.
conclusions Ecstasy can cause a diversity of psychopathology. Apart from the acute complications, the psychiatrist can be confronted with long term psychopathology. The research of neurotoxicity is in full progress and reinforces the idea that XTC users are at risk of permanent brain damage.