Is Ecstasy an Empathogen? MDMA and Autism Spectrum Disorders

The following is a series of excerpts from the original article, published in Biological Psychiatry, 2010; 68:1082-1083.

Is Ecstasy an Empathogen?

Lawrence Scahill and George M. Anderson
From Yale University School of Nursing (LS); the Child Study Center (LS, GMA); and the Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.
Address correspondence to Lawrence Scahill, M.S.N., Ph.D., Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT 06520-7900; E-mail:

The potential relevance of these findings to autism, a disorder characterized by profound delay in social relatedness, is intriguing but remote. First, even if additional study shows that MDMA has positive effects on the emotional component of empathy, accumulating evidence suggests that it is the cognitive aspects of empathy that are deficient in autism. By contrast, the emotional component seems less impaired (6,7). This insight concerning the ability of individuals with autism to feel the emotions of others is relatively recent. It parallels the emerging evidence that individuals with autism do not display a reduced sensitivity to painful stimulation but rather have an altered expression of the sensation of pain (8).

Second, 5-HT–enhancing drugs such as fenfluramine and citalopram do not seem effective in autism (9). Third, although concern about the neurotoxicity of MDMA has declined on the basis of accumulated evidence over the past decade, the potential for adverse effects should not be dismissed (10). This concern might be heightened in vulnerable populations such as individuals with autism. Finally, given that autism is characterized by decreased sensitivity to reading social cues, the finding that MDMA reduced the ability to detect fearful facial expression seems potentially counterproductive in this population. Thus, even setting aside possible safety concerns, MDMA (and perhaps other 5-HT–enhancing drugs) seem unlikely to be useful in autism.”

6. Blair RJ (2008): Fine cuts of empathy and the amygdala: Dissociable deficits in psychopathy and autism. Q J Exp Psychol 61:157–170.
7. Dziobek I, Rogers K, Fleck S, Bahnemann M, Heekeren HR, Wolf OT, Convit A (2008): Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the Multifaceted Empathy Test (MET). J Autism Dev Disord 38:464–473.
8. Tordjman S, Anderson GM, Botbol M, Brailly-Tabard S, Perez-Diaz F, Graignic R, et al. (2009): Pain reactivity and plasma beta-endorphin in children and adolescents with autistic disorder.

Anecdotal reports have suggested to some researchers that MDMA could be useful in the treatment of autism and related illnesses. However, this letter published in the peer-reviewed academic journal Biological Psychiatry argues that using MDMA in the treatment of autism spectrum disorders may not be effective, and could even be counterproductive.